Yearly Archives: 2017

Disaster CalFresh for fire victims

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CDSS has issued several directives regarding CalFresh for victims of the Northern California fires.  These directives include issuance of mass replacement benefits, statewide access to CalFresh (and CalWORKs) services statewide, allowing purchase of hot food with CalFresh benefits and waiver of timely reporting requirements.

California has been approved to issue Disaster CalFresh. Current CalFresh recipients can request supplemental disaster benefits.   New applicants affected by the disaster can be eligible for Disaster CalFresh if the household lived in the disaster area at the time of the disaster, and experienced either damage to their home or self-employment property, disaster-related expenses, disruption in income or inaccessible liquid resources.

CDSS also has links to the application for disaster CalFresh and the affidavit form for issuance of replacement CalFresh.  Disaster CalFresh, October 2017.

Responsibility for developing written evidence in Social Security hearings

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Social Security has issued a ruling regarding the responsibilities of both the Social Security Administration and the claimant to develop evidence and other information in disability and blindness claims for both SSDI and SSI cases.  The ruling applies at all levels of review, including administrative law judge hearings.

Social Security states that the claimant has the primary responsibility to provide evidence in support of disability or blindness claims.  The Social Security Act also requires the Social Security Administration to make reasonable efforts to obtain all medical evidence from the claimant’s treating source that is necessary to properly evaluate the claim prior to evaluating medical evidence obtained from a consultative source.  Social Security must also develop a complete 12-month medical history when making a disability determination.  This means that Social Security will make an initial request for evidence from the medical source, and will follow up with the provider between 10 and 20 days after the request if it has not received the evidence.

Claimants must submit or inform Social Security of all evidence known to them that relates to the disability claim.  Claimants must submit or inform Social Security of any written evidence no later than 5 business days before an administrative law judge (ALJ) hearing.  The ALJ can ignore evidence submitted less than 5 business days before the hearing unless the claimant demonstrates good cause for late submission.  To satisfy the duty to inform, the claimant must provide information specific enough to identify the source of the evidence and the relevance of the evidence.

Representatives have a duty to assist claimants in obtaining evidence. Representatives must also submit or inform Social Security of evidence as soon as they obtain or become aware of it.  Representatives should not wait until 5 business days before the hearing to submit or inform Social Security of evidence unless they have a compelling reason for the delay.  In addition, representatives cannot inform Social Security of evidence without submitting it unless the representative shows they could not obtain the evidence despite good faith efforts. Violation of these duties can result in referral to the Office of General Counsel for disciplinary action.

At the Appeal Council level, the Appeals Council will not obtain or evaluate additional evidence when deciding whether to grant review unless there is good cause for failure to previously submit it or the case is a SSI claim that is not based on an initial application for benefits (an age-18 redetermination for example).  SSR 17-4p (October 4, 2017).

Posted in SSI

Child support order suspension for incarcerated obligors

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The Department of Child Support Services has issued statewide policy instructions regarding suspension of child support orders for incarcerated obligors.  This policy implements revisions to Family Code 4007.5 in AB 610 (2015).

Child support obligations are suspended when a qualifying order is issued or modified after October 8, 2015 and the obligor has been incarcerated or involuntarily institutionalized for more than 90 consecutive days after the order was issued or modified.  The suspension applies to payments on a current order and arrears payments.

Exceptions to child support obligation suspension are when the obligor has the means to pay while incarcerated or involuntarily institutionalized, the incarceration or involuntary institutionalization is for domestic violence, or the incarceration or involuntary institutionalization is for failure to comply with a child support order.

Local Child Support Agencies (LCSA) can administratively adjust orders at any time after the initial 90 days of incarceration or involuntary institutionalization provided that the LCSA sends notice of the intended adjustment to both the obligor and obligee and neither party has objected within 30 days of receipt of the notice.  If either party objects, the LCSA must file a motion in court. The child support order suspends effective the first day of the first full month following incarceration or involuntary institutionalization.

If there is no evidence of ability to pay when the obligor is incarcerated or involuntarily institutionalized, the LCSA can ask the court to establish a $0 order when the order is initially established or when the LCSA determines based on its review of the case that the order should be modified.

These policies do not apply to orders established or modified prior to October 8, 2015. (CSSP Letter 17-03, October 10, 2017.)

CAPI Indigents Exception form and policy

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CDSS has issued clarification regarding county completion of the Cash Assistance Program for Indigents (CAPI) indigence exception form.  Included in this clarification are several policy statements about evaluating eligibility for the indigence exception from sponsor deeming.

CDSS states that an applicant for the CAPI indigence exception is considered homeless if he or she has no permanent living arrangement, that is, no fixed place of residence.  Examples include persons who sleep in doorways, homeless shelters or parks, and persons who are couch surfing and have no permanent living arrangement at the beginning of the month.

CDSS states that monthly income for purposes of determining eligibility for the CAPI indigence exception include any in-kind contributions from either a sponsor or anyone else.  In addition, monthly income includes the cash value of any other public benefits that the applicant receives.  If the applicant resides with their spouse, the spouse’s earned or unearned income is included.

CDSS states that if an applicant for the indigence exception claims to be living independently or living with others and paying rent (as opposed to claiming to be homeless), there is a contradiction with claiming the indigence exception.  In those cases, CDSS requires the applicant to submit a written statement from anyone who has given the applicant a loan, and failure to submit that statement means the indigence exception is denied.

Based on the written statement, the county determines whether the loan is genuine.  A loan is considered genuine if it must be repaid under any circumstances (for example repayment from CAPI benefits if received is considered conditional and the loan is not genuine) and the applicant currently (before a decision on the CAPI application) has sufficient income such that there is a reasonable likelihood of repayment of the loan.

If the loan is genuine, it does not count as income for purposes of the CAPI income standard, but its value is considered for in determining eligibility for the indigence exception by counting it towards the CAPI applicant’s ability to purchase shelter and food.  If the loan is not genuine, it is considered a gift, and the applicant is ineligible for the indigence exception because the applicant’s needs for shelter and food are satisfied by gifts.  (ACL 17-100, September 20, 2017.)

Hearing representative responsibilities and privileges process

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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.)

Use of Immunization Registry and new immunization forms

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CDSS has issues recommendations and instructions regarding the process for verifying immunizations for children under age 6 who receive CalWORKs.  CDSS states that clients have a responsibility to provide verification of immunization of children under age 6 and counties must first ask client to provide verification of immunization.  If a client does not have the verification, CDSS strongly recommends that counties use the California Immunization Registry 2 to search for verification before asking the client to get the needed documents.  If the client is unable to provide the requested verification after a good faith effort, the county is required to assist in getting the needed verification.

Applicants under age six or children under age six being added to the household must provide verification of immunization within 30 days of being found eligible for Medi-Cal or within 45 days if already receiving Medi-Cal.  Counties must provide clients with the CW 2209 form to claim good cause.

The immunization penalty must be removed when all children in the Assistance Unit have reached age six.  Removal of the penalty must be done manually because it is not automated in the consortia computer systems.  The penalty continues if there is a child under age six in the Assistance Unit who has not been immunized and does not meet one of the exemption or good cause criteria.

CDSS issued a new CW 101 informing notice about the immunization requirement.  The form notice is now required.  Counties or computer consortia cannot change the form without CDSS’ approval.  (ACL 17-87, September 7, 2017.)