Author: Stephen Goldberg

Extension of CalFresh Standard Medical Expense Deduction

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The California Department of Social Services has provided policy guidance regarding extension of the CalFresh Standard Medical Expense Deduction (SMD).  The SMD waiver was scheduled to expire on September 30, 2021 and has been extended to September 30, 2025.

The SMD is a standard $120 per month deduction for households with an elderly and/or disabled member with verified medical expenses of at least $35 per month.  Households with more than $155 per month in verified medical expenses can deduct all expenses from their income.

If a household voluntarily reports and verifies an increase in medical expenses mid-period, and the report of a new or changed medical expense results in an increase in benefits, the change must be effective no later than the first allotment issued 10 days after the date the change was reported.

Failure to verify medical expenses is not a basis to deny or discontinue a case.

Countable medical expenses include the cost of health insurance premiums; co-payments for appointments or prescriptions; acupuncture, chiropractic or herbal treatments; health care supplies and equipment, incontinence supplies; maintaining care attendants, home health aides, homemakers or child care services that are necessary because of age, disability or illness; over the counter drugs, ointments, or other treatments recommended by a licensed health care practitioner (excluding nutritional drinks, other dietary supplements, and medical marijuana); eyeglasses, contact lens solution, hearing aids, batteries, dental care, dentures; costs of public or private car transportation to health care appointments or pharmacies at the federal mileage reimbursement rate; and any paid or outstanding medical bills for which there is no third party reimbursement (a bill can be averaged over the remaining months in the CalFresh certification period or claims in one month, whichever is better for the household).  (ACL 21-117, September 30, 2021; ACL 21-117E, January 11, 2022.)

Extension of COVID-19 exceptions to IHSS program requirements

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The California Department of Social Services has provided guidance regarding extension of COVID-19 related exceptions for self-attestation of In Home Supportive Services (IHSS) forms.  County IHSS offices should begin transitioning back to in-person initial assessments and reassessments when possible.  When initial assessments and re-assessments are in person, required forms should be presented signed and collected at the assessment.

However, when the applicant or recipient or someone in their household has been infected with, has symptoms of, or has been exposed to COVID-19 in the two weeks prior to the assessment or re-assessment, the county should use telephone or video-conference to conduct the assessment. In such cases self-attestation of documents is acceptable.  This policy will continue until the end of the COVID-19 state of emergency.  However, some forms cannot be self-attested.  Original signatures may be mailed to the county IHSS for the Request for Order and Consent—Paramedical Services (SOC 321), IHSS Designation of Authorized Representative (SOC 839); and the IHSS Recipient’s Request for Provider Waiver (SOC 862).

When the COVID-19 state of emergency ends, the county must require original signatures on new forms at the recipient’s next annual reassessment.

Counties could accept copies of provider identity verification documents until September 30, 2021. However, when closure of county IHSS offices is required by their local Board of Supervisors, counties can continue to accept mailed in copies or fax copies of identity verification documents until the end of the COVID-19 state of emergency.  When the state of emergency ends, all applicant providers will again be required to present original identity verification documents.  Providers who provide copies of their identity verification documents will not be required to present original documents.  (ACL 21-112, September 29, 2021.)

Compromise CalFresh overissuances for elderly or disabled households

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The California Department of Social Services has issued guidance regarding its compromise policy for households with elderly and/or disabled members.  Counties will compromise Administrative Error (AE) and Inadvertent Household Error (IHE) overissuances for active and inactive households that include at least one elderly and/or disabled household member.  AE and IHE claims for active and inactive households consisting solely of members who are elderly and/or disabled at the time of discovery of the claim will be reduced by 100 percent.  AE and IHE claims for active and inactive households that include at least one elderly and/or disabled household member and only an elderly and/or disabled household member is responsible for the claim will be reduced by 100 percent.  AE and IHE claims for active and inactive households that include at least one household member is elderly and/or disabled and one who is not and the non-elderly or disabled household member is responsible for the claim will be reduced by 50 percent.

The date of discovery is the date the county determined that an overissuance occurred.

For active and inactive cases, counties must use the most recently verified information to determine household composition at the time of discovery.

