Adoption Assistance Program eligibility for children relinquished to private adoption agencies

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The California Department of Social Services has clarification about Adoption Assistance Program (AAP) eligibility when a child is relinquished to a private adoption agency.  When a private adoption agency is involved, the adopting family can be eligible for AAP if the child is eligible to receive SSI or the child was eligible to receive AAP based on a prior adoption that dissolved due to death or termination of parental rights of the previous adoptive parents.

For eligibility based on a finding that remaining in the home is contrary to the child’s welfare, CDSS states that private adoption agencies cannot seek the required juvenile court finding that staying with the natural parents is contrary to the child’s welfare.  Only the county child welfare agency can seek that finding.  This means if there is no petition to remove the child from the home or no subsequent judicial determination that remaining in the home is contrary to the child’s welfare, the child is not eligible for AAP based on a juvenile court finding.  In addition, if a court only sanctions a voluntary relinquishment, the child is not eligible for AAP.

Children adopted through private agencies can be eligible for state-only AAP if the county child welfare agency certifies that the child was at risk of dependency.  The private agency must get this certification from the county child welfare agency.  The county child welfare agency has discretion whether to make this finding.   For this certification, the county child welfare agency must find that the child was at risk of dependency without voluntary relinquishment and there was substantial risk of abuse or neglect.  ACL 16-38 (May 10, 2016).

The Work Number

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The California Department of Social Services has issued instructions about using an employment verification service called The Work Number.  After counties execute contracts and Memoranda of Understanding, they can use The Work Number for initial and ongoing CalWORKs and CalFresh eligibility, fraud investigations, and to verify employment and income for TANF participation rate data.

If a county takes adverse action based on information received from The Work Number, the county must send a notice stating the name, address, and telephone number of The Work Number, the right to get a copy of the report from The Work Number if requested within 60 days, and that the information can be disputed by contacting The Work Number.

The Work Number is in addition to the existing IVES income verification system.  As with IVES matches, counties must contact the assistance unit and give an opportunity to resolve any discrepancies before taking adverse action.  ACL 16-43 (May 12, 2016).

Extraordinary circumstances exception to IHSS provider workweek and travel time limitations

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The California Department of Social Services has issued instructions about the extraordinary circumstances exception to IHSS provider workweek and travel time limitations.  The extraordinary circumstances exception is available to providers who work for two or more recipients and the recipients meet at least one of the following: 1) have complex medical and/or behavioral needs that must be met by a provider who lives in the same home as the recipient; 2) live in a rural or remote area where providers are limited and as a result the recipient cannot hire another provider or 3) is unable to hire a provider who speaks their language in order to direct their care.

The complex medical or behavioral needs exception applies only when the recipient’s physical or mental health would be harmed to the point of risking out of home placement if services are provided by anyone other than the primary IHSS provider.  Counties will review this exception every 12 months.

The rural or remote location exception applies to areas that are outside of urban areas, defined as population over 50,000 people and outside of urban clusters, which is defined as population centers of between 2,500 and 50,000 people.  The county is required to search for alternative providers, and must review this exception every six months.

The language barrier exception only applies when the inability to hire a provider who speaks the recipients language results in a consistent barrier to the recipient directing their own care that cannot be overcome.  CDSS states that tasks that do not require direction by the recipient such as domestic or related services or some personal care services which only require some direction from the recipient, can be performed by a provider who does not speak the recipient’s language.  The county is required to search for alternative providers, and must review this exception every six months.

CDSS also clarified the live-in family care provider exception.  This exception can apply people who were live-in care providers before January 31, 2016 if the exception is needed after that date because of a change in the recipient’s condition.  ACL 16-22 (April 1, 2016).

Violations for exceeding IHSS provider workweek and travel time limitations

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The California Department of Social Services has issued instructions about violations for IHSS providers who exceed workweek and travel time limitations.  Those limitations are described in ACL 16-01.

A violation of the workweek and travel time limitations occurs when: 1) a provider works more than 40 hours in a workweek without county approval and the recipient’s receives less than 40 hours; 2) a provider works more hours in a workweek than the recipient’s maximum weekly hours causing the provider to work more overtime hours in a month than normal without county approval; 3) a provider works more than 66 hours in a week when working for multiple recipients and 4) a provider claims more than 7 hours of travel in a workweek.

The first violation causes a written warning.  The second violation is a warning and a one-time opportunity to complete voluntary instructional materials.  If the materials are completed within 14 days, the second violation is rescinded.  The next violation would then be considered the second violation and will not be rescinded.  The materials are attached to ACL 16-44.

The third violation causes a 90 day suspension of the IHSS provider’s eligibility to work.  The fourth violation causes a one year suspension of the IHSS provider’s eligibility to work.

If a provider has no violations for a year, one violation is rescinded.

For first and second violations, providers can request a county administrative review of the violation, followed by an administrative hearing.  For third and fourth violation, providers can request a county administrative review, then a CDSS administrative review, then an administrative hearing.  ACL 16-36 (April 21, 2016).

Submission of IHSS Provider Enrollment Agreement

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The California Department of Social Services previously stated in ACL 16-01 that In Home Supportive Services providers were required to submit the Provider Enrollment Agreement (SOC 846) by April 15, 2016 or be terminated on May 1, 2016.

CDSS changed its policy so that providers who did not submit the SOC 846 by April 15, 2016 will not be automatically terminated.  The SOC 846 remains a required form that must be submitted and counties must assist in providers in completing the form.  ACL 16-27 (April 14, 2016).

Expanded eligibility and services under CMSP

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As of May 1, 2016, the County Medical Services Program (CMSP) is changing some of its eligibility requirements and benefits.  CMSP provides limited-term health coverage for indigent residents in 35 mostly rural California counties.  These changes should be operational in C-IV counties by May 23, and in CalWIN counties by May 9.

Eligibility Changes

The CMSP Eligibility Manual has been revised with new provision taking effect after May 1, 2016.  Among the changes that have been made:

  • Increasing the cap on income eligibility from 200% FPL to 300% FPL
  • Eliminating the asset test and share of cost for those with incomes up to 138% FPL (in line with MAGI Medi-Cal)
  • Increasing the asset limit for those with incomes between 138% FPL and 300% FPL to $20,000 for individuals and $30,000 for couples
  • Reducing the share of cost for those with incomes between 138% FPL and 300% FPL by 75%
  • Establishing a one-month retroactive eligibility period that replaces the ten-day pre-enrollment eligibility period
  • Revising the term of enrollment to six months

Note that the CMSP application process is supplemental to the Medi-Cal application.  The time period for counties to complete all processing will be 75 days.  Undocumented recipients will still be primarily limited to restricted scope benefits.

CMSP ACL No. 16-02 (April 27, 2016).

Benefit Changes

As of May 1, 2016, CMSP members with a share of cost will qualify for a new CMSP Primary Care Benefit in addition to the CMSP Standard Benefit.  Under this new Primary Care Benefit, eligible members will receive:

  • Up to three medical office visits with a primary care doctor, specialist, or other selected services with no share of cost or copay
  • Preventive health screenings with no copay or share of cost
  • Specific diagnostic tests and minor office procedures with no copay or share of cost
  • Prescription drug coverage up to $1500 in prescription costs, with a $5 copay

Benefits must be provided during the Primary Care Benefit eligibility period (members will get a special card in addition to the standard CMSP card and BIC) by a contracted CMSP provider with a reservation.

The Primary Care Benefit will begin the first of the month following approval for CMSP eligibility with no retroactive coverage provided.

CMSP ACL No. 16-03 (April 27, 2016).