Resolving what must have been a heated dispute between various counties when processing inter-county transfers of IHSS cases, CDSS has verified that, notwithstanding the fact the form is not listed among required forms in the Manual of Policies and Procedures, the Health Care Certification Form (SOC 873) is indeed required to be provided in hard copy format by the transferring county during an inter-county transfer. ACL 14-86 (12/9/14)
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Guidance on transitioning Covered California cases to Medi-Cal
DHCS issued a letter to guide counties on how to handle Covered California cases transitioning to Medi-Cal after Covered California’s annual redetermination process, which will always run at the same time each year. When Covered California determines that a beneficiary may now be income-eligible for Medi-Cal, it will forward the information to the counties for final determination.
Those found eligible, conditionally eligible, or pending eligible are sent to the county for appropriate verification. Eligible cases were granted temporary full-scope Medi-Cal eligibility as of January 1, 2015, and assigned to the same health plan where possible.
DHCS’s letter included talking points on the transition process and sample notices/letters to consumers. DHCS ACWDL 15-01 (1/7/15).
Guidance for counties on the Expanded Subsidized Employment (ESE) Program
County welfare departments have submitted numerous questions to CDSS about the CalWORKs Expanded Subsidized Employment (ESE) Program, which was established to increase the number of subsidized employment placements provided by the counties for CalWORKs recipients who are required to participate in welfare to work. CDSS clarifies that counties may add ESE programs to their existing subsidized employment programs, but cannot combine ESE funds with other funds for individual placements. ACL 14-81 (11/20/14)
Directions for issuing refunds for premiums from Optional Targeted Low Income Children Program
DHCS issued a letter with directions on how the county should deal with refunds of TLICP premiums or waivers due to beneficiary request or retroactive eligibility for non-premium aid codes. When a beneficiary requests prospective discontinuance in writing, counties must request the refund or waiver on the beneficiary’s behalf even if the beneficiary claims not to have paid the premium. When retroactive eligibility for free Medi-Cal is determined, the county must submit a request to Maximus (the administrative vendor) for refund/reimbursement. Note that a beneficiary may continue to receive premium due invoices after discontinuance due to the billing cycle. DHCS ACWDL 14-43 (1/5/15)
Prior felony drug conviction no longer precludes CalFresh and CalWORKs eligibility
It took nearly two decades for California to lift the statutory prohibition preventing individuals with prior drug felony convictions from qualifying for CalFresh or CalWORKs benefits. But the recent enactment of AB 1468 (2014) did just that. Effective April 1, 2015, no person can be excluded from an assistance unit or otherwise be denied CalFresh or CalWORKs benefits because of a prior felony drug conviction. Two important All County Letters have been issued addressing this change: All County Letter No. 14-100 sets out in detail the rule changes, key implementation dates, applicable forms, as well as what is expected of local county welfare offices to facilitate eligibility and receipt of benefits for individuals previously excluded. There is also the related All County Letter No. 14-92 explaining specific changes made to the CalFresh application form to conform to AB 1468. ACL 14-100 (December 19, 2014); ACL 14-92 (December 22, 2014).
Plans must ensure continuity of care for Medi-Cal beneficiaries transitioning into managed care
DHCS issued an All-Plan Letter providing requirements for continuity of care for Medi-Cal beneficiaries that are transitioning into managed care plans from fee-for-service Medi-Cal. The requirements allow for the option to continue treatment for up to 12 months with an out-of-network Medi-Cal provider for Medi-Cal services. The letter also covers issues relating to outpatient mental health services, transition from Covered California to Medi-Cal, transition of Seniors and Persons with Disabilities, and coverage of behavioral health treatment for children with autism. DHCS APL 14-021 (12/29/14).