CCWRO PowerPoint Training

“Healthcare Reform and Immigration Status in California May 13, 2014 Speakers Kellen Russoniello, Staff Attorney Health and Drug Policy, ACLU of San Diego & Imperial Counties Gabrielle Lessard, Health Policy Attorney, National Immigration Law Center Betzabel Estudillo, Health Policy Coordinator, California Immigrant Policy Center Basics of the Affordable Care Act Kellen Russoniello Staff Attorney Health and Drug Policy ACLU of San Diego and Imperial Counties [email protected] May 13, 2014 ACLU of San Diego and Imperial Counties We fight for individual rights and fundamental freedoms for all through education, litigation, and policy advocacy Focus areas: Immigrants’ Rights Criminal Justice and Drug Policy Reform Voting Rights Overlap of ACA and Criminal Justice System Overview Medi-Cal Expansion Covered California Residency Individual Mandate and Exceptions Open Enrollment and Special Enrollment Periods Medi-Cal Expansion Provides health coverage to low-income residents Expanded Jan. 1, 2014 to cover most adults <65 years of age with incomes at or below 138% FPL $16,105 for an individual $32,913 for a family of four Eligibility for new population based on projected annual income (MAGI); assets not considered Full-scope vs. Restricted-scope Medicaid is a joint federal and state funded program. States administer the program and must conform to federal regulations. States must cover certain categories, such as aged, blind, disabled, and pregnant women and children. In California, Medicaid is called Medi-Cal. CA covers most optional categories and provides state-only funding for categories that the federal government won't pay for, such as lawfully present people who have been in the US under five years. Under the ACA and the Supreme Court ruling in 2012, Medicaid expansion became optional for states. California was one of the first states to expand. 250% FPL = $59,625 for a family of four MAGI applies to newly eligible, parents, children, and pregnant women. Coverage for certain categories will remain higher than 138% FPL. Children are eligible if household income is at or below 250% FPL = $59,625 for a family of four. Full-scope Medi-Cal is available where all eligibility requirements are met, including immigration status. This gives the full range of coverage, including hospitalizations, outpatient treatment, prescription drugs, mental health and substance use disorder treatment, and so on. Limited, restricted, or emergency scope Medi-Cal is available to those who meet income and residency requirements but are ineligible for full-scope coverage due to immigration status. Limited-scope Medi-Cal provides coverage for emergency, pregnancy-related services, and renal dialysis. 6 Covered California California's Health Benefit Exchange One-stop shop for insurance plans, including Medi-Cal (no wrong door) Four levels of plans based on actuarial value Advanced premium tax credits