Emergency child care program for foster children

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CDSS has issued instructions about the child care Bridge Program.  The program provides emergency child care vouchers, child care navigator services and trauma-informed care training and coaching in counties that choose to participate in the program.

Families eligible for the child care Bridge Program payment include resource families and families who have a child placed with them in an emergency or for a compelling reason, licensed foster family home or certified family homes, approved homes of relatives and nonrelative extended family members, and parents under the jurisdiction of the juvenile court, including non-minor dependant parents.

These families can receive a payment or voucher when work or school responsibilities prevent the eligible families from being at home when the foster child is not in school or when the family is required to participate in activities of parenting beyond ordinary parental duties such as administrative or judicial reviews, case conferences and family trainings.

The payment or voucher is available for up to six months until the child is placed in long-term subsidized child care.  The payment can be extended to up to 12 months at the county’s discretion if the family is unable to secure long-term child care in the first six months.

The child care navigator works for the local Resource and Referral agency and assists the family with locating child care and developing a long-term plan for child care.

The Resource and Referral agency also provides trauma-informed care and coaching to providers and children of parenting youth in the foster care system.

Resource and Referral agencies must enter into a memorandum of understanding or contract with the county child welfare agency.

Counties must apply for the program by November 30, 2017.  (ACL 17-109, October 27, 2017.)

CalWORKs asset limit increase for families with an elderly or disabled member

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The California Department of Social Services (CDSS) has increased the CalWORKs asset limit for families that include an elderly (age 60 or over) or disabled household member to $3,500 effective October 1, 2017.  The CalWORKs asset limit remains the same for all other households.

If counties find that an assistance unit was denied CalWORKs or had their CalWORKs discontinued as a result of exceeding the prior $3,250 asset limit, counties must re-evaluate eligibility and restore any lost benefits effective October 1, 2017 and moving forward.

If the county has collected or is currently collecting an overpayment based on excess resources for a family with an elderly or disabled member after September 30, 2017, the county must review the case to determine if the family is under the new $3,500 asset limit, and if so must cancel the overpayment and return any funds collected.  (ACL 17-108, October 25, 2017.)

Coordination of Long Term Care and Medi-Cal Managed Care

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All Medi-Cal managed care plans are required to coordinate the care and placement of beneficiaries who need long term care services.  Plans in non-COHS counties are responsible for all medically necessary long term care services provided from the time of admission into a long term care facility and up to one month after the month of admission.  For beneficiaries requiring a longer LTC stay, plans must submit a disenrollment request to DHCS to be effective the first day of the second month after admission.  Non-COHS plans are required to coordinate transfer to the Medi-Cal Fee for Service program and notify the beneficiary of the change.  The request cannot be submitted before a beneficiary is placed into long term care, and plans are still responsible for coordinating care, including coordinating placement in the LTC facility.

Plans in COHS counties are required to covered all medically necessary LTC services regardless of length of stay in the facility.  LTC is a contractual obligation for these plans.

People who become Medi-Cal eligible while in long term care are not eligible for plan enrollment.

DHCS APL 17-017 (October 27, 2017)

Medi-Cal Coverage of Palliative Care

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Under Welfare and Institutions Code section 14132.75, the Medi-Cal program covers palliative care for non-dual eligible beneficiaries.  Palliative care is defined as patient- and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering.  The services available for palliative care can be similar to those available under hospice care, which is intended for pain and symptom management for those with a life expectancy of six months or less.  A non-child beneficiary may not concurrently receive hospice and palliative care, but palliative care may be provided concurrently with curative care.

To be eligible for palliative care, a Medi-Cal beneficiary must meet general eligibility requirements and disease-specific eligibility requirements.  In general:

  1. A beneficiary needs to be likely to or have started to use the hospital or emergency room to manage advanced disease on a non-elective manner.
  2. The beneficiary must have an advanced illness with decline in health and not participating in hospice care.
  3. The beneficiary’s death within a year would not be unexpected.
  4. The beneficiary has received appropriate medical care or the medical therapy is no longer effective
  5. The beneficiary agrees to try alternatives to emergency room care and participate in advance care planning discussions

There are disease-specific requirements for congestive heart failure, chronic obstructive pulmonary disease, advanced cancer, and liver disease.  As long as beneficiaries meet these criteria, they will continue to have access to palliative and curative care until the condition improves, stabilizes, or results in death.  The managed care plan can terminate palliative care if it is no longer medically necessary.

Starting January 1, 2018, managed care plans must authorize palliative care when a beneficiary, regardless of age, meets the minimum criteria.  Services must be medically necessary and reasonable for the patient’s condition, and can include: advance care planning, palliative care assessment and consultation, plan of care, palliative care team, care coordination, pain and symptom management, and mental health and medical social services.  Plans may offer additional palliative care services, and may authorize them to be provided in a variety of settings by appropriate providers.

DHCS APL 17-015 (October 19, 2017).

SAWS Soft Pause Removal

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Currently, the Soft Pause feature of SAWS protects consumers from losing MAGI-based Medi-Cal eligibility when personal circumstances change.  The soft pause allows the county to run eligibility determinations for other programs while keeping the beneficiary on a MAGI aid code.  This generally happens when a MAGI beneficiary becomes eligible for APTCs, premium-based Medi-Cal, or limited scope/restricted/pregnancy-related Medi-Cal, or if the beneficiary becomes ineligible for MAGI Medi-Cal.

The county worker must screen the beneficiary for Non-MAGI programs before removing the soft pause or before sending the case for APTC evaluation.  If the individual is eligible for Non-MAGI Medi-Cal, the county can remove the soft pause to place the beneficiary into an appropriate aid code.  The same 90-day cure period applies to restore a beneficiary to a proper non-MAGI aid code if the individual did not respond to the Non-MAGI evaluation request.

County workers have the ability to remove the soft pause directly.  If an individual has been determined eligible for APTCs, the county worker can help the beneficiary complete plan enrollment in CalHEERS after removing the soft pause.

DHCS ACWDL 17-35 (October 5, 2017)

Extension of Presumptive Eligibility Period for Pregnant Women

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DHCS has reminded counties that women on Presumptive Eligibility for Pregnant Women should have their PE period extended when they submit the required application.  Currently, PE benefits last for up to two months beginning on the day of the PE determination.  Individuals must submit a Medi-Cal application to continue receiving benefits beyond the PE period.  The MEDS system automatically terminates PE benefits unless it notes a pending application.  Counties must ensure that such transactions are posted to MEDS to continue PE benefits until they make a final eligibility determinatio.

MEDIL I 17-17 (October 3, 2017).