Medi-Cal

Benefits eligibility for citizens of freely associated states

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Effective March 9, 2024, citizens of the Compact of Free Association states of Micronesia, Palau, and the Marshall Islands are eligible for federal Supplemental Nutrition Assistance Program benefits (CalFresh in California).  This population is not subject to a waiting period and is immediately eligible for benefits.

State agencies must verify the immigration status of this population using the Systematic Alien Verification for Entitlements (SAVE) system.

Members of this population who applied for Supplemental Nutrition Assistance Program benefits on or after March 9, 2024 and were denied may reapply to be determined eligible from the date of reapplication.  In addition, people who applied and were denied can request a hearing within 90 days of the denial[1] and if the Administrative Law Judge determines that the household was eligible at the time of application, benefits can be issued retroactive to the date of application.

As a best practice, states should track members of this population who were denied benefits on or after March 9, 2024 and do outreach to encourage them to reapply or request a hearing.

Citizens of the Compact of Free Association states of American Samoa and the Northern Mariana Islands remain ineligible for Supplemental Nutrition Assistance Program benefits.   (FNS Memo, July 12, 2024.)

The California Department of Social Services has now issued a policy that mirrors the FNS memo except that when the date of denial is within 30 days, counties must reopen the application and process it in accordance with the new rules.  (ACL 24-61, August 21, 2024.)

NOTE:  Citizens of the Compact of Free Association states of Micronesia, Palau, and the Marshall Islands are now also eligible for Medicaid.  (P.L. 118-42, Section 209(f)(1).)

[1] In California, that 90 day deadline can be extended to 180 days for good cause, and the 90 time limit does not begin to run if the denial notice does not meet legal requirements.

CalWORKs Stage 2 child care eligibility

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The California Department of Social Services (CDSS) has issued a clarification about eligibility for CalWORKs Stage 2 child care.  To be eligible for Stage 2 child care, families must either be 1) receiving CalWORKs, and the county determines they are stable in their welfare-to-work activity or transitioning off of CalWORKs, 2) have formerly received CalWORKs, or 3) formerly received a CalWORKs diversion payment and a funded space is not immediately available in Stage 3 child care.  Families who have never received CalWORKs or diversion are not eligible for Stage 2 or Stage 3 child care.

This clarification is necessary because of legislation that expanded eligibility for subsidized child care services to recipients of MediCal; CalFresh; California Food Assistance Program; Women, Infants and Children program; Food Distribution Program on Indian Reservations; Head Start; and Early Head Start.  However, CDSS has clarified that this expansion does not apply to Stage 2 and Stage 3 child care.

If an agency has enrolled a family into Stage 2 or Stage 3 child care who does not meet eligibility requirements, the contractor must transfer them to an Alternative Payment Program (CAPP) contract without a change or disruption in their services.  If the contractor does not have a CAPP contract, they must work with another local CAPP contractor and transfer the family with no disruption or change to their services.  (CCB 24-06, April 16, 2024.)

Withdrawing state hearing requests

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California Department of Social Services (CDSS) State Hearings Division (SHD) has issued instructions regarding withdrawing of a state hearing request.  A claimant or the Authorized Representative can withdraw a hearing request any time before a decision is issued.

A withdrawal can be unconditional or conditional.  An unconditional withdrawal is a complete retraction of the hearing request without conditions.  There are three ways to unconditionally withdraw a hearing request.  A claimant can request an unconditional withdrawal in the ACMS computer system if they have an account.  A claimant can submit a request to unconditionally withdraw their hearing by mail, fax or email.  A claimant can submit a verbal request to unconditionally withdraw their hearing request using the Interactive Voice Response (IVR) system or by telephone.  SHD will send a letter to the claimant confirming the unconditional withdrawal request.

