The State issued an urgent reminder to counties to review caseloads for share of cost cases (or potential share of cost cases denied due to assets) for MAGI eligibility. These cases should be appropriately determined back to January 1, 2014, so that the state can issue proper 1095-B forms and get individuals signed up for Covered California where appropriate. DHCS MEDIL I 15-29 (10/22/15).
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Welfare-to-work satisfactory progress determination
CDSS has issued guidance on determining satisfactory progress in an assigned welfare-to-work (WTW) activity. The guidance states that the satisfactory progress standard for each activity must be stated in the WTW plan. If an individual is not making satisfactory progress, the county should offer learning disability screening and determine whether the client has a learning or physical disability.
If a student does not make satisfactory progress in an education program despite regular attendance and participation, the county should consider alternative classes for the classes that are causing trouble or doing a new assessment and modifying the WTW plan accordingly.
If an individual loses a job because of inability to meet job requirements despite regular attendance and participation, the individual should not be sanctioned and instead the individual should be reassessed to determine a new appropriate WTW activity. ACL 15-80 (10/20/15).
Medi-Cal Benefits for Students Attending College Out of County
When a student attends college in a different county, the family needs to inform the county of this change. The county will update only the student’s address in SAWS and MEDS. This change will trigger change in health plans where applicable, and the student can pick a new health plan based on the student’s college address. Until the student enrolls in a new plan, Medi-Cal benefits will be administered on a fee for service basis. If a student returns home for a school break and needs services, the student will need to update the address of record.
DHCS has issued this guidance along with a Frequently Asked Questions. DHCS MEDIL I 15-32 (10/20/15).
Medi-Cal Discontinuance Notices for Overincome, Ineligible Beneficiaries
DHCS is clarifying NOA issuing requirements for Medi-Cal discontinuances when the beneficiary is over income for MAGI, not eligible for consumer protection programs, and has no potential non-MAGI eligibility. Counties must issue a timely and adequate manual discontinuance notice when an individual loses eligibility for one of the above mentioned reasons, whether or not the individual is eligible for Covered California coverage. Sample NOAs are included with the letter. DHCS ACWDL 15-33 (10/9/15)
Spanish versions of the notices are available with DHCS MEDIL I 15-33 (10/16/15).
Medi-Cal Managed Care Coverage of BHT Services through Regional Centers
Medi-Cal managed care plans are responsible for providing medically necessary Behavioral Health Treatment (BHT). This includes coordinating with Regional Center and BHT providers as applicable. Plans are required to execute an MOU with local regional centers by December 31, 2015 (a sample MOU is included with the letter). DHCS will review to make sure plans are making a good faith effort. DHCS APL 15-022 (10/2/15).
CalFresh fleeing felon and probation violation rules
CDSS has issued new rules about when persons can be disqualified from CalFresh for being a fleeing felon violating a condition of probation and parole. These rules comply with new federal regulations issued at 80 Fed. Reg. 54410. To be considered a fleeing felon and ineligible for CalFresh, a person must have a warrant issued for their arrest that is under the National Crime Information Center (NCIC) code for escape, flight to avoid prosecution or flight-escape. Only warrants with one of those three NCIC codes are a reason to deny or terminate CalFresh benefits.
To be considered violating a condition of probation or parole and be ineligible for CalFresh, there must be a judicial determination that the individual violated a condition of probation or parole. Issuance of a warrant for a violation of probation or parole by itself is not a reason to deny or terminate CalFresh benefits.
In addition, local law enforcement must be actively seeking the individual to enforce a condition of probation or parole. To determine whether law enforcement is actively seeking an individual, the county must contact local law enforcement and ask whether they intend to enforce violation of probation or parole within 30 days. If the answer is no, then the individual is not considered a probation or parole violator. If the answer is yes, the case is held for 30 days to find out if local law enforcement takes action to enforce the probation or parole violation. If no action is taken in 30 days, the individual is not consider a probation or parole violator.
The new rules are effective December 1, 2015. ACL 15-82 (10/14/15).