IHSS telehealth assessments

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The California Department of Social Services (CDSS) has issued an All-County Letter (ACL) to implement Telehealth Reassessment Options for In-Home Supportive Services (IHSS).

Due to COVID-19, California declared a state of emergency which authorized the IHSS program to conduct assessments and reassessments over phone or video call. This authorization ended when the state of emergency ended on February 23, 2023

On May 1st, 2024 the federal government approved State Plan Amendments that authorize the Telehealth Assessment Option for the IHSS programs.

Telehealth Reassessment Options will allow reassessments by phone or video call for any IHSS recipients who choose to participate and are determined eligible by county staff. To be eligible recipients must have stable care needs, have received an initial in-person assessment, and one in-person reassessment. In-person reassessments are the default and participants must opt-in to telehealth reassessments. Recipients cannot have consecutive telehealth reassessments unless there is a State of Emergency.  Recipients will be reevaluated for eligibility before every telehealth reassessment.

All counties must implement the Telehealth Reassessment Option sixty days after completing computer system changes. Counties can choose to begin implementing this option after the publication of this letter, However, counties must manually research cases to determine eligibility and can use scheduling and assessment practices used during the COVID-19 pandemic. Recipients who have not had an in-person reassessment due to COVID-19 must receive one before using the Telehealth option.

Recipients must be able to independently use the technology required for telehealth or have someone assist them. This ensures that they can fully participate in the reassessment. In-person assessments must be conducted every other year and telehealth cannot be used for quality assurance or program integrity home visits.

To qualify as having “stable care needs” the recipient must meet 10 criteria at the time of reassessment. First, telehealth recipients must be 19 years of age with minors being ineligible due to changes in need of care. A minor who turns 18 must have one in-person reassessment after their birthday to qualify. Second, recipients cannot have had any incidents involving Adult Protective Services or other similar agencies. Third, there can be no documented concerns about health or safety and no suspicion of fraud in their case. Fourth, recipients cannot have been hospitalized or admitted to an overnight facility for 24 hours nor had multiple ER or urgent care visits in the last 3 months. Fifth, the recipient must not have had a gap in provider services in the last six months ensuring that needs are being met. Counties can use the 60-day no-activity report to identify cases that have gaps in provider services. Sixth, they must not have changed residence since the last reassessment. Seventh, they live with others when in need of assistance with memory, orientation, and judgment (MOJ), or they live alone and do not need assistance. If they have rank 2 or 5 in MOJ and live with others, they must have access to additional resources and support and are determined to have stable care needs. A recipient who lives alone should be rank 1 and not require any assistance with MOJ or need additional assistance. Eighth, the recipient cannot have an authorized representative who directs all care needs. Ninth, the recipient must not require assessment or reassessment for protective supervision. Finally, 10th, the recipient must not have complex paramedical needs. If a recipient has management through another program that helps stabilize them but does not meet all the criteria above, they can receive an exception as it pertains to stable care.

During a State of Emergency, recipients of impacted countries can receive telehealth reassessments regardless of stable needs criteria. When conducting a reassessment, the county is expected to fulfill documentation requirements for completion of an annual reassessment. The recipient must be in their home environment for the reassessment regardless of whether they are participating in the telehealth option. If a country cannot visually assess the recipient and their environment during the telehealth reassessment, they must ask questions to obtain the same information they would have during an in-person reassessment and document it. All standard forms are still required and original signatures are needed on forms that require it. When doing assessments with recipients with language or communication barriers the county must ensure the recipient’s comfort and provide translation services.  (ACL 24-72, October 8, 2024.)

Extension of CalFresh ABAWD waiver

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The United States Department of Agriculture has granted a one year extension of the statewide waiver of the Able-Bodied Adults Without Dependents (ABAWD) rules. The ABAWD  rule means anyone between the ages of 18 and 54 with no children and who is not disabled, might only be able to get three months of CalFresh benefits every three years. The extension is effective from November 1, 2024 to October 31, 2025.

The waiver requires counties to identify ABAWDs, screen for exemptions, inform clients of ABAWD rules, and track and report work registrant, ABAWD, and Employment and Training data.  (ACL 24-76, October 11, 2024.)

Change in definition of part time child care

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The California Department of Social Services (CDSS) has issued a Child Care Bulletin (CCB) regarding definitional changes to part-time and full-time care consistent with Senate Bill (SB) 140 and clarifies inconsistencies with other regulations and codes.

Part-time care is defined as care certified for less than 25 hours per week, and full-time care as 25 or more hours per week, effective no later than March 1, 2024. This conflicts with the existing California Code of Regulations (CCR) definitions that define part-time as less than 30 hours and full-time as 30 or more hours per week. The CDSS must adopt new regulations by July 1, 2026, but this CCB guides the implementation of the latest definitions until then.

CCR section 18075 defines multiple time-based definitions but the Welfare and Institutions Code (WIC) section 10213.5(al)(1)-(2) only defines part-time and full-time weekly. Contractors need to adjust their systems to reflect the updated definitions for hourly, part-time, monthly, and full-time me as outlined in the CCB while the definition of daily remains unchanged.