The opposing party may be aware that the claimant wants to unconditionally withdraw their hearing request.  If the opposing party tells SHD that the claimant or their Authorized Representative wants to unconditionally withdraw a hearing request, SHD will contact the clamant to confirm their intent to unconditionally withdraw their hearing request. If the claimant has any questions, SHD will tell the claimant to talk to the opposing party.  If the claimant or Authorized Representative confirms that they want to unconditionally withdraw the hearing request, SHD will enter the withdrawal in ACMS and will send the claimant a letter confirming the unconditional withdrawal.

A conditional withdrawal is a retraction of the hearing request based on the opposing party’s agreement to certain actions to resolve the case.  A conditional withdrawal must be in writing signed by the claimant or their Authorized Representative.

SHD will accept any conditional withdrawal request that is submitted by mail, fax, email, text, IVR, phone, or uploaded to ACMS, that includes written terms and is signed by the opposing party and the claimant.  These methods are considered to be a valid electronic signature.

A claimant or Authorized Representative can confirm a conditional withdrawal by phone with SHD.  The opposing party must contact the claimant to confirm the agreement.  The opposing party cannot rely on a telephonic signature unless they have gotten the claimant’s consent.  If the opposing party parts gets consent, they must upload the terms to ACMS.  SHD will then contact the claimant to confirm the terms.

The claimant or Authorized Representative can use the SHD IVR to state the terms of a conditional withdrawal.  If the opposing party has their own IVR, it can upload a recording of the terms to ACMS.  The agreement must state that the parties complete all terms within 30 days.

If the case has multiple opposing parties, all parties must consent to the conditional withdrawal.

When a case is withdrawn, SHD will notify all parties that the hearing request has been dismissed.

If the claimant or Authorized Representative does not appear at the hearing and a conditional withdrawal has not been processed, SHD will dismiss the case.

A party can withdraw a rehearing request any time before SHD acts on it.  After a rehearing request has been granted, the claimant can withdraw it with the approval of the Chief Administrative Law Judge.  The parties can submit a conditional withdrawal to resolve the case after rehearing is granted.  SHD will review the terms to ensure that all issues in the rehearing are addressed, and then will forward the request to the Chief Administrative Law Judge for approval.  (ACL 23-82, September 19, 2023.)

 

BenefitsCal Release of Information

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The California Department of Social Services (CDSS) has announced the release of the integrated release of information form for BenefitsCal.

Currently, people can request access to their county welfare department file using the ABCDM 228 form, or an alternative document that identifies the participant releasing the information and the agency institution or provider to whom information is released.

People can grant access to the county welfare department case file information in BenefitsCal using the ABCDM 229 form, which will be integrated into the BenefitsCal portal.  The ABCDM 229 form is the only way for a community based organization (CBO) to access client information on BenefitsCal.  Either the benefits applicant or the CBO can submit ABCDM 229 form by document upload to BenefitsCal.  The ABCDM 229 can also be submitted to the county in a paper format.

With a ABCDM 229 release of information, CBOs can access notice of action, verification requests, benefit award, program status, termination reasons, and upcoming SAR 7 and renewal dates.  CBOs will be able to access information in BenefitsCal for up to 1 year.  However, benefits award, program status, termination reasons and upcoming SAR 7 and renewal due dates will be limited to 60 days of case history.

To have access to BenefitsCal, a CBO must have a formal written agreement with the state or with any county, and have been approved by a county for a CBO account.  After the ABCD 229 is submitted, the county will determine whether the person who signed the form is the primary applicant in the household and whether the data elements in the system align with the information in the form.  If not, the county may contact the applicant to resolve any discrepancies.  If the county cannot resolve the issues, the form will remain pending for up to 365 days.  The county should fix data mismatches can be easily resolved (such as using the name Jim instead of James) without contacting the applicant.

Applicants can revoke a release of information at any time.  CBOs cannot revoke a release of information.

A separate ABCDM 229 is required for each county that a client has a case in (for example if a client moves) and for each CBO that the client authorizes.  (ACL 23-37, May 1, 2023.)

