Medi-Cal Eligibility Exceptions due to Public Health Crisis or Disaster

Posted on by

DHCS has issued guidance about the timeliness exceptions for processing applications and redeterminations in counties affected by a state or federally declared major public health crisis or natural disaster.

Applicants in affected areas requested expedited medical services shall not have their applications delayed.  Counties shall inform persons with immediate needs of available resources, expedite eligibility determinations, and accept self-attestation and electronic verification.

Any beneficiaries in affected areas shall have discontinuances delayed to the extent possible and be allowed additional time to provide required documents.  The County shall accept a signed and dated affidavit in place of requested verification documentation.  Those who were discontinued may have their benefits reinstated and given more time to provide information.

DHCS will waive premiums for state programs when a major public health crisis or natural disaster occurs.  Cash payments received for repair or replacement of lost, damaged, or stolen exempt property shall be treated as exempt property for nine months from the date of receipt (can be extended for good cause).

A beneficiary’s current health plan will be the point of contact for services out of county until an official change of address occurs.  Beneficiaries who are displaced may get assistance with transferring a case on a permanent or short-term basis.

DHCS ACWDL 19-01 (January 9, 2019)

Recent Changes to Medi-Cal Notice of Action Requirements

Posted on by

Revised NOA for 250% Working Disabled Program Approval

DHCS has revised NOAs for Working Disabled Program approvals to clarify that couples do not need to pay separate premiums as a couple.  DHCS has also revised its EFT premium payment flyer for county use. DHCS ACWDL 18-18 (August 9, 2018).

NOAs for Beneficiaries Who Do Not Complete Non-MAGI Evaluation at Annual Renewal/Change in Circumstance

DHCS updated guidance to counties regarding MAGI discontinuance NOAs when the beneficiary is ineligible for MAGI, is potentially eligible for Non-MAGI, and the beneficiary does not complete the Non-MAGI evaluation when ex parte review is not successful.  The discontinuance NOA must indicate both why a beneficiary is not eligible for MAGI and why the county could not complete the Non-MAGI evaluation.  This guidance provide required language for such notices. DHCS ACWDL 18-24 (October 29, 2018).

Information Regarding Reporting Requirements on NOAs

DHCS is providing guidance about the requirement to include information about an applicant’s or beneficiary’s responsibility to report changes in circumstances on all MAGI and Non-MAGI NOAs that approve, change, or continue Medi-Cal eligibility.  The letter includes sample NOA snippets for various situations. DHCS ACWDL 19-02 (January 9, 2019).

NOA Requirements at Annual Renewal or Change in Circumstance Resulting in Resetting Annual Renewal Date

DHCS has issued updated requirements for NOAs for continuing eligibility at annual renewal and change in circumstances.  Federal regulations require counties to send NOAs when there are no changes to eligibility at annual renewal or following a change in circumstances resulting in resetting of the annual renewal date.  DHCS has provided sample language for these circumstances. DHCS ACWDL 19-03 (January 9, 2019).

Updated Specialty Thresholds for Medi-Cal Programs in 2018-2019

Posted on by

Effective July 1, 2018, through June 30, 2019, the FMBA amount for a family member living with the community spouse of an institutionalized spouse is $2,058 (compared to last year’s $2,030). DHCS ACWDL 18-13 (July 3, 2018); DHCS ACWDL 18-13E (November 20, 2018).

As a result of the 2.8% COLA for 2019 Social Security benefits, DHCS has updated various threshold documents, including Pickle and SSI/SSP payment levels. This change does not affect MAGI eligibility. DHCS ACWDL 18-27 (December 7, 2018).

Effective January 1, 2019, the community spouse resource allowance is $126,420.  The maximum spousal income allocation/minimum monthly maintenance needs allowance is $3,161. DHCS ACWDL 18-28 (January 14, 2019).

Welfare-to-work sanction checklist

Posted on by

CDSS has issued a checklist to determine non-compliance with welfare-to-work requirements. The checklist is designed to ensure appropriate steps are taken to resolve any instance on non-compliance.

Counties may revise the checklist to remain consistent with county-level guidance. However, any modifications should be inclusive of the steps and content provided in the checklist.

Use of the checklist is voluntary.  (ACIN I-84-18, January 14, 2019.)

EBT skimming and scams

Posted on by

The California Department of Social Services has issued instructions regarding replacement of electronic benefits transfers (EBT) stolen by skimming or scams.  Skimming is using electronic equipment to capture the recipients’ EBT card and create a counterfeit card.  Scams involve deceiving or misleading a recipient to provide their account information and then using that information to create a counterfeit card.

Claims for electronic theft are made using the EBT 2259 form.  Recipients can contact either the EBT Customer Service Helpline or the county welfare department. 

In addition to the EBT 2259 form, recipients are required to file a police report unless there is good cause.  The police report number is required on the EBT 2259 form but a copy of the report is not required.  Good cause for not filing a police report includes that the police department does not accept reports of identity theft or financial fraud, the police department does not provide interpreter services for non-English speakers, there is a fee to file the police report, the police department does not provide disability accommodations, the recipient does not have transportation, and submitting a report in person would interfere with participation in welfare-to-work activities.

Counties review the EBT 2259 form and determine if it is complete and whether the allegations are consistent with typical scamming practices.  If the claim does not allege typical scamming practices it is considered for further review.  In addition, counties must verify that benefits for the recipient have not been restored because of scamming in the last 36 months. 

Recipients must file an electronic theft claim within 90 days.

Counties have 10 days to issue repayment unless there is a fraud investigation or over $2,000 is involved.  The reimbursement is not counted as income or property in the month received or the next month.  (ACL 18-148, December 31, 2018.)

Update: People reporting electronic theft no longer need to contact the electronic benefits transfer vendor prior to submitting the form EBT 2259 to the county.  People reporting electronic theft must contact the county within 10 days of the loss, and file the EBT 2259 form with the county within 90 days of the loss. People no longer are required to file a police report to submit the form EBT 2259 and get replacement benefits.  (ACL 23-13, January 27, 2023.)

Febraury 2019 early CalFresh issuance

Posted on by

CDSS is issuing CalFresh benefits for February 2019 early between January 16 and January 20.  This early issuance is required because, as a result of the federal government shutdown, there is no appropriation to fund the Supplemental Nutrition Assistance Program (SNAP)  after January 20.

Counties must provide client notice as they would for a mass change.  This includes county websites, posters, press and social media.  There is no individual household noticing requirement.  However, counties are encouraged to contact individual households as feasible using communication channels such as text messaging, email and phone messges.

Most clients will receive their benefits between January 16 and 20.  However, some clients will receive benefits on their normal issuance date if they are eligible and federal reserve funds are available.  These clients are 1) current clients who have a report due in January but the report is received and processed after the early issuance but before the end of January; 2) current clients who have a report due in January and whose eligibility is determined after the end of January; 3) News client determined eligible after the early issuance is completed and 4) New clients who apply on or after February 1.  CDSS estimates that about $86 million in benefits is associated with cases which will not be completed by January 20 because reports have not been submitted or case processing is not completed.

Without a new appropriate for the United States Department of Agriculture either by resolution of the federal government shutdown or by enactment of separate legislation appropriating funds for the SNAP program, there is insufficient federal funding for March benefits.  (All County Welfare Directors Letter, January 11, 2019.)