DHCS has set priorities for counties to process Medi-Cal batch applications. Counties are to resolve batch transactions that DHCS has not batched in weekly 45-day accelerated enrollment (AE) batch runs. Then, counties need to review Rivera Notice of Inaction individuals. Next, counties would process applications within the required 45 day timeframe. Finally, counties should process full eligibility determinations for those batched in aid code 8E.
DHCS MEDIL I 15-15 (7/13/15).
DHCS issued an All Plan Letter clarifying how Medi-Cal plans should determine medical need for wheelchairs and applicable seating and positioning components. The criteria for medical necessity must include a medical evaluation of the beneficiary and review of the equipment to ensure that the beneficiary has appropriate mobility in or out of the home.
Medi-Cal covers medically necessary equipment when it is appropriate for use in or out of the patient’s home, regardless of whether the needed equipment will be used inside or outside of the home. DHCS APL 15-018 (7/9/15).
CDSS has released its new Online CalWORKs Appraisal Tool (OCAT). OCAT guides county welfare department workers through the CalWORKs appraisal process and generates recommendations for welfare-to-work and supportive services. The OCAT appraisal includes a section to screen for learning disabilities.
OCAT is currently only available in English. Clients with limited English proficiency are to be referred for evaluation and services to address their language barrier. Counties have the option to reassess current welfare-to-work clients using OCAT if they believe doing do will identify barriers to self-sufficiency. Clients must be informed of their privacy rights at the beginning of the OCAT appraisal. Training on OCAT started in April, 2015. All counties must have fully implemented OCAT by October 1, 2015. ACL 15-43 (4/17/15).
DHCS recently issued guidance around Medi-Cal residency requirements for students either from out-of-state who attend California schools or California residents who attend out-of-state schools. If otherwise eligible, those students who come to California to attend school may apply for Medi-Cal (all other eligibility rules apply). Similarly, Medi-Cal beneficiaries who leave California to attend school can continue their Medi-Cal eligibility assuming they are still otherwise eligible. These beneficiaries may also apply for Medicaid in the state in which they attend school.
Parents/caretakers and households would also retain Medi-Cal eligibility if the only child or one child attends school out of state. Medi-Cal will only cover emergency services as long as the provider agrees to accept Medi-Cal. DHCS ACWDL 15-23 (7/9/15).
Effective July 1, 2015, the CalWORKs Minimum Basic Standard of Adequate Care (MBSAC) increased by 2.54%. The MBSAC is the maximum amount of income an assistance unit can have, after income deductions, and be eligible for CalWORKs. The increase is the cost of living increase required by Welfare and Institutions Code Section 11453. This cost of living increase also increased the Income-In-Kind (IIK) level by 2.54%. These increases also apply to Refugee Cash Assistance, Entrant Cash Assistance and Trafficking and Crime Victims Assistance Program benefits. The California Department of Social Services issued a chart showing the new MBSAC and IIK amounts.
Effective January 1, 2015, the school attendance penalty for children under age 16 is repealed. Previously, if a child under age 16 was not regularly attending school, the CalWORKs household was penalized by removing all adults in the assistance unit from the grant. AB 2383 amended Welfare and Institutions Code Section 11253.5 to repeal this penalty. As a result, county welfare departments can no longer require families to provide proof of school attendance.
If a 16 or 17 year old is deemed a chronic truant by the school district or a county School Attendance Review Board (SARB), then the needs of that child are not considered in determining the family’s CalWORKs grant. Exceptions to this rule include when there is good cause for non-attendance, when any member of the household is eligible for the family stabilization program and when the child, parent or caretaker is complying with requirements from a SARB, probation department or district attorney. A child whose needs are not considered in computing the family’s grant is eligible for services that may lead to school attendance and can sign a welfare-to-work plan to attend school (with no minimum number of participation hours for that plan).
Penalties imposed prior to January 1, 2015 on children under age 16 should have been lifted effective January 1, 2015. Counties were directed to review all cases of school attendance penalties for 16 and 17 year olds.