CalFresh ABAWD Handbook

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CDSS has released a handbook about the CalFresh Able-Bodied Adults Without Dependents (ABAWD) time limit.  The handbook provides policy guidance regarding implementation and administration of the ABAWD time limit.

California has had a statewide wavier of the ABARD time limit since 2008 because of a high statewide unemployment rate.  The waiver will expire on August 31, 2018.  Some geographic areas of the state will be ineligible for continuation of the waiver.  Counties that lose waiver eligibility will be required to implement the ABAWD time limit beginning September 1, 2018.  The ABAWD rule limits receipt of Supplemental Nutrition Assistance Program (CalFresh in California) to three full months in a 36-month period for people between ages 18 and 50 who are not disabled and who do not have children.

The handbook includes a general overview of the ABAWD time limit, guidance on exemptions and how to satisfy the ABAWD work requirement.  The handbook also addresses counting months of ABAWD participation, losing and regaining CalFresh eligibility and tracking ABAWD eligibility and participation.  (ACL 18-08, January 26, 2018.)

Suspension, reinstatement, termination and reapplication for CAPI benefits

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CDSS has issued instructions suspension, reinstatement and termination of Cash Assistance Program for Immigrants (CAPI) benefits and reapplication for CAPI.

Suspension is an interruption of CAPI benefits because of the recipient’s failure to satisfy one or more CAPI eligibility requirements.  CAPI benefits can be reinstated without a new application if they re-qualify for benefits within 12 months of the date of suspension.  Suspension is effective the first day of the month in which the recipient no longer meets all CAPI eligibility requirements.  The county sends a notice of change of benefits (NA 692) form when suspending CAPI benefits.

Examples of events that can cause suspension of benefits include: income in the budget month exceeding the payment standard in the payment month, resources exceeding the allowable limit, failing to provide proof of applying for SSI, being outside the United States for 30 consecutive days, being a resident of a public institution for an entire calendar month, and failing to cooperate in providing requested information.

CAPI benefits can be reinstated when the recipient submits evidence requested by the county to reestablish eligibility during the suspension period.  A recipient does not need to file a new application to request reinstatement within the 12 month suspension period.  Benefits are reinstated effective the first day the recipient meets all eligibility requirements, even when that day is in the middle of the month.  This may require counties to make partial month payments.

Termination occurs when benefits have been suspended for 12 consecutive months and cannot be reinstated without filing a new application.  The county sends a second NA 692 notice when terminating benefits.  After this notice, the former recipient must reapply for benefits.  This is treated as a new application with a new protected application date.  (ACL 18-07, January 19, 2018.)

Paid sick leave for IHSS providers

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CDSS has issued instructions implementing SB 3 regarding paid sick leave for IHSS providers.  Beginning July 1, 2018, IHSS providers who work 100 hours will be eligible for 8 hours of paid sick leave per year. The sick leave time will increase to 16 hours per year on July 1, 2020 and 24 hours per year on July 1, 2022.

Providers will be able to use paid accrued sick leave after working an additional 200 hours or 60 calendar days from the date when the provider earned the sick leave, whichever is first.

Providers will lose any used sick leave at the end of each fiscal year.  Accrued sick leave will not be paid at the end of employment.  However, if the provider is rehired as an IHSS provider within a year, previously accrued sick leave will be reinstated.

IHSS providers can use accrued sick leave for diagnosis, care or treatment of an existing condition or preventative care for themselves or their family, or if the provider is a victim of domestic violence, sexual assault or stalking.

IHSS providers can request paid sick leave by completing the SOC 2302 IHSS Program Provider Sick Leave Request Form.  Both the recipient and the provider sign the form.  The provider submits the form to the CMIPS vendor, Enterprise Services.  The minimum increment for paid sick leave is 1 hour, and additional sick leave may be used in 30 minute increments.  Providers should give 48 hours notice to the recipient for planned usage of paid sick leave and immediate notice or at least two hours prior to the start of the work day for emergencies.

CDSS will add the amount of available sick leave to each provider’s pay warrant.  Providers will receive a supplemental check which will include the wages received for the sick time used.  (ACL 18-01, January 9, 2018.)

Providing Voluntary Inpatient Detox Services through Medi-Cal Fee for Service

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Voluntary inpatient detoxification (VID) services are a Medi-Cal benefit carved out of managed care and covered through Medi-Cal fee for service.  To be eligible, inpatient detoxification must be the primary reason for voluntary admission.  DHCS’s All Plan Letter sets out medical criteria for inpatient admission for VID.

When a managed care plan sees a member who does not meet the medical necessity criteria, the plan should refer the member to the county’s behavioral health department for referral to other medically necessary substance use disorder treatment services.  Plans must also provide care coordination to ensure appropriate referrals to available services.

To receive VID services, plans must refer members to VID service providers in general acute care hospitals.  The VID service provider must submit a TAR to a local Medi-Cal field office with documentation verifying admission criteria and medical necessity.

DHCS APL 18-001 (January 11, 2018).

Clarification of Medi-Cal ICT Process after SB 1339

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SB 1339 codified the Medi-Cal Intercounty Transfer (ICT) process, effective June 1, 2017.  Medi-Cal beneficiaries must notify either the county they are leaving (sending county) or the county to which they are moving (receiving county) of a change in residence.  Once this happens, it is the responsibility of the notified county to initiate an ICT for all public benefits within seven business days of notice of new residence.

The bill prohibits counties from requiring the beneficiary to reapply for Medi-Cal benefits in the receiving county.  Benefits must continue without interruption during the ICT process.  The ICT must be completed no later than the first day of the next available benefit month following the 30 days after the beneficiary’s initial notification of change in residence.

If a beneficiary moves and is still enrolled in a managed care plan from the sending county, the beneficiary should continue to have access to emergency services and authorized out-of-network coverage until the ICT is processed and the beneficiary is disenrolled from the plan.  If the beneficiary needs non-emergency care the same month in the new county, the Medi-Cal Managed Care Ombudsman should disenroll the beneficiary from the plan on an expedited basis.  Changes requested by phone to the Ombudsman will be effective within two business days of processing the request.

If an individual household member moves out of the county, Medi-Cal eligibility must continue uninterrupted.  For short-term changes, counties can update the address; this does not initiate an ICT.  If an individual beneficiary moves to a new county but continues to be claimed as a member of a tax household in their former county, the county will update the individual’s address only.  This is not considered an ICT, but the individual will be able to enroll in a health plan in the new county while remaining in the existing case.

DHCS ACWDL 18-02 (January 11, 2018).

Denials and Terminations of Caretaker Adult MAGI Medi-Cal Cases when Child Lacks Coverage

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Under current State and Federal regulations, a parent or caretaker relative with a dependent child under 19 living in the home does not qualify for MAGI Medi-Cal if the child does not have minimum essential coverage (MEC).

Applicants and beneficiaries can self-attest that a dependent child has MEC at the time of application, renewal, or change in circumstance unless the county has information that states otherwise.  If a County worker learns that a dependent child does not have MEC, the worker should do an ex parte review to confirm MEC status.

As with any other discontinuance or denial, the County must send a NOA with proper language.  DHCS has provided sample language for such notices.

DHCS ACWDL 18-01 (January 8, 2018).