Misconduct and unemployment insurance ALJ duty to develop the record

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The California Unemployment Insurance Appeals Board (CUIAB) has issued P-B-510 which holds that due process requires the Administrative Law Judge (ALJ) to develop the record in an unemployment insurance hearing.  The case involves termination for tardiness based on an employer’s no fault attendance policy.  The decision first holds that an employer’s attendance policy has no bearing on eligibility for unemployment insurance, and whether an employee has committed misconduct is based on unemployment insurance law and the particular facts of the case and not on the employer’s attendance policy.

The decision continues that, in attendance cases, the final incident must be analyzed to determine if it is misconduct, and that is done by examining whether the incident breached an important duty to the employer and injured or tended to injure the employers interest.  If so, the employee must show good cause.  If there is not good cause, the employee will have committed misconduct if the final incident was substantially detrimental to the employer’s interest or the employee had at least one prior justified warning for a similar incident.

The CUIAB then found that the ALJ had to a duty to develop “a comprehensive evidentiary record” surrounding the final incident, including the reason for the tardiness, the reasons the employee did not provide notice of the tardiness, the impact on the employer and the facts surrounding prior attendance issues and reprimands.  The ALJ failed to develop the record, and that failure justified remand for a new hearing to fully develop the record.  P-B-510 (February 24, 2016).

Clarifying the Inter-county Transfer Process

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DHCS has issued this letter to update information about how to process an ICT and how that affects managed care enrollment.

A beneficiary needs to report a change in county address within ten days of the change in residence either to the county welfare office or through CalHEERS.  After this, the Sending County must assist the beneficiary with transitioning benefits to the Receiving County.  The Sending County initiates the ICT and may only discontinue benefits during the ICT once a new effective date is confirmed with the Receiving County.  The Sending County is allowed seven days to initiate an electronic ICT to the Receiving County, and the Receiving County is required to complete and process the eICT within 30 days.

If a beneficiary contacts the Receiving County to request an ICT, the Receiving County will submit a request to the Sending County within three days of the beneficiary’s notification.  Once the Sending County is notified of an ICT request, the Sending County will initiate the eICT within seven days.

If a beneficiary contacts a Medi-Cal managed care plan, the plan will contact the county offices to provide updated beneficiary contact information.  When the plan indicates that it has received permission from the beneficiary to provide updated contact information to the Sending County, counties must incorporate this information into the case record.  The County may fill out a request to deal with managed care enrollment issues.

DHCS ACWDL 16-10 (4/21/16).

Transitioning from APTCs to Medi-Cal

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CMS has recently issued guidance to DHCS about how to help those enrolled in Covered California plans with APTCs who are later determined eligible for Medi-Cal.  DHCS has issued this letter to explain that those who transition from APTCs to Medi-Cal may have retroactive Medi-Cal coverage that can be used for unpaid medical expenses received up to three months prior to the month of transition, where the QHP will be the primary payor and Medi-Cal the secondary payor.

Those enrolled in QHPs with APTCs who later become eligible for Medi-Cal are not disqualified from receiving tax credits until the month following the Medi-Cal approval, even if Medi-Cal eligibility is retroactive.  Changes to enrollment are to be made prospectively and there would be no retroactive termination of enrollment from a QHP or termination from APTC.

Individuals do not lose eligibility for APTC until the first day of the month following the approval.  An individual can claim the tax credits for these months, if otherwise eligible.  Meanwhile, there is no requirement to be refunded premiums paid of QHP coverage.

DHCS ACWDL 16-08 (4/21/16).

Guidance on COLAs and Health Insurance Costs

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DHCS has issued guidance about the effect of this year’s lack of a Social Security COLA on Medicare premiums and costs, along with other programs such as the Pickle program.

The Medicare Part A premium increased to $411 for those who do not receive free Part A; the reduced Part A premium is $226.  Part B premiums will stay at $104.90 for current Medicare beneficiaries who have the premium deducted from Social Security; those new to Medicare this year, or those who do not have Part B deducted from their Social Security check, will pay $121.90.  Those with higher incomes will pay higher premiums.

Medi-Cal resource limits remain at $2000 for an individual and $3000 for a couple.  DHCS ACWDL 16-05 (4/15/16).

Medicare Savings Program property limits remain unchanged: $7280 for an individual and $10930 for a couple.  DHCS ACWDL 16-07 (4/21/16).

Benefits and same-sex marriages and domestic partnerships

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The California Department of Social Services has issued policies about how same-sex marriages and domestic partnerships are treated for purposes of various programs.  For CalWORKs, same-sex spouses and registered domestic partners who have adopted the children are treated as members of the assistance unit who are subject to welfare-to-work requirements.  These households are considered two parent households for purposes of welfare-to-work requirements.  Same-sex spouses and registered domestic partners who have not adopted the children are considered step-parents, meaning they can be considered part of the assistance unit and participate in welfare-to-work but are not required to do so.

For purposes of eligibility for child care, same-sex spouses and registered domestic partners who have adopted the children are treated as members of the assistance unit, meaning the same-sex spouse or registered domestic partner can be considered an able and available parents who can provide child care.  Same-sex spouses and registered domestic partners who have not adopted the children are considered optional step-parents and are not considered for purposes of eligibility for child care.

For purposes of CalFresh, any group of persons who customarily purchase and prepare meals together are considered a household.   Same-sex spouses are considered spouses and must be included in the CalFresh household.  However, registered domestic partners are not considered spouses and are not automatically included in the household.  Registered domestic partners who are part of the CalWORKs assistance unit or customarily purchase and prepare meals with the family must be included in the CalFresh household.

Refugee Cash Assistance has the same requirements as CalWORKs.  Registered domestic partners have the same status as married couples for purposes of eligibility for Refugee Cash Assistance.  ACL 16-13 (March 28, 2016).