Yearly Archives: 2018

Disaster CalFresh changes

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CDSS has provided implementing instructions for changes to Disaster CalFresh (D-CalFresh) mandated by AB 607.  CDSS and counties must now request to operate D-CalFresh when the President of the United States issues a major disaster declaration.  The request must include a waiver request to provide automatic, mass replacement of CalFresh benefits to eligible, ongoing CalFresh households affected by disaster and a waiver request to allow households to purchase hot, prepared food at authorized retailers with D-CalFresh benefits.  An automatic mass replacement waiver can be requested without a Presidential Declaration.

Effective January 1, 2018, all counties must submit a CalFresh disaster plan annually.  CDSS, in consultation with counties and additional stakeholders, must identify the necessary elements of a county disaster plan.  CalFresh disaster plans must identify mutual aid regions consisting of two or more counties.

CDSS must offer D-CalFresh training to all counties, organizations, and institutions receiving federal reimbursements, including private nonprofits, public postsecondary education institutions or other state or local agencies that secure funds federal funds for CalFresh outreach.

CDSS must maintain updated D-CalFresh materials, including state and county disaster plans, the D-CalFresh application, a D-CalFresh webpage, and D-CalFresh outreach flyers.

Upon county request, CDSS must provide necessary support for out-stationed D-CalFresh application intake locations and make available technology and equipment for mobile issuance of EBT cards to D-CalFresh recipients.

AB 607 also allows a CalWORKs recipient to be out of the state for more than 60 days because of displacement caused by a disaster declared by the Governor or the President.  (ACL 18-17, February 28, 2018.)

CalFresh action on unclear information received mid-period

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CDSS has provided implementing instructions for changes to federal regulations at 7 C.F.R. § 273.12(c)(3) regarding processing of unclear information received during the certification period.  Unclear information is information about a household’s circumstances from which the county cannot readily determine the impact on the household’s continued eligibility or benefit amount.  Information is considered unclear if the county needs additional information to act on the change appropriately.  If the county does not need additional information to act on the change, the information is not considered to be unclear.

The new rules about unclear information apply to information received during the certification period from a third party that indicates a household may not have made a required mid-period report.  California requires mid-period reporting of income over the Income Reporting Threshold and a drop in hours worked by an Able-Bodied Adult Without Dependents (ABAWD) to under 20 hours per week.

If the information received during the certification period is unclear and is less than 60 days old relative to the first day of the month in which the information was received, and indicates the household missed a required report, the county must issue a request for verification to the household.  The county must use the CW 2200 form for this request.  The form must inform households that they have 10 days from the date of the form to respond.

If the household responds within 10 days by providing sufficient information, the county must act accordingly to determine continuing eligibility.  If the household does not respond or responds but refuses to provide sufficient information by the specified date, a discontinuance notice is sent to the household.  Note that there must be refusal to provide the requested information to justify termination of benefits.  Failure to provide information is not a basis for adverse action.  Federal regulation defines refusal as “the household must be able to cooperate, but clearly demonstrate that it will not take actions that it can take and that are required.  (7 C.F.R. § 273.2(d), see also MPP § 63-505.12.)

If the information is unclear, is more than 60 days old relative to the first day of the month in which the information was received, and does not indicate the household missed a required report, the county is not required to immediately follow-up on the information and instead will hold the information until the next SAR or recertification.

If the county receives unclear information from the Nationwide Prisoner Match or Deceased Persons Match the county must request additional information from the household regardless of the age of the information.  The county must use the CW 2200 form to request additional information.  If the household does not respond or responds but refuses to provide sufficient information, the county shall act on the change by removing the individual from the household and adjusting benefits accordingly.

CDSS will update its CalFresh reporting regulations as soon as administratively feasible.  (ACL 18-20, February 28, 2018.)

Medi-Cal Managed Care Network Adequacy Requirements

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Beginning July 1, 2018, all Medi-Cal managed care plans (MCPs) will be required to submit annual network certifications in addition to continuing requirements for reporting significant changes to their networks.

MCPs must confirm that their networks will meet the anticipated needs of their service areas.  This means that plans must maintain a provider network adequate to serve their service areas.  DHCS requires network capacity adequate to serve 60% of all eligible beneficiaries in the service areas of county/two-plan model plans, 60% of geographic managed care plans, and 100% of county-organized health system plans.  MCPs must also meet FTE provider-to-beneficiary ratios of 1 FTE PCP to every 2000 beneficiaries, and 1 FTE network physician to every 1200 beneficiaries.

MCP provider networks must include FTE adult and pediatric PCPs, FTE adult and pediatric core specialists, mental health providers, hospitals, pharmacies, and ancillary services.  MCPs must also include at least one FQHC, one rural health clinic, and one freestanding birth center, where available in the contracted service area.  Plans must also meet requirements regarding midwifery, Indian Health Facilities, and Behavioral Health Treatment.

Effective July 1, 2018, DHCS has also established time and distance standards based on county population density.  These standards apply to primary and specialty care for adults and children, OB/GYN services, hospitals, pharmacy, and mental health services.  Primary care and mental health outpatient services should be offered within 10 business days of request, while specialty care appointments should be offered within 15 business days of request.  Primary care, hospital, and pharmacy sites must be located within 10 miles or 30 minutes of a beneficiary’s residence regardless of county; time and distance standards vary by county density designation.

Plans may use telehealth and mail order pharmacies to meet network adequacy requirements, but plans may not require use of either in place of in-person services.  Plans may also subcontract, but subcontractors must have an adequate provider network.

Dental managed care plans also must meet DHCS-required network adequacy standards.  Primary care dental appointments must be located 10 miles or 30 minutes from a beneficiary’s residence.  Routine appointments must be provided within 4 weeks of request, while specialty dental services must be scheduled within 30 business days of request for adults and 30 calendar days of request for children.  Emergency appointments must be available within 24 hours from the request for appointment.

DHCS APL 18-005 (February 16, 2018)

DHCS APL 18-005 Attachment A

DHCS Dental APL 18-003 (January 9, 2018)

DHCS Dental APL 17-008 (November 8, 2017)

CalFresh changes to reporting requirements

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CDSS has provided implementing instructions for changes to federal regulations regarding reporting requirements.  For periodic reporting, any increase in unearned income that is less than $100 will be disregarded.  All unearned income increases must still be reported on the SAR 7 form.  However, any unearned income increases that is less than $100 reported on the SAR 7 will be disregarded.  In the future, the amount of unearned income increase that is disregarded will be adjusted annually and will be rounded to the nearest $25.

For mandatory mid-period reports, income increases over the Income Reporting Threshold (IRT) must be reported within 10 days of receipt of the first payment attributable to the change, that is, the first payment that places the household over the IRT.  For mandatory mid-period reporting of a drop in ABAWD work hours below 20 hours per week, the household must report within 10 days of the date the drop in ABAWD work hours becomes known to the household.

Federal regulations now specify that counties must send a reminder notice to households that do not submit a complete SAR 7 form by the filing date.  If a household fails to submit a complete SAR 7 report by the 5th of the month, the county must provide a reminder notice advising that household that it has 10 days to submit a complete SAR 7.  This includes failure to submit a SAR 7 at all and submitting a SAR 7 by the due date but the SAR 7 is missing required information.  CDSS developed a new reminder notice for this purpose.  If the household does not respond within 10 days, the county will send the appropriate notice of action.  (ACL 18-18, February 16, 2018.)

Expiration of indigence exception for CAPI

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CDSS has provided clarification about the process for renewal of an indigence exception in the Cash Assistance Program for Immigrants (CAPI) program.  For CAPI, if an immigrant’s sponsor has signed the New Affidavit of Support (I-864 form), the sponsor’s income and resources are deemed to the immigrant for 10 years (extended CAPI cases).  If the sponsor becomes disabled, deeming continues indefinitely (basic CAPI cases).  Counties determine the sponsor’s income and resources using the SOC 860 form.  Sponsor deeming can be suspended under the indigence exception.  When the immigrant is no longer being provided with support by their sponsor, and as a result the immigrant is no longer able to provide themselves with food and shelter, the immigrant may be eligible for the indigence exception to sponsor deeming.

The indigence exception applies 12 months after it is granted.  After 12 months, the application for the indigence exception must be completely redone.  CDSS recommends that the CAPI redetermination process begin no later than 10 months after the previous redetermination to have enough time to receive the redetermination paperwork.

For renewal of the indigence exception, the recipient must complete the SOC 809 CAPI Indigence Exception Statement.  The sponsor must complete the SOC 860 form.  The county must then complete the SOC 813 CAPI Indigence Exception Determination form.

The SOC 860 sponsor income and resources form must be redone at each annual redetermination, regardless of whether the recipient requests the indigence exception unless the sponsor’s whereabouts are unknown.  The form is sent to the sponsor and the recipient.  If it is not returned, CAPI is suspended and benefits stopped.  (ACL 17-33, summarized here.)[1]

The initial clarification incorrectly stated that counties could redetermine the indigence exception if the county becomes aware of a change in circumstances.  In fact, the CAPI indigence exception applies for a full 12 month period.  CDSS issued an errata correcting this error.  (ACL 17-70, July 21, 2017 and ACL 17-70E, December 21, 2017.)

[1] Two lawsuits have been filed challenging the policy in ACL 17-33 to suspend CAPI benefits if the sponsor does not return the SOC 860 form.

CalFresh Maximum Certification Periods

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CDSS has provided information about amendments to Welfare and Institutions Code Section 18910.1 that requires counties to assign the maximum certification period allowable for the household type.  The maximum certification period is generally 12 months.  Households in which all adult members are elderly or disabled are certified for 24 months.  Households with only elderly and/or disabled members with no earned income are assigned a 36 month certification period.

Any determination of a certification shorter than 12 months should be made on a case-by-case basis.  (ACL 17-101, December 22, 2017.)