Benefits eligibility for persons paroled as refugees

The California Department of Social Services has issued instructions about benefits eligibility for persons paroled as refugees.  The immigration status paroled as a refugee is a category of parole that includes persons who enter the United States under the Central American Minors program and persons eligible for conditional entry, between February 1970 and April 1980 whose application for admission to the United States was denied because of an inadequate number of visas.

Persons paroled as refugees are eligible for Refugee Resettlement Program benefits, CalWORKs and CalFresh.  Persons paroled as refugees should be eligible for SSI after one year and are eligible for CAPI until they are eligible for SSI because they are considered permanent residents under color of law.  ACIN I-48-16 (June 29, 2016).

Medi-Cal Termination NOAs for Over Income and Not Otherwise Medi-Cal Eligible

DHCS issued new guidance on the requirements for issuing Notices of Action to individuals discontinued from Medi-Cal due to being over income for MAGI programs, not being eligible for Consumer Protection Programs, and not being eligible for any non-MAGI programs.  SAWS now has been programmed to automatically generate the Over Income NOA for the appropriate scenario.  The NOA provides more detail related to the income, household size, and income limit for the individual losing eligibility.

All counties must ensure that timely and adequate NOAs are issued to all discontinued individuals.  For those also found ineligible for non-MAGI programs, those individuals would also be issued the appropriate non-MAGI NOA.  These individuals should be immediately evaluated through CalHEERS for Covered California eligiblity.

Those losing Medi-Cal are not subject to the 15-day rule to pick a plan.  They may pick a Covered California plan by the end of the month in which they lose coverage and have Covered California coverage start at the beginning of the next month as long as they pay the first month’s premium on time.  The county shall assist individuals in completing the enrollment process into Covered California, including helping with plan selection should an individual request such assistance.  A beneficiary may have less than ten days to prevent a gap in coverage, but affected beneficiaries would still have the full 60 days to pick a plan through Covered California.

DHCS ACWDL 16-14 (June 15, 2016).

Medi-Cal Coverage for Services under End of Life Option Act

DHCS issued an All Plan Letter to guide managed care plans about the administration of the End of Life Option Act benefit.  This benefit allows terminally ill beneficiaries over the age of 18 with the capacity to make medical decisions to be prescribed aid-in-dying medications if they meet certain conditions.  Coverage is carved out of managed care plans, so effective June 9, 2016, physicians must seek reimbursement through Medi-Cal Fee for Service.

If a managed care doctor also contracts under fee for service, that physician may choose to become the beneficiary’s attending physician through the steps of obtaining end of life services.  Services provided after the initial visit are no longer the responsibility of the managed care plan.  Managed care physicians who are not FFS providers would need to advise beneficiaries about seeking out FFS providers.

DHCS APL 16-006 (June 2016).

Adoption Assistance Program eligibility for children relinquished to private adoption agencies

The California Department of Social Services has clarification about Adoption Assistance Program (AAP) eligibility when a child is relinquished to a private adoption agency.  When a private adoption agency is involved, the adopting family can be eligible for AAP if the child is eligible to receive SSI or the child was eligible to receive AAP based on a prior adoption that dissolved due to death or termination of parental rights of the previous adoptive parents.

For eligibility based on a finding that remaining in the home is contrary to the child’s welfare, CDSS states that private adoption agencies cannot seek the required juvenile court finding that staying with the natural parents is contrary to the child’s welfare.  Only the county child welfare agency can seek that finding.  This means if there is no petition to remove the child from the home or no subsequent judicial determination that remaining in the home is contrary to the child’s welfare, the child is not eligible for AAP based on a juvenile court finding.  In addition, if a court only sanctions a voluntary relinquishment, the child is not eligible for AAP.

Children adopted through private agencies can be eligible for state-only AAP if the county child welfare agency certifies that the child was at risk of dependency.  The private agency must get this certification from the county child welfare agency.  The county child welfare agency has discretion whether to make this finding.   For this certification, the county child welfare agency must find that the child was at risk of dependency without voluntary relinquishment and there was substantial risk of abuse or neglect.  ACL 16-38 (May 10, 2016).

The Work Number

The California Department of Social Services has issued instructions about using an employment verification service called The Work Number.  After counties execute contracts and Memoranda of Understanding, they can use The Work Number for initial and ongoing CalWORKs and CalFresh eligibility, fraud investigations, and to verify employment and income for TANF participation rate data.

If a county takes adverse action based on information received from The Work Number, the county must send a notice stating the name, address, and telephone number of The Work Number, the right to get a copy of the report from The Work Number if requested within 60 days, and that the information can be disputed by contacting The Work Number.

The Work Number is in addition to the existing IVES income verification system.  As with IVES matches, counties must contact the assistance unit and give an opportunity to resolve any discrepancies before taking adverse action.  ACL 16-43 (May 12, 2016).

Extraordinary circumstances exception to IHSS provider workweek and travel time limitations

The California Department of Social Services has issued instructions about the extraordinary circumstances exception to IHSS provider workweek and travel time limitations.  The extraordinary circumstances exception is available to providers who work for two or more recipients and the recipients meet at least one of the following: 1) have complex medical and/or behavioral needs that must be met by a provider who lives in the same home as the recipient; 2) live in a rural or remote area where providers are limited and as a result the recipient cannot hire another provider or 3) is unable to hire a provider who speaks their language in order to direct their care.

The complex medical or behavioral needs exception applies only when the recipient’s physical or mental health would be harmed to the point of risking out of home placement if services are provided by anyone other than the primary IHSS provider.  Counties will review this exception every 12 months.

The rural or remote location exception applies to areas that are outside of urban areas, defined as population over 50,000 people and outside of urban clusters, which is defined as population centers of between 2,500 and 50,000 people.  The county is required to search for alternative providers, and must review this exception every six months.

The language barrier exception only applies when the inability to hire a provider who speaks the recipients language results in a consistent barrier to the recipient directing their own care that cannot be overcome.  CDSS states that tasks that do not require direction by the recipient such as domestic or related services or some personal care services which only require some direction from the recipient, can be performed by a provider who does not speak the recipient’s language.  The county is required to search for alternative providers, and must review this exception every six months.

CDSS also clarified the live-in family care provider exception.  This exception can apply people who were live-in care providers before January 31, 2016 if the exception is needed after that date because of a change in the recipient’s condition.  ACL 16-22 (April 1, 2016).