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).

CalFresh Expedited Service

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The California Department of Social Services issued this letter to clarify and transmit current state and federal rules about CalFresh Expedited Service (ES). Counties must screen all CalFresh applications for ES. Applicants have the right to file a CalFresh application on the day they contact the county during business hours. The application is considered complete if it contains the applicant’s name, address and signature.  Counties cannot refuse or deter submission of a CalFresh application during normal business hours.

Counties must verbally inform each CalFresh applicant of ES availability.  ES information must be added to at or near the beginning of each online CalFresh application.  The CalFresh application asks ES screening questions but county review for ES cannot be limited to the screening questions on the application.

Applicants are eligible for ES if:

  1. Household has both less than $150 in gross monthly income and less than $100 liquid resources
  2. Household combined gross monthly income and resources is less than household’s monthly rent or mortgage and utilities.
  3. Migrant or seasonal farmworker who is destitute and has less than $100 resources.
  4. Household is destitute, meaning the household’s only income was received before the application date and has terminated, the household has income from a new source but no more than $25 will be received within 10 calendar days of the application, or a combination of those.

Counties are not required to notify applicants that ES has been denied. However, counties must offer an agency conference for ES denials.  Counties must provide information about the agency conference at the same time the household is informed of ES.

ES must be granted within 3 business days of the application, which means EBT cards must be available within the 3 business day timeframe.  The only verification required for ES is identity, which can be verified using MEDS or any other information known to the county including a prior application. If identity cannot be verified, the county can accept attestation of identity from a collateral contact who confirms the applicant’s identity. All other verification is postponed until processing of the application, which is up to 30 days.  If ES eligibility is discovered at a subsequent interview or any later time during the application process, the 3 business day ES time clock begins when the county discovered ES entitlement.

If a household missed their ES interview, the county will send a notice to the applicant to reschedule the interview prior to 30 days after application.  Counties should route the application for normal processing if the applicant misses the ES interview. If the applicant does not contact the county to reschedule the interview within 30 days, the application is denied.

Based on input from a workgroup, CDSS has recommendations for ES, including that the county assign a lobby greeter, the county attach a half-sheet to the application explaining ES, and the county post signs in welfare department lobbies about ES.  ACL 16-14 (February 29, 2016).

Sick leave for CalWORKs Subsidized Employment program

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The California Department of Social Services has issued instructions for sick leave in the CalWORKs Subsidized Employment program. AB 1522 requires, after July 1, 2015, that an employee who works more than 30 days within a year from the beginning of employment is entitled to accrued sick leave of no less than 1 hour for every 30 hours worked. An employee is entitled to use accrued sick leave starting the 90th day after the beginning of employment.

For purposes of accrued sick leave, the employer is entity paying wages and taxes for the Subsidized Employment participant.  Subsidized Employment participants are not exempt from sick leave unless they are covered by a collective bargaining agreement.   Counties should ensure that employers of Subsidized Employment participants are complying with sick leave requirements and the appropriate amount of sick leave has accrued since July 1, 2015.  ACL 16-17 (March 4, 2016).