Remember budget bill SB 72? It required an IHSS certification form, the SOC 873 to be received prior to the authorization of IHSS services for new applicants and to allow the continuation of IHSS services for current recipients. There are two exceptions to this rule as it relates to applicants, who are considered temporarily eligible if they meet the exceptions. 1) IHSS services have been requested on behalf of an individual being discharged from a hospital or a nursing home and those services are needed to enable the individual to return safely to their own home or into the community; 2) Services may be authorized temporarily pending receipt of the certification when the county determines that there is a risk of out-of-home placement. The SOC 873 or appropriate documentation must be received within 45 days, or 90 with good cause. There are instructions about the NOAs required. [Download]
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
ACL 11-61: Extended Foster Care (EFC) (11/4/11)
AB 12 hits the streets. This ACL covers the extension of Foster Care for youth that remain in foster care beyond age 18. Extended benefits for CalWORKs court dependents placed with approved relatives, Kin-GAP [ACL 11-15], and Adoption Assistance Payment (AAP) benefits will be covered in separate ACLs. [Download]
ACWDL 11-31: Lomeli Litigation Settlement Updates Supplemental Security Income/State Supplementary Income (SSI/SSP) Applicant and Recpient Medi-Cal Information Notices and Retroactive Eligibility Processing (08/17/11)
The Lomeli settlement agreement requires Department of Health Care Services (DHCS) to send written notice to SSI/SSP applicants and recipients about the opportunity to receive retroactive Medi-Cal coverage for the three month period prior to the SSI/SSP application month. This change will help ensure that SSI/SSP beneficiaries do not miss the window to request retroactive coverage. The letter instructs Counties how to process retroactive eligibility requests. Beneficiaries should also be informed about the opportunity to seek reimbursement for medical costs incurred during the retro period and disability evaluation period. [Download]
ACWDL 11-32: 2011/2012 Family Member Base Allocation Amount (08/16/11)
The letter provides the updated family member “base allocation amount,” which is used to determine how much a long-term care (LTC) Medi-Cal beneficiary may allocate to family members. Effective July 1, 2011, the base allocation amount is $1839 for family members living with the community spouse of the LTC beneficiary. [Download]
ACWDL 11-33: Deemed Eligibility and Continued Eligibility for Infants (08/25/11)
This letter modifies policies for deemed eligibility (DE) and continued eligibility (CE) for infants. This letter supersedes ACWDL 09-17.
An infant born to a Medi-Cal eligible woman at the time of birth has deemed eligibility for Medi-Cal until age one year. The infant is deemed eligible regardless of the infant’s living arrangements. The letter provides additional guidance about specific share-of-cost scenarios. Infants may stay enrolled in Medi-Cal through age one regardless of increases in family income. Counties must conduct a redetermination for the infant as it approaches age one. Counties may terminate a family with a deemed infant from Medi-Cal due to loss of contact but may also reinstate deemed eligibility if contact is re-established.
Review the letter for additional guidance on DE and CE for infants. [Download]
ACWDL 11-34: Section 1931(b) and new CalWORKs Time Limits As a Result of Senate Bill 72 (08/17/11))
This letter clarifies that beneficiaries experiencing a CalWORKs reduction or termination as a result of SB 72 should maintain Medi-Cal eligibility. SB 72 reduced the CalWORKs time-on-aid for adults from 60 months to 48 months. If any beneficiary becomes ineligible for CalWORKs solely because of the time limit changes, the county must transition these individuals to Section 1931(b) Medi-Cal and use the CalWORKs case information for the Medi-Cal case file until the next annual re-determination. [Download]