More guidance about Medi-Cal application batches for Rivera, Covered CA transition

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DHCS provided an update on the batching process for dealing with processing Medi-Cal applications in a more timely manner in the wake of the Rivera decision.  DHCS was to issue a Notice of Inaction mailer for individuals who have not received a final Medi-Cal determination and NOA.   The letter describes the different batches and what counties must do.

DHCS provides weekly results files to SAWS counties, which includes individuals whose applications are nearing the 45 days.  Counties must review these files for the Rivera mailing.

The batch process to transition beneficiaries from Covered California to Medi-Cal will continue on a monthly basis until the process is automated.

DHCS MEDIL I 15-13 (5/15/15).

Coverage of anesthesia services for Medi-Cal dental services

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DHCS issued instructions on the coverage of IV sedation and general anesthesia services in connection with dental services.  Medi-Cal beneficiaries are entitled to dental services under IV sedation and general anesthesia when medically necessary in an appropriate setting.  The letter lists the requirements for MCPs to cover general anesthesia services.  All Plan Letter 15-012 (5/14/15).

AB 1614 codifies existing practices and establishes new requirements for EBT program

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CDSS has published instructions to local county welfare departments to assure compliance with recently enacted AB 1614 (2014). Its provisions codify a range of established practices in California’s EBT program, the default payment mechanism for CalFresh, CalWORKs, Refugee Cash Assistance (RCA), Cash Assistance Program for Immigrants (CAPI), and several other state-administered cash programs, as well as some local county general assistance programs. AB 1614 also establishes a set of new requirements to make certain elements of the EBT program easier to use by recipients, including more ready access to the recipient’s EBT account information. Among the requirements now codified in AB 1614 are:

  • 24-hour recipient access by toll-free telephone so they can hear a listing of their last ten EBT transactions, with the option to request by telephone to have a copy of their transaction history detail for the past two months mailed to them;
  • Local county welfare offices must make a recipient’s EBT transaction history available to them within 10 business days of such a request, at no cost to the recipient;
  • The EBT system must establish the capacity to deliver “system outage alerts” to recipients, to inform them when the system is not functioning or is expected not to function for more than one hour between 6am and midnight during any 24-hour period;
  • Recipients must be informed by the county welfare department where they can use their EBT cards to withdraw benefits without incurring a fee, charge, or surcharge;
  • If a local county welfare department makes direct deposit available to its employees, then it must also make direct deposit available to its CalWORKs recipients.

Providing recipients with information about how to access their EBT benefits without surcharge fees is no small matter. CDSS confirms in this ACL that “almost two-thirds of ATM withdrawals made by EBT recipients incur surcharge fees.” (Federal law prohibits surcharge fees for CalFresh transactions.) CDSS also notes that recipients can access the MoneyPass website (or its mobile apps, linked there) to locate ATMs that provide surcharge-free transactions. ACL 15-39 (April 21, 2015).

Clarifications of Income Reporting Thresholds (IRT) in the CalFresh program

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This is a must-read for CalFresh advocates. But to read a 10-page All County Letter like ACL 15-42 is to be reminded how complicated and therefore error-prone welfare programs have become, or at least continue to be, despite improvements such as broader categorical eligibility and simplified reporting requirements. Exhibit A here is an admittedly helpful chart on page two that breaks down six differing types of CalFresh-eligible households, each with differing rules for gross income limits and/or household compositions, with corresponding semi-annual reporting requirements (SAR), triggered by the applicable Income Reporting Thresholds (IRT). Or not.

This is an arena where client advocates need to be something akin to a tax lawyer. Perhaps it was a bit of CDSS humor that it chose to publish this on Tax Day? In any event, the rules here are quite technical and demand close reading to get them right. ACL 15-42 (April 15, 2015). Be sure also to review the “errata” related to these same issues in ACL 14-56E, laying out corresponding corrections to its earlier 2014 ACL about CalFresh modified categorical eligibility (MCE).

Updated County instructions about verification of Social Security numbers and income

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In July 2014, the Social Security Administration (SSA) announced the availability of SSA benefit verification letters and other SSA verification processes, via its My Social Security site. CDSS has now issued updated instructions (along with a few pointed reminders) to counties about the changes in the SSA processes for verification of Social Security account information, and how they relate to largely unchanged CDSS requirements for a client’s submission of Social Security numbers and income information. The specifics for verification of Social Security account information vary somewhat in the CalWORKs, Medi-Cal and and CalFresh programs, highlighted here. There is language here that is horatory but still helpful to the client’s cause, where CDSS reminds counties that “the CWD shall make every effort to assist the individual in obtaining the documents necessary to submit a complete application for a SSN card” and “strongly recommends that counties ensure that the forms they are using are adequate in providing all necessary information to clients.” ACIN I-24-15 (April 13, 2015).