CalFresh application denials before 30th day

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Under a federal waiver, California can deny CalFresh applications 10 days after the date of a request for verification if the applicant does not provide the requested information. This letter states that a welfare department cannot deny a CalFresh application for failure to provide verification within 10 days of a request unless an interview is completed. In addition, the denial cannot be effective until 30 days after the application is filed.

This letter also reminds counties: 1) they must schedule interviews for all CalFresh applicants who are not interviewed on the day they submit their application, 2) cannot deny an application prior to the 30th day after application if the household misses their first scheduled interview, 3) they must send a denial notice on the 30th day following the date of the application if the household misses a scheduled interview and does not tell the county they want to pursue the application, and 4) counties must give at least 10 days for applicants to provide missing verification.  ACL 15-93 (11/20/15).

Requests for child support accountings

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The California Department of Child Support Services has released a reminder that local child support agencies (LCSAs) must provide accountings in child support cases on request. The LCSA must provide an audit of arrears within 30 days of a request by either a custodial or non-custodial party. If the LCSA cannot complete a review of arrears within 30 days, the LCSA should send a letter to the requestor informing of the delay and an estimate date for completion of the audit of arrears.

The LCSA must also provide a payment history to non-custodial parents on request.

A custodial or non-custodial party can file a request for complaint resolution for failure of a LCSA to provide a financial audit on request.  CSS Letter 15-12 (12/3/15).

Medi-Cal managed care coverage of BHT for children with autism

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DHCS has provided new guidance on how Medi-Cal managed care plans cover BHT services to beneficiaries under 21 through EPSDT.  Beginning 2/1/16, BHT services for those who received them at regional centers prior to 9/15/14 will transition to managed care plans over a six-month period.  For those who do not meet regional center criteria, managed care plans must cover medically necessary services upon enrollment.

For those transitioning from regional centers, plans must automatically generate a continuity of care request and proactively contact providers to begin the process.  Plans must offer up to 12 months of continuity in accordance to existing contract requirements.  BHT services will not be discontinued until a new treatment plan has been completed and approved by the plan.  If continuity of care cannot be reached, the plan must transition the beneficiary in-network and ensure no gap or change in services occurs.  Plans are supposed to contact beneficiaries starting 12/1/15 on a rolling basis over the transition period.

To receive BHT services, a Medi-Cal beneficiary must be under 21, have a diagnosis of autism spectrum disorder based on a comprehensive diagnostic evaluation, have a recommendation for BHT from a licensed physician/psychologist, be medically stable, and be without a need for 24-hour monitoring.  BHT services must be medically necessary and provided and supervised under a plan-approved behavioral treatment plan developed by a contracted and credentialed qualified autism service provider.  DHCS APL 15-025 (12/3/15).

Unticking CalWORKs clock for zero participation months

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CDSS has issued guidance about unticking months on the 24 month time on aid clock for adults with zero participation hours. Months should be unticked from the 24 month time on aid clock if, for any six consecutive month period between January 1, 2013 and September 30, 2015, the adult was aided, had zero WTW participation hours and the 24 month clock ticked.

In addition, good cause should be found and months unticked from the 24 month time on aid clock when either the client was unengaged in WTW prior to initiation of WTW compliance process, or months when more than 60 days passed between the initiation of WTW compliance and imposition of a sanction.

Counties are required to identify these cases and send an informing notice that months are being added to the 24 month time on aid clock.  ACL 15-99 (12/1/15).

Fixes for Former Foster Youth who enrolled in Covered California

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Former foster youth (FFY) up to the age of 26 may be eligible for Medi-Cal under the Affordable Care Act, though CalHEERS has only recently implemented the proper software.  DHCS issued a letter to clarify how to fix the situation for FFY who enrolled in a qualified health plan (QHP) through Covered California.

DHCS was to reach out to FFYs enrolled in a QHP about their potential eligibility for Medi-Cal, informing them that counties would evaluate for Medi-Cal.  If the county verifies an FFY status, no further verification is required.  FFYs can either elect to be enrolled into Medi-Cal coverage (under aid code 4M) until age 26, or they can enroll in unsubsidized Covered CA coverage.  The county will assist FFY with disenrolling from a QHP after enrolling the individual into Medi-Cal.  DHCS ACWDL 15-37 (11/30/15).