Criminal welfare fraud prosecution timeframe

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The California Department of Social Services (CDSS) has issued instructions implementing SB 360 regarding criminal prosecution for welfare fraud based on a match from the Income and Eligibility and Verification (IEVS) system.

Counties must review and compare information from IEVS with the case record to determine any differences that affect eligibility or benefit levels.  If there are differences that would affect eligibility or benefit level, the county must mail the client a verification letter within 45 days of receiving the IEVS data.  In addition, counties must establish an overpayment or overissuance by the end of the quarter following the quarter in which the county received the IEVS data.

The client can no longer be subject to criminal prosecution for any month following the 45th day of the county’s receipt of the IEVS data if the county does not provide the client a verification letter within 45 days of receiving the data or the county does not establish the overpayment or overissuance by the end of the quarter following the quarter in which the county received the IEVS data.  (ACL 18-22, March 27, 2018.)

CalWORKs Immediate Need overpayments

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The California Department of Social Services (CDSS) has issued instructions about overpayments of CalWORKs immediate need benefits.

Applicants are eligible for CalWORKs immediate need if they are apparently eligible for CalWORKs and have an emergency situation.  With limited exceptions, information does not need to be verified for immediate need eligibility.

An immediate need payment is only an overpayment if the applicant was not apparently eligible for CalWORKs when the immediate need payment was issued.  A finding by the county that the assistance unit is not eligible for CalWORKs after full evaluation of the case does not, by itself, mean that immediate need is an overpayment.

A change in circumstances between issuance of immediate need and full evaluation of the application does not make the immediate need payment an overpayment unless the applicant was not apparently eligible for CalWORKs when the immediate need payment was issued based on the circumstances at the time the immediate need payment was issued.  (ACL 18-26, June 6, 2018.)

Homeless Assistance for family reunification

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The California Department of Social Services (CDSS) has issued instructions implementing AB 236 regarding homeless assistance for family reunification cases.

CalWORKs families receiving family reunification services are now eligible for 16 days of temporary homeless assistance while searching for permanent housing.  CalWORKs families receiving family reunification services are eligible if they are homeless and have no more than $100 in liquid resources.  Counties should offer additional services to assist with housing including Family Stabilization, Housing Support Program and Bringing Families Home program.  (ACL 18-71, June 25, 2018.)

Domestic Violence expansion of homeless assistance

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The California Department of Social Services (CDSS) has issued instructions implementing AB 557 regarding the expansion of homeless assistance for persons escaping domestic abuse.

CalWORKs applicants who provide a sworn statement of past or present domestic abuse and are fleeing the abuser are eligible for up to 32 days of temporary homeless assistance benefits if found to be apparently eligible for CalWORKs regardless of the abuser’s income or assets.  This benefit is available even if the applicant has not spent a night homeless.  This benefit is available even if the applicant has a joint bank account that they claim belongs to the abuser.

Any income or assets the applicant has on hand will be evaluated toward the $100 limit for homeless assistance eligibility.  There is no requirement that the applicant verify homelessness beyond the sworn statement that they are fleeing domestic abuse.

CalWORKs applicants fleeing domestic abuse shall receive a lump sum equal to 16 days of temporary homeless assistance benefits on the date of application.  Applicants will received a lump sum for an additional 16 days of homeless assistance if they remain homeless and their CalWORKs application has not yet been granted.  Payments can be made to the applicant or to the temporary shelter at the applicant’s choice.  If the applicant does not provide verification that the funds were spent on shelter, the second 16 days can be issued by voucher.

Persons fleeing domestic violence are not required to provide proof of their search for housing unless they have also been granted immediate need or are issued their first month of CalWORKs benefits and therefore have been issued regular homeless assistance.  In such cases, counties are strongly encouraged to grant good cause from complying with the housing search verification requirement.

The homeless assistance benefit for persons fleeing domestic violence is available once in a lifetime.  (ACL 18-78, June 29, 2018.)

Non-MAGI Denial and Termination Notices for Non-Linkage

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The State has revised Notices for individuals who are not eligible for Non-MAGI Medi-Cal due to lack of linkage.  Counties will manually issue these NOAs until SAWS is updated.

Counties are to send denial notices to applicants who are not eligible for MAGI Medi-Cal and are found to have no Non-MAGI linkage after a full Medi-Cal determination.  Additionally, those who lose MAGI Medi-Cal and are found to have no Non-MAGI Medi-Cal linkage will receive a denial notice.  These applicants and beneficiaries should immediately be assessed for Covered California subsidy eligibility.

Counties will send discontinuance notices after annual renewal or change in circumstances reporting when beneficiaries no longer have linkage to Non-MAGI Medi-Cal and cannot establish eligibility on any other basis.

DHCS ACWDL 18-12 (July 2, 2018)

Medi-Cal Denial Notices for Retroactive MAGI Eligibility Determinations

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Counties are required to send Notices of Action when an individual is denied MAGI Medi-Cal as a result of being over MAGI income limits (138% FPL) during any of the three retroactive months prior to the application month.  In most cases, SAWS will generate the relevant notice.  CalHEERS will generate an over income denial NOA when there’s a tax subsidy approval.

Counties are encouraged to avoid sending multiple NOAs. When individuals who are not eligible for MAGI Medi-Cal are approved for Non-MAGI Medi-Cal in a retroactive coverage month, counties must send only the NOA that provides the final Non-MAGI eligibility determination for that month.  If an individual is not eligible for either MAGI or Non-MAGI Medi-Cal, the county must send both MAGI and Non-MAGI denial NOAs for the retroactive month.

DHCS ACWDL 18-11 (June 29, 2018)