Separation of SIU and eligibility determination functions

The California Department of Social Services (CDSS) has issued a reminder to counties that management of eligibility determination and program integrity investigation must be separate.

County Special Investigative Unit (SIU) staff is responsible for preventing and discovering fraud by applicants and recipients.  SIU staff must investigate fraud allegations.  County eligibility workers are responsible for referring cases to the SIU.

The SIU must be a separate organization, independent of organizations performing eligibility and benefit determination functions.  Counties must ensure separate and independent operation of eligibility and investigation activities.  SIU staff cannot dictate CalWORKs or CalFresh eligibility determinations but can make recommendations.  (All County Welfare Directors Letter May 1, 2019.)

Disability and domestic violence questions computer system flags

The California Department of Social Services (CDSS) has issued directions regarding AB 2030.  AB 2030 requires CDSS to include in any amendments or revisions to standard application or semi-annual reporting forms after January 1, 2019 that allow applicants or recipients to disclose disabilities, the need for reasonable accommodations because of a disability and any experiences of domestic violence. 

CDSS states that initial application forms and semiannual report will capture the need for reasonable accommodations the next time they are revised.

The current welfare computer system vary in how they flag reasonable accommodations.  CalWIN has an icon for disability accommodations that is displayed in the upper-right side of the “Display Individual Demographics Summary” window.  CalACES North (formerly known as C-IV) can flag cases with an indicator type that county users can select (special accommodations, special circumstances etc.)  CalACES South (formerly known as LRS) allows any county user with access to falg a case to alert the first point of contact.  These flags are identified by a banner at the top of every page.  (ACL 19-13, February 21, 2019.)

Hearing representative responsibilities and privileges process

The California Department of Social Services (CDSS) has issued clarification about county hearing representative responsibilities before a hearing.  The county hearing representative initially impartially reviews the hearing request.  After the review, the hearings representative either orders the county to take corrective action or defends the action at hearing.  The county hearings representative also provides claimants with information about the hearing process, including preparing a position statement.

The county hearings representative ensues that aid paid pending is paid when appropriate, identifies the issues raised in the hearing request, reviewed the disputed action(s) based on available evidence and regulations, and determines whether the case can be resolved or should proceed to hearing.

The county hearings representative also must provide reasonable accommodations for claimant’s disabilities, and services for limited English proficient claimants, including using forms that have been translated and using an interpreter for communication with the claimant at no cost to the claimant.

If the hearings representative cannot identify the issues from the hearing request, the hearings representative should attempt to contact the claimant to discuss the case.  If the hearings representative cannot reach the claimant, the hearings representative should review the case file for 90 days prior to the hearing request to determine issues.  If the hearings representative still cannot determine the issues, the hearings representative should write a limited position statement for the hearing. If the issues are identified on the day of the hearing and the hearings representative and claimant cannot reach a resolution, the hearings representative can request postponement of the hearing.

If the hearings representative determines the county action is correct, the county hearings representative should contact the claimant to explain the basis for the county action.  The hearings representative cannot imply that the claimant cannot or should not proceed with the hearing.  The hearings representative can explain the claimant’s right to withdraw if the claimant states they do not want to proceed with the hearing, but the county hearings representative cannot request a withdrawal.

If the hearings representative determines the county action is incorrect, the county representative must contact the case worker to take corrective action.  The county hearings representative must also contact the claimant to resolve the case without a hearing.  If that resolution is a conditional withdrawal, the language of the conditional withdrawal must be specific regarding the duties of the county and claimant for the action to be corrected.  A conditional withdrawal that states the county will re-review its action is insufficient. Conditional withdrawals should be in writing.  The county must ensure that corrective action is completed within 30 days.  If the claimant still chooses to attend the hearing, the hearings representative must be prepared for the hearing.

The hearings representative should inform the claimant of their right to review the case file and provide that access in two business days.  If the hearings representative withholds documents from the claimant pursuant to a claim of privilege, the hearings representative must prepare and give to the claimant a form identifying the withheld documents and the basis of the claim of privilege or confidentiality.  Welfare fraud investigation information from an active investigation is confidential unless that information has been used or relied on by the county in making its decision to take administrative action.  When the claimant challenges a county claim of privilege or confidentiality, the administrative law judge will convene an in camera proceeding to adjudicate that claim.

Finally, CDSS has issued guidelines for the content and format of county position statements for hearings.  (ACL 17-102, September 29, 2017.)

ACL 14-28: Expansion Of The Definition Of Relative For The Federal KIN-GAP Program (3/25/14)

Instructions on the implementation of the expanded definition of “relative” for the federal KinGAP program. (No change to the state-funded KinGAP).  In addition to the traditionally defined relatives, California can now provide federal KinGAP to “fictive” relatives. These are: non-related extended family members; adult members of the child’s tribe or an Indian custodian, and a current foster parent who has established a family-like relationship with the child and who enters into an agreement to be a permanent connection for the child.  These new definitions cannot be retroactive to the period prior to federal approval, even though the state law exercising the state optional expansion passed in 2013.  All the other eligibility rules that apply to KinGAP must be met. [Download]