Hourly care is used when a child’s need for care is fewer than 25 hours per week and fewer than five hours on any day, or when unscheduled needs are fewer than five hours per occurrence.

Daily is used when there is a certified need for child care of six or more hours per day or there is an unscheduled but documented need of six hours or more per occurrence.

Part-time monthly is used when there is a need for child care for fewer than 25 hours per week and that need occurs every week of the month or the need for care averages fewer than 25 hours per week when calculated by dividing the total hours of need in the month by 4.33.

Full-time monthly is used when there is a need for child care greater than 25 hours per week and that need occurs every week of the month or the need for care averaged more than 25 hours per week when calculated by dividing the total hours of need by 4.33.

Previously contractors receiving the standard reimbursement rate could adjust enrollment by time-based factors. They now must align with the new definitions of part-time and full-time care. Contractors must report all children according to these definitions.

The new definitions do not impact family fee determinations at this time. Contractors must adhere to the family fee schedule in CCB 23-22 while continuing to follow the 130-hour threshold for assessments.

Providers do not have to update their rate sheets but contractors must accept updates to rate sheets at any time within 60 days of implementing changes. Without updated rate sheets contractors should compare the provider’s full-time rate to the market rate ceiling and pay the lesser of the two amounts.

The new thresholds for part time and full time care end the need for the Individualized County Child Care Subsidy (Pilot) Program flexibility on service hours.

These changes do not apply to CalWORKs Stage One Child Care and the Emergency Child Care Bridge program.  (CCB 24-04, March 8, 2024.)

Changes to CalFresh electronic theft policy

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Electronically stolen CalFresh benefits are currently replaced with federal funds.  However, federal funding for this purpose expires on December 20, 2024.  If Congress does not act, replacement for electronically stolen food benefits will be from state funds starting on December 21, 2024.  Current policy about replacing electronically stolen CalFresh benefits will not change.

CalFresh recipients are, and will continue to be, eligible to receive up to two months of replacement food benefits for each countable replacement of electronic theft.  A countable replacement is each overall sequence of electronic theft transactions reported by a recipient on the EBT 2259 form, regardless of the number of transactions involved.

All transactions that occur within 90 days and are listed on the same EBT 2259 form will be considered one countable replacement unless the county suspects, based on the information on the EBT 2259 form, that there were two series of thefts in the 90-day period.  In that case, the county must contact the customer.  Indicators that there are separate incidents of theft include thefts the occurred in different states, thefts that are across multiple months, and thefts in which there are weeks between the dates of the transactions.  In these situations, households cannot be required to submit another EBT 2259 form.  The county worker must document in the case record and inform the household why two countable replacements were issued.

A household cannot receive more than two instances of replacement benefits each federal fiscal year (October 1 to September 30).   (ACL 24-62, August 23, 2024 and ACL 24-62E, September 30, 2024.)

CalWORKs best practices for supportive services

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All CalWORKs Welfare-to-Work participants are eligible to receive supportive services that are necessary for their Welfare-to-Work activity.  This includes child care, transportation, and ancillary expenses.  Supportive services must be advanced to participants when needed and requested by the participant.  This is to prevent participants from needed to use personal funds to pay for these services.  If supportive services are not available, or have not been advance paid, the participant has good cause for not participating.  However, the time on aid clock continues to tick when participants are in good cause.  For that reason, counties are strongly encouraged to provide supportive services and engage participants in Welfare-to-Work activities as soon as possible.

The California Department of Social Services recommends as a best practice that counties issue transportation and ancillary services at least 10 days prior to the start of the Welfare-to-Work activity, or within 10 days if the county receives the request less than 10 days prior to the start of the activity.  Counties should also use this timeline for notice that a supportive service request is denied, or that additional documentation is needed.

Timelines for other supportive services, including child care, diapers, and the advance standard payment for students, remain unchanged.  (ACIN I-36-24, August 23, 2024.)

Increase in CalWORKs Maximum Aid Payment

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The CalWORKs Maximum Aid Payment will increase by .3% effective October 1, 2024.  The grant increase is funded by the Child Poverty and Family Supplemental Support Subaccount.  Grant increases in future years will depend on the amount of funds in the Subaccount.

The grant increase applies to all CalWORKs cases.  Counties must treat the grant increase as a mandatory mid-period action.

The California Department of Social Services will send an informing flyer to all CalWORKs recipients.

For children who have opted to receive child support instead of CalWORKs, counties must used updated charts to determine if that is still an option.  Children can get child support instead of CalWORKs, when there are multiple children with different paying parents in the same Assistance Unit, and the child support received for the child is greater than the CalWORKs grant for that child.  If the amount of child support received is no longer greater than the amount in the updated charts, the county cannot add the child to the grant until the next semi-annual report or annual recertification.  However, in that situation, the parent/caretaker relative can ask to add the child to the CalWORKs grant mid-period. (ACL 24-55, August 8, 2024.)