Yearly Archives: 2017

More SB 1041 Questions and Answers

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The California Department of Social Services has issued its seventh set of questions and answers about SB 1041.  Most of the questions and answers involve data gathering.  However, a few of the questions and answers contain important policy guidance.

Question and Answer 3 addresses averaging of welfare-to-work participation hours.  Hourly welfare-to-work participation hours are determined using an average weekly requirement.  However, in some months, this average calculates to more than the minimum required 20, 30 or 35 hours. When that happens, an alternative calculation method must be used.  The alternative methods are the most days averaging method, which is based on the number of weeks in the month that contain four or more days, or the Friday Falls Averaging Method, which is based on the number of weeks in the month that contain a Friday.  The intent of these alternative methods is to prevent sanctions for recipients who are participating their minimum 20, 30 or 35 hours per week.

Several questions and answers address cross-over between California and federal work participation requirements.  California allows certain activities that are federal work participation requirements limit.  In particular, California allows vocational education while federal work participation limits vocational education to 12 months in the participants lifetime, and California requires job search at the beginning of the welfare-to-work process while federal work participation requirements limit the amount of countable job search.  CDSS states that participants are not required to have their federal time and the time on their 24 month clock run concurrently.  The participant can choose whether to first count these activities toward their 24 month clock or towards their federal limit.

CDSS also states that counties are not required to initiate a new review of 24 month extensions when there is an intercounty transfer.  Counties can review the case if the extension is not based on a formal request from the participant, but the new county cannot request verification until it has reviewed documentation from the prior county and determined it is insufficient.  The receiving county cannot deny a 24 month extension based on the county already having met its 20% extension target.

In addition, CDSS states that counties must reevaluate all 24 month extensions every six months even if the participant does not request to continue the extension.  (ACL 17-78, September 1, 2017.)

IHSS Protective Supervision clarifications

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The California Department of Social Services has issued clarification regarding several In Home Supportive Services (IHSS) Protective Supervision (PS) issues.

When two or more IHSS recipients are living together and receiving PS, the need is considered a common need and is prorated between the recipients.  CDSS issued instructions for how to prorate PS in the CMIPS II computer system.

Alternative resources are supportive services that are available to meet the recipient’s needs.  The county shall arrange for delivery of alternative services when they are available at no cost to either the IHSS program or the recipient.  Examples of alternative resources include adult or child day care centers, schools, community resource centers, Senior Centers and respite centers.  Multipurpose Senior Services Program and Regional Centers cannot be considered alternative resources.  Voluntary services cannot be considered an alternative resource, but can be used to fulfill the recipient’s 24 hour per day plan.

Environmental modification cannot be required to eliminate the need for PS.  However, existing environmental modifications can be considered if they eliminate the safety hazard that puts the recipient at risk.  Modifications or restraints such as locking the recipient in a room cannot be considered an appropriate modification.

The risk of falling can be considered for PS if the reason for the fall risk is related to the recipient’s mental impairment or illness.  For example, PS can be authorized for a recipient who has a fall risk if the recipient is unable to walk unassisted but, due to a mental impairment, forgets and frequently attempts to walk unassisted.

Eligibility for PS because of combative behavior is based upon evaluation of the willfulness of that behavior.  The recipient is considered nonself-directing if they are unable to assess the danger and risk of self harm.  An example is head banging as a manifestation of mental impairment or illness.  A recipient who displays intentional self-destructive behavior with the knowledge that the behavior may cause self harm would not be eligible for PS.  Recipients who exhibit anti-social or aggressive behavior directed to harm other people are ineligible for PS.  (ACL 17-95, September 12, 2017.)

Medi-Cal System Treatment of New Medicare Beneficiary Identifiers

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The Centers for Medicare and Medicaid Services (CMS) is planning to phase in Medicare Beneficiary Identifiers (MBIs) between April 2018 and April 2019 to replace the current Medicare Health Insurance Claim Number (HICN) based on beneficiary Social Security Numbers.  The MBI and HICN will be linked and used, with SSA generating HICNs and CMS generating MBIs.

Starting April 2018, the SAWS and MEDS systems, along with other statewide systems, are expected to be able to receive MBI information.  The transition period will run through December 2019.  During this time, when beneficiaries will only receive an MBI, Counties are not to share MBI with anyone.  County workers will continue to enter Medicare information as they receive it.  A new field for MBI has been added to MEDS.

DHCS MEDIL I 17-15 (September 18, 2017).

Blind FPL Medi-Cal Income Threshold/Disregards Update

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Effective April 1, 2017, the Blind Federal Poverty Level income limits are as follows:

  • For a blind individual, the monthly income threshold is $1235, the same as the Aged and Disabled FPL threshold.
  • For a couple where both individuals are blind, the monthly income threshold is $1751
  • For a couple where one individual is blind and the other is aged or disabled, the monthly income threshold is $1666

DHCS ACWDL 17-33 (September 14, 2017)

CalWORKs and financial aid

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The California Department of Social Services has issued a reminder to counties about counting financial aid as income for CalWORKs. Most education grants, scholarships and loans are exempt in their entirety from consideration as income for CalWORKs regardless of how they are used.  Loans and grants that are entirely exempt include loans and grants under Title IV of the Higher Education Act or the Bureau of Indian Affairs student assistance program, grants administered by the federal Department of Education, educational grants based on need, and loans or grants from community college extended opportunity services, the California Student Aid Commission or a college accredited by the Western Association of Schools and Colleges.

Applicants or recipients can choose to pay education expenses from their exempt financial aid.  However, they cannot be required to do so, and supportive services cannot be reduced if a participant chooses not to use financial aid for education expenses otherwise covered by supportive services.  The WTW 8 form is used to documents this choice.

In general, non-federal financial assistance that is based on merit instead of need, including grants from charitable organizations, private scholarships, and non-federally subsidized loans are exempt to the extent the proceeds are used to meet education expenses.  Any portion of non-exempt financial aid that is not used for education expenses counts for CalWORKs.  If the non-exempt financial aid is a recurring payment, it counts as income.  If it is a one-time payment, it is a non-recurring lump sum that counts as a resource in the month after it is received.  Recipients must provide the county with verification of the education expenses for which they used non-exempt financial aid.  (ACIN I-58-17, August 29, 2017.)

Updated Guidance on Medi-Cal Failure to Respond NOAs

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In response to the Korean Community Center of the East Bay settlement, DHCS has issued new guidance to clarify procedures for discontinuing Medi-Cal cases for failure to respond at annual redetermination for MAGI and Non-MAGI cases.

In both MAGI and Non-MAGI cases, the county should use ex-parte resources to confirm continued eligibility.  If information is missing, the county should send an appropriate request for only the information that could not be verified (MC 216 for MAGI, or an appropriate non-MAGI renewal form).  If the beneficiary does not respond (and not just providing incomplete or insufficient information), the county must discontinue with an appropriate notice.  Sample language for these notices is included in the guidance.  Beneficiaries continue to have a 90-day cure period.

DHCS ACWDL 17-32 (August 31, 2017).