DHCS issued a letter updating the family member base allowance amount from $1967 to $1991, effective July 1, 2015. This allowance is used to determine how much a long-term care beneficiary may allocate to family members living with a community spouse. DHCS MEDIL I 15-40 (12/7/15).
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Unticking CalWORKs clock for zero participation months
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
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).
IHSS provider overtime rules
CDSS has issued guidance implementing limitations on overtime and travel for IHSS providers to be effective February 1, 2016.
Welfare and Institutions Code Section 12300.4 sets a specified number of hours per week an IHSS provider can work and forbids overtime beyond the specified hours. Section 12300.4 also limits travel for providing services to multiple recipients to seven hours per week. Recipients will need to hire multiple providers if their hours are greater than the specified maximum. CDSS will be mailing informational notices and forms to IHSS recipients and providers.
Counties will be responsible for implementing and enforcing the overtime and travel limitations. ACL 15-97 (12/1/15).
Computation of CalWORKs and CalFresh overpayments and overissuances
NOTE: This ACL is superseded in part by ACL 24-23, summarized here. It no longer applies to CalFresh overissuances.
CDSS has changed its policy regarding computation of CalWORKs overpayments and CalFresh overissuances. The amount of an overpayment or overissuance is determined by recreating the circumstances of the case and recalculating the grant based on all of the income that the client was required to report. Previously, any decreases in income during the payment period that were not reported were not considered in the determining the amount of the overpayment or overissuance.
CDSS’ new policy is that decreases in income that would have increased the grant amount must be considered in determining the amount of the overpayment or overissuance. The result of this change is that the amount of overpayments and overissuances based on unreported income must be adjusted based on any unreported decreased in income during the reporting period. ACL 15-95 (12/1/15).
How to treat disaster-related payments for Medi-Cal eligibility
DHCS issued guidance to the counties on how to treat certain disaster assistance payments for MAGI and Non-MAGI Medi-Cal programs. Existing rules remain applicable for non-MAGI cases (see ACWDL 92-08, MEPM Article 9M, 22 CCR §§ 50481, 50535.5). In MAGI Medi-Cal cases, most disaster assistance in federally recognized disasters are exempt as income depending on the source of payment:
- Payments from charitable organizations are considered gifts and are excluded from the tax household’s gross income.
- Payments from insurance are exempt as income in federally declared disaster areas, while insurance payments in non-federally declared disaster areas may count depending on whether they are taxable.
- Payments from federal or state government sources that are based on need are exempt, as are payments in qualified disasters from federal, state, or local government.
When a Medi-Cal beneficiary is temporarily living out of county due to displacement from disaster, the county must help that beneficiary with the Office of the Ombudsman. DHCS ACWDL 15-36 (11/9/15).