Changes to State-Funded Breast and Cervical Cancer Treatment Program

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The State-funded Breast and Cervical Cancer Treatment Program (BCCTP) supplements the Federal program by providing eligibility for women regardless of immigration status or age and for men with breast cancer of any age or immigration status.  The state program also covers those who are uninsured or underinsured (including those with a share of cost or those eligible for Covered California).

Prior to January 1, 2017, coverage was time-limited (18 months for breast cancer, 24 months for cervical cancer).  Reoccurrence of either breast or cervical cancer would not qualify for a new period of eligibility unless there was a new qualifying diagnosis approved by the state’s consultant.

As of January 1, 2017, an individual diagnoses with recurring breast or cervical cancer may receive an additional period of eligibility if the original period of coverage has expired and the individual submits a physician’s statement.  The cancer may be located at the original location or a different location, but the individual must continue to meet all other eligibility criteria to receive the new period of coverage.

DHCS ACWDL 17-11 (April 12, 2017).

CalFresh Standard Medical Expense Deduction project

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The California Department of Social Services (CDSS) has issued instructions about implementation of CalFresh Standard Medical Expense deduction.  CDSS received a waiver to implement a Standard Medical Expense deduction beginning October 1, 2017.

Elderly and/or disabled households with medical expenses over $35 per month are entitled to a CalFresh income deduction for their medical expenses.  Currently, the deduction is dollar for dollar verified medical expenses over $35 per month.  Effective October 1, 2017, the medical expense deduction will be a standard $120 per month when the elderly and/or disabled household has over $35 per month of medical expenses.  If verified medical expenses are over $155 per month, the household will be able to deduct actual medical expenses.

Households can voluntarily report medical expense increases mid-period and the new deduction amount will be used for the remainder of the reporting period.  (ACL 17-35, April 25, 2017.)

Changes to Medi-Cal’s Special Needs Trusts Rules

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The passage of the 21st Century Cures Act has expanded the category of individuals authorized to establish a special needs trust to include the disabled trust beneficiary.  Previously, SNTs were only established by a disabled beneficiary’s parent, grandparent, legal guardian, court, or third party nonprofit.  This change is effective for trusts established on or after December 13, 2016.

DHCS ACWDL 17-13 (April 14, 2017).

CalFresh processing for domestic violence survivors

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The California Department of Social Services (CDSS) has issued instructions about AB 2057 regarding CalFresh processing for domestic violence survivors.  A domestic violence survivor who is a resident of a shelter and whose current CalFresh household includes the abuser can apply for CalFresh as a separate household and may be eligible for an additional allotment of CalFresh once per month.  Shelter residents and their children can be aided as members of the former household and as members of a new household once per month.

If the domestic violence survivor is the head of household, the survivor may ask to close the former CalFresh case that included the abuser.  If the request is made is writing or in the presence of an eligibility worker, the change can be made with adequate notice.  If the request is made verbally, the county must provide both adequate and timely (10 days) notice.

CDSS must provide shelters with information about CalFresh eligibility for domestic violence survivors.  CDSS provided a sample with its instructions.

Domestic survivors are now deferred from mandatory participation in CalFresh Employment and Training.  Counties must accept self-attestation of domestic violence unless there is strong evidence that the self-attestation is not credible.  (ACL 17-30, April 17, 2017.)

Evidence to determine medical equivalence in Social Security cases

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Social Security has issued a ruling regarding evidence needed for a finding of medical equivalence to a listing.  This ruling rescinds and replaces Social Security Ruling 96-6p.

An impairment is considered medically equivalent to a listed impairment if it is at least equal in severity and duration to the criteria of a listed impairment.  Social Security can find medical equivalence in three ways:  1) the individual does not exhibit one or more of the findings required by a listing or one or more of the findings is not as severe as required by a listing, but there are other findings related to the impairment that are at least of equal medical significance to the required criteria; 2) the individual has an impairment not described in a listing but has findings related to the impairment that are at least of equal medical equivalence to an analogous listing or 3) the individual has a combination of impairments no one of which meets a listing but has findings related to the impairment that are at least of equal medical equivalence to an analogous listing

To demonstrate an individual is disabled based on medical equivalence, the record must contain either 1) a prior administrative finding from a medical consultant or psychological consultant; 2) medical expert evidence at the hearing level or 3) a report from the Appeals Counsel medical support staff.  It seems that evidence from the claimant’s provider cannot support a finding of medical equivalence.

An administrative law judge (ALJ) is not required to obtain medical expert evidence if the ALJ believes that the evidence does not reasonably support a finding of medical equivalence.  ALJs are not required to articulate specific evidence to support a finding that an impairment does not equal a listing.  A statement that the impairment does not equal a listing is sufficient.  SSR 17-2p (March 27, 2017).

 

 

 

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IHSS overtime exemption for extraordinary circumstances

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CDSS has issued instructions about the IHSS overtime exemption for extraordinary circumstances.  The criteria and initial instructions for the IHSS overtime exemption for extraordinary circumstances are in ACL 16-22, summarized here.

CDSS’ new instructions address renewal of an extraordinary circumstances exemption.  All conditions on which the exemption was initially granted must remain the same for an exemption to be renewed.  If there has been any changes, the county must submit to CDSS a referral for a new exemption instead of renewal of the existing exemption.

Prior to submitting the renewal request, the recipients must explore and exhaust all options for hiring additional providers in the same manner as for the initial exemption request.  This includes contacting relatives, friends, neighbors or other people the recipient knows about their willingness to be a provider, contacting provider registries both in the county where the recipient lives and in neighboring counties, and utilizing alternative resources such a Regional Center services, to address issues with the recipient’s ability to tolerate an outside provider.

CDSS eliminated the requirement to perform a renewal at the next face-to-face reassessment when reassessment occurs before the end of the six month or one year period of the exemption.  However, requests for renewals must be submitted to CDSS by the county no less than 30 days before the exemption ends.

CDSS also clarified that counties determine when to submit exemption requests to CDSS and the county shall not submit either an initial referral or request to renew to CDSS if the county decides other resources are available.  (ACL 17-13, April 7, 2017.)