Eligibility of Cuban, Haitian, Nicaraguan, and Venezuelan parolees for federal and state benefits

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The California Department of Social Services (CDSS) has issued guidance regarding eligibility of Cuban, Haitian, Nicaraguan, and Venezuelan parolees for federal and state benefits.

Cuban, Haitian, Nicaraguan, and Venezuelan refugees and asylees are eligible for CalWORKs, CalFresh, SSI, Refugee Cash Assistance, and Refugee Support Services.  Asylum applicants are not eligible for federally funded benefits and services unless they hold another qualifying status.

Humanitarian parolees are generally not eligible for federal benefits.  Nicaraguan and Venezuelan parolees are not eligible for refugee benefits and services.  Cubans and Haitians who arrive in the United States under the supporter-based parole process are eligible for benefits to the same extent as refugees.

Temporary Protected Status holders are not eligible for most federal or state benefits or services.

For Refugee Cash Assistance, counties can accept a declaration under penalty of perjury that the individual has a qualifying immigration status if the worker is unable to confirm status after reviewing documents that suggest eligibility.  Refugee Cash Assistance applicants are not required to provide Social Security Numbers.

Cuban, Haitian, Nicaraguan, and Venezuelan parolees are eligible for CalWORKs because humanitarian parolees have Permanent Residence Under Color of Law.  As CalWORKs recipients, they are eligible for Welfare-To-Work services, Family Stabilization, domestic abuse survivor services, Housing Support Program, Homeless Assistance, Bringing Families Home, Housing and Disability Advocacy Program, and Home Safe.  Housing Support Program and Homeless Assistance can supplement federal refugee resettlement funding.

Cuban, Haitian, Nicaraguan, and Venezuelan parolees are eligible for Cash Assistance Program for Immigrants.

Cuban, Haitian, Nicaraguan, and Venezuelan parolees may be eligible for CalFresh or the California Food Assistance Program if they have been paroled into the United States for at least one year.

Cuban, Haitian, Nicaraguan, and Venezuelan parolees may be eligible for Medi-Cal.

Counties must submit cases to the SAVE system for verification.

Cuban, Haitian, Nicaraguan, and Venezuelan parolees can present a copy of their electronic Form I-94.  Additional verification may be required in limited circumstances, such as when information from the applicant does not match federal immigration records. (ACIN I-13-22, April 20, 2023.)

 

Treatment of CAPP payments for various programs

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The California Department of Social Services (CDSS) has issued guidance to County Welfare Departments (CWDs) regarding treatment of California Arrearages Payment Program (CAPP) payments issued to California assistance program applicants and recipients to help pay eligible past due energy bills that increased during the COVID-19 pandemic

CAPP payments do not count as income when determining eligibility and/or grant amount for the CalWORKs program and do not count against the resource limit for the 12 months after receipt of payment. Furthermore, CAPP authorized payments are not considered in-kind income for CalWORKs recipients.

For both CalFresh and the California Food Assistance Program (CFAP), CAPP payments are considered third-party payments that are not owed to the household and therefore are not counted income. CAPP payments are not considered resources for CalFresh and CFAP.

For Modified Adjusted Gross Income (MAGI) Medi-Cal, CAPP payments are treated as a qualified disaster relief payment similar to other disaster payments that the IRS exempts from gross income. This means that CAPP payments are not counted in the MAGI Medi-Cal eligibility determination. For Non-MAGI Medi-Cal, CAPP payments are considered exempt disaster and emergency assistance and do not count as income or a resource.

CAPP payments do not count as income for the Cash Assistance Programs for Immigrants (CAPI), because they are considered to be a tax refund. CAPP payments do not count as a resource for CAPI for the 12 months after the payment is made.

RCA, ECA, and TCVAP programs do not count CAPP payments as income and do not count as a resource limit for 12 months after receipt of the payment because their programs use the same rules as CalWORKs. (ACL 22-83, October 21, 2022.)