Yearly Archives: 2017

Transfer of families to Stage 2 child care

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The California Department of Education (CDE) has issued instructions about the process for transferring families from Stage 1 to Stage 2 child care.  Both Stage 1 and Stage 2 child care are for families receiving CalWORKs.  Stage 1 child care is administered by a county welfare department (CWD) or a child care alternative payment program (APP) under contract with a CWD.  Families are transitioned to Stage 2 when the county determined they are “stable.”  Stage 2 is administered by APPs.

The process to transfer from Stage 1 to Stage 2 is to be seemless with no break in services.  Stage 2 programs must develop efficient and coordinated systems with Stage 1 programs to ensure that child care services seamlessly continue for families moving between Stage 1 and Stage 2 with no break in aid.

CalWORKs families are categorically eligible for Stage 2 and pay no family fees.  A family receiving CalWORKs does not need to report changes in income or family size to the APP and cannot be terminated for failure to do so.  If a family receiving CalWORKs would otherwise have their child care terminated for violation of an APP’s policies, the APP must notify the CWD to determine what steps to take including referral back to Stage 1.

When transferring from either Stage 1 or another Stage 2 program, the APP can only require nine listed data elements and cannot require any other information from the family.  The APP must request the nine data elements from Stage 1 or other Stage 2 program.  The family is not responsible for providing the information.  APPs cannot require the family or child care provider to furnish documentation provided to the Stage 1 or other Stage 2 program within one year of the application date unless documentation is missing and that documentation affects eligibility for services.

When the Stage 2 program receives the nine data elements, it must assume full responsibility for reimbursing the provider, provide the parent with a notice that the transfer is complete, and notify the family about returning the transfer of enrollment form to certify that the nine data elements are correct.  The APP should allow at least 30 days to return the transfer of enrollment form and should not terminate services for failure to return the transfer of enrollment for six months.

The APP cannot require the family to complete a new application and cannot require the family to furnish information previously provided to the transferring Stage 1 or other Stage 2 program unless there is a reported change that requires an update.  (Management Bulletin 17-06, May, 2017.)

Changes to State-Funded Breast and Cervical Cancer Treatment Program

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The State-funded Breast and Cervical Cancer Treatment Program (BCCTP) supplements the Federal program by providing eligibility for women regardless of immigration status or age and for men with breast cancer of any age or immigration status.  The state program also covers those who are uninsured or underinsured (including those with a share of cost or those eligible for Covered California).

Prior to January 1, 2017, coverage was time-limited (18 months for breast cancer, 24 months for cervical cancer).  Reoccurrence of either breast or cervical cancer would not qualify for a new period of eligibility unless there was a new qualifying diagnosis approved by the state’s consultant.

As of January 1, 2017, an individual diagnoses with recurring breast or cervical cancer may receive an additional period of eligibility if the original period of coverage has expired and the individual submits a physician’s statement.  The cancer may be located at the original location or a different location, but the individual must continue to meet all other eligibility criteria to receive the new period of coverage.

DHCS ACWDL 17-11 (April 12, 2017).

CalFresh Standard Medical Expense Deduction project

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The California Department of Social Services (CDSS) has issued instructions about implementation of CalFresh Standard Medical Expense deduction.  CDSS received a waiver to implement a Standard Medical Expense deduction beginning October 1, 2017.

Elderly and/or disabled households with medical expenses over $35 per month are entitled to a CalFresh income deduction for their medical expenses.  Currently, the deduction is dollar for dollar verified medical expenses over $35 per month.  Effective October 1, 2017, the medical expense deduction will be a standard $120 per month when the elderly and/or disabled household has over $35 per month of medical expenses.  If verified medical expenses are over $155 per month, the household will be able to deduct actual medical expenses.

Households can voluntarily report medical expense increases mid-period and the new deduction amount will be used for the remainder of the reporting period.  (ACL 17-35, April 25, 2017.)

Changes to Medi-Cal’s Special Needs Trusts Rules

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The passage of the 21st Century Cures Act has expanded the category of individuals authorized to establish a special needs trust to include the disabled trust beneficiary.  Previously, SNTs were only established by a disabled beneficiary’s parent, grandparent, legal guardian, court, or third party nonprofit.  This change is effective for trusts established on or after December 13, 2016.

DHCS ACWDL 17-13 (April 14, 2017).

CalFresh processing for domestic violence survivors

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The California Department of Social Services (CDSS) has issued instructions about AB 2057 regarding CalFresh processing for domestic violence survivors.  A domestic violence survivor who is a resident of a shelter and whose current CalFresh household includes the abuser can apply for CalFresh as a separate household and may be eligible for an additional allotment of CalFresh once per month.  Shelter residents and their children can be aided as members of the former household and as members of a new household once per month.

If the domestic violence survivor is the head of household, the survivor may ask to close the former CalFresh case that included the abuser.  If the request is made is writing or in the presence of an eligibility worker, the change can be made with adequate notice.  If the request is made verbally, the county must provide both adequate and timely (10 days) notice.

CDSS must provide shelters with information about CalFresh eligibility for domestic violence survivors.  CDSS provided a sample with its instructions.

Domestic survivors are now deferred from mandatory participation in CalFresh Employment and Training.  Counties must accept self-attestation of domestic violence unless there is strong evidence that the self-attestation is not credible.  (ACL 17-30, April 17, 2017.)

Evidence to determine medical equivalence in Social Security cases

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Social Security has issued a ruling regarding evidence needed for a finding of medical equivalence to a listing.  This ruling rescinds and replaces Social Security Ruling 96-6p.

An impairment is considered medically equivalent to a listed impairment if it is at least equal in severity and duration to the criteria of a listed impairment.  Social Security can find medical equivalence in three ways:  1) the individual does not exhibit one or more of the findings required by a listing or one or more of the findings is not as severe as required by a listing, but there are other findings related to the impairment that are at least of equal medical significance to the required criteria; 2) the individual has an impairment not described in a listing but has findings related to the impairment that are at least of equal medical equivalence to an analogous listing or 3) the individual has a combination of impairments no one of which meets a listing but has findings related to the impairment that are at least of equal medical equivalence to an analogous listing

To demonstrate an individual is disabled based on medical equivalence, the record must contain either 1) a prior administrative finding from a medical consultant or psychological consultant; 2) medical expert evidence at the hearing level or 3) a report from the Appeals Counsel medical support staff.  It seems that evidence from the claimant’s provider cannot support a finding of medical equivalence.

An administrative law judge (ALJ) is not required to obtain medical expert evidence if the ALJ believes that the evidence does not reasonably support a finding of medical equivalence.  ALJs are not required to articulate specific evidence to support a finding that an impairment does not equal a listing.  A statement that the impairment does not equal a listing is sufficient.  SSR 17-2p (March 27, 2017).

 

 

 

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