Household members who become elderly and/or disabled during collection of an overissuance are eligible for reduction.  The household must inform the county and verify their elderly and/or disabled status verified by the county to have their remaining overissuance claim reduced.

Counties are only required to inform households of a reduction if the household’s claim is reduced by 100 percent on an already established claim.  No notice is required if a household’s overissuance is reduced by 100 percent prior to establishment of the claim.  Counties must give notice to households of a 50 percent compromise and of the remaining overissuance balance.

The new policy does not affect claims already in collection.  However, households can request a reduction if they become elderly or disabled after the new policy is in effect.

This compromise policy does not apply to overissuances incurred while waiting for a unsuccessful hearing decision.

This policy is anticipated to become effective in Fall, 2022.  CDSS will issue final guidance when the implementation date is determined.  (ACL 21-118, September 30, 2021.)

UPDATE: Automation of the overissuance compromise policy and revised Notices of Action is expected to be completed by May 1, 2023, which is the final date that the policy can become effective.  (ACL 22-61, July 22, 2022.)

UPDATE: Automation of the overissuance compromise policy and revised Notices of Action is expected to be completed by September 1, 2023.  (ACL 22-61E, April 11, 2023.)

Two year timeframe to establish overpayment/overissuances

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Current California Department of Social Services policy limits establishment of CalFresh overissuances to three years prior to the date of discovery.  (See ACL 18-99.)  Effective July 1, 2022, or when automation can be completed, whichever is later, counties can only establish nonfraudulent CalWORKs overpayments and CalFresh overissuances for two years prior to the date of discovery.  The date of discovery is the date the county determined by computation that an overpayment or overissuance occurred.  The overpayment/overissuance is considered established as of the date of the initial demand letter or written notice.

When a valid overpayment/overissuance is established, any overpaid or overissued benefits paid more than 24 months prior to the date of discovery cannot be included in the overpayent/overissuance claim.

The 24 month timeframe does not apply to fraudulent overpayment/overissuances.  A fraudulent overpayment/overissuance is an Intentional Program Violation.  An Intentional Program Violation can only be established by an administrative disqualification hearing finding that fraud has occurred, a signed administrative disqualification waiver, a criminal prosecution, or a signed disqualification consent agreement.

Counties can reclassify nonfraudulent overpayments/overissuances if the county later determines that fraud occurred.  An Intentional Program Violation can include overpayment/overissuances beyond the 24 month limit.  When reclassification occurs, the county must issue a new notice of action.  (ACL 21-109, September 29, 2021.)

CalWORKS Income Reporting Threshold for the Federal Fiscal Year 2022

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The California Department of Social Services (CDSS) issued new amounts for the Income Reporting Threshold (IRT) for CalWORKs and CalFresh.

CalWORKs and CalFresh recipients do not need to report changes to their income between semiannual reports or annual recertifications unless their combined earned and unearned income increase to an amount over the IRT.

For persons who report income over the IRT, the county will determine if the reported income is anticipated to continue. If the income amount over the IRT is reasonably anticipated but not at a level that results in ineligibility, the grant amount will be recalculated.

If the income over the IRT makes the recipient ineligible, the county will discontinue benefits at the end of the month.

Recipients will be sent individualized notices to inform them of their new IRT amount.  (ACL 21-92.)

Statewide CalFresh Restaurant Meals Program

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Effective September 1, 2021, the CalFresh Restaurant Meals Program (RMP) is available statewide.  RMP allows elderly, disabled or homeless CalFresh recipients to purchase hot food at authorized restaurants.  Previously, 18 counties operated RMP.  The California Department of Social Services (CDSS) will operate RMP in counties that did not previously have it, and in counties that have chosen to transfer administration of their RMP to CDSS. CDSS’ administration includes vendor outreach and technical assistance, maintaining vendor agreements, supporting vendors in obtaining authorizes from the United States Department of Agriculture Food and Nutrition Service (FNS), and program monitoring.  CDSS will also be the RMP liaison between counties and FNS.

Counties that continue to administer RMP will need an outreach and marketing plan and outreach materials, will work with vendors and will enter into vendor agreements.  (ACL 21-100, August 27, 2021.)