Anthem Blue Cross’s January data breach may have affected 120,000 beneficiaries of the CMSP and Path2Health programs. These beneficiaries were sent notices at their last known address, but counties are to post information in county offices. CMSP ACL 15-04 (4/7/15).
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Welfare to Work’s altered “flow”
Beginning in 2014, CDSS implemented AB 74, which changed the sequence of activities for CalWORKs Welfare to Work (WTW) participants provided in Welf. & Inst. Code Section 11320.1 in order to better serve individuals who face significant barriers to employment in light of the WTW 24-month clock. AB 74 permits participants to bypass the job search (job market test) when the participant is identified as having potential barriers to employment, such as mental health, substance abuse or domestic abuse, which warrant further assessment during the appraisal process. AB 74 also provides for a standardized appraisal tool to identify such individuals. That tool, the Online CalWORKs Appraisal Tool (OCAT), is to be implemented in Spring 2015. When significant barriers are identified during appraisal, the participant should be evaluated for a WTW exemption and referred for barrier evaluation and related services when appropriate. ACL 15-09.
2015 Statewide nursing facility Average Private Pay Rate
DHCS has updated the statewide average private pay rate (APPR) for 2015 to $8092. This is used to determine periods of ineligibility due to transfers of nonexempt personal property for less than FMV. DHCS ACWDL 15-17 (3/26/15).
Resource materials for remote identity proofing proces
DHCS has issued guidance and resources materials on the remote identity proofing process for CalHEERS. The letter contains a guide compiling a number of job aids about the RIDP process, as well as two reference sheets to address additional questions.
Currently, there are three methods for identity proofing in CalHEERS:
- Visual verification (mail, upload, or scan an identity document)
- RIDP (connect to data hub for in-person, online or telephone application)
- Signature (paper application)
DHCS MEDIL I 15-10 (3/24/15).
Medi-Cal eligibility and transition of Refugee Medical Assistance cases
DHCS has instructed counties to evaluate all RMA beneficiaries for eligibility for MAGI and Covered California back to January 1, 2014. New RMA applicants will be screened for Medi-Cal up to 138%, 8 months of RMA from 138% to 200%, and Covered California above 200%.
For current RMA beneficiaries whose 8 month time limit has not expired, counties must restore eligibility back to 1/1/14 for those who would have been eligible for MAGI Medi-Cal; those who are not eligible for MAGI or for other Medi-Cal linkage will be assessed for Covered California APTCs once their eight month eligibility period has run. Reviews should be ex parte to the fullest extent possible, with requests for information used only if counties can not get the information through available sources.
For RMA/RCA cases closed after 1/1/14, counties must redetermine them for MAGI or Covered California eligibility.
RCA beneficiaries must stay in the RCA aid code for the full eight months until further notice. DHCS ACWDL 15-16 (3/20/15).
Instructions to determine IHSS eligibility for “non-disabled” people with MAGI Medi-Cal
Under the ACA, 19 to 64 year olds who are neither disabled nor blind can be eligible for Medi-Cal if if their modified adjusted gross income (MAGI) is below a certain amount. There are several MAGI aid codes, many of which indicate eligibility for full-scope Medi-Cal with federal financial participation (FFP). For such individuals who have not yet been determined to be disabled by CDSS or the Social Security Administration, they may still receive IHSS if they (1) meet the criteria for disability under MPP Section 30-780.2(b), and (2) have an assessed need for IHSS. ACL 14-67.