CalWORKs Homeless Assistance Program

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Effective January 1, 2017, clients are eligible to receive CalWORKs Homeless Assistance once every 12 months with exceptions.  Previously, clients were eligible for Homeless Assistance once in their lifetime with exceptions.  This change is because of AB 1603, Section 15 (2016).

There are two types of Homeless Assistance.  Temporary Homeless Assistance is available to CalWORKs recipients or apparently eligible applicants and provides up to 16 consecutive days of shelter, which is generally a hotel.  Permanent Homeless Assistance provides security deposit, last month rent and utility deposit for commercially available rental unit where rent does not exceed 80 percent of the client’s income.  Alternatively, for clients facing eviction, Permanent Homeless Assistance can provide up to two months or rental arrearages for a client to remain in their unit.

The 12 month period begins the day the welfare department issues the first payment of temporary or permanent homeless assistance.  Exceptions are available once during the 12 month period.  ACL 16-98 (November 30, 2016).

Counting income of children formerly excluded by the MFG rule

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CDSS has issued an errata to All County Letter 16-66 about implementation of the repeal of the Maximum Family Grant (MFG) rule.  ACL 16-66 stated changes in MFG status were to be treated as county initiated mid-period changes to be acted on immediately even if the change resulted in a mid-period decrease in the grant.  ACL 16-66E corrects this to state that income from children formerly excluded by the MFG rule is not considered until the beginning of family’s next reporting period unless that income puts the assistance unit over the Income Reporting Threshold.

If the family’s reporting period ends in December, 2016, then income of a child previously excluded by the MFG rule is used to determine the grant beginning in January, 2017.  If the family’s reporting period ends after January, 2017, the income cannot be used until the beginning month of the family’s next reporting period.  ACL 16-66E (November 17, 2016).

IHSS licensed health care professional certification

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CDSS has issued instructions and forms to counties about certification from a licensed health care professional as a condition of eligibility for In Home Supportive Services (IHSS) benefits.  Counties are required to provide applicants with the SOC 873 certification form and SOC 874 instructions.  Applicants must submit the completed form within 45 days of receiving it from the county.  Applicants can submit alternative documentation if it contains the same information as the SOC 873 form.  The application will be denied if certification is not submitted within 45 days of the county providing the forms.

The health care certification is not the only factor in determining the need for IHSS services, but should be considered as one indicator of the need for services.  However, the IHSS application must be denied if the first two questions on the SOC 873 form are not answered yes by the licensed health care professional.  If the county believes the applicant should be eligible for IHSS despite not receiving yes answers to those questions, the form must be returned to the health care professional to be reconsidered.

Services cannot be authorized until the county has received certification from a licensed health care professional unless services are being requested on behalf of an applicant who is returning to the community from a hospital or nursing home and needs services to remain safely in the community or the applicant is at imminent risk of out-of-home placement.  ACL 16-78 (September 28, 2016).

Access to Medi-Cal Services for Transgender Beneficiaries

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DHCS updated its guidance to managed care plans regarding covered services for transgender beneficiaries.  Under the state Insurance Gender Nondiscrimination Act and the federal Affordable Care Act, plans cannot discriminate in its health care benefits against individuals based on gender, including gender identity and expression.  Services that are available based on gender should not be denied or limited based on a beneficiary’s gender assigned at birth.  Federal regulations also prohibit categorical exclusions or limitations for services related to gender transition.

The DHCS All Plan Letter reminded plans that they must cover medically necessary services (services which are reasonable and necessary to protect life, to prevent significant illess or significant disability, or to alleviate severe pain through the diagnosis and treatment of disease, illness or injury) and reconstructive surgery (surgery performed to correct or repair abnormal structures of the body . . . to create a normal appearance to the extent possible).  Plans do not have to cover cosmetic surgery (surgery that is performed to alter or reshape normal structures of the body in order to improve appearance).

The letter prescribes the use of nationally recognized guidelines to review requested services, specifically naming the WPATH Standards of Care for the treatment of gender dysphoria.  Identified core services for the treatment of gender dysphoria include behavioral health services, hormone therapy, psychotherapy, and a variety of surgical procedures to conform primary and secondary gender characteristics with a person’s gender identity.

Evaluation of requested services must be made by a qualified and licensed mental health professional and the treating provider in collaboration with a primary care provider.  Plans must provide in a timely manner all medically necessary services that are otherwise available to non-transgender beneficiaries.  Plan decisions are subject to review through the plan appeal and grievance process, the State Fair Hearing process, and/or the DMHC IMR process.

DHCS APL 16-013 (October 6, 2016).

Certain IHSS/HCB caregiver wages are MAGI exempt

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DHCS clarified its MAGI Income and Deductions chart to account for recent IRS clarification about live-in caregiver wages.  Caregiver wages paid under certain IHSS and Home and Community Based Waivers are not counted for MAGI determinations when paid to a provider who lives with the Medi-Cal beneficiary receiving personal care services.

This exemption applies to:

  • In-Home Operations Waiver
  • Nursing Facility/Acute Hospital Waiver
  • Personal Care Services Program
  • In-Home Supportive Services Plus Option
  • Community First Choice Option
  • In-Home Supportive Services – Residual Program

DHCS MEDIL I 16-17 (September 21, 2016).

Changes to Medi-Cal estate recovery

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Effective January 1, 2017, SB 833 changes rules regarding Medi-Cal estate recovery.  DHCS will be limited to recovering for nursing facility services, home and community-based services, and related hospital and prescription drug services when beneficiaries receive nursing facility and/or home and community-based services.

Other important changes include:

  • An additional hardship waiver if DHCS determines that enforcement of the claim would result in substantial hardship to other dependents, heirs, or survivors of the decedent.  Subject to federal approval, “substantial hardship” can include consideration of a homestead of modest value, defined as “a home whose fair market value is 50 percent or less of the average price of homes in the county.”
  • Prohibition of recovery from the estate of a deceased beneficiary who is survived by a spouse or registered domestic partner.
  • Setting how a voluntary post death lien accrues interest
  • Allowing eligible Medi-Cal beneficiaries to request a copy of the amount of recoverable Medi-Cal expenses once per calendar year for $5.

The estates of Medi-Cal beneficiaries who pass on or before December 31, 2016, will be subject to existing estate recovery rules.

DHCS MEDIL I 16-16 (September 21, 2016).