Author: Stephen Goldberg

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.)

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.)

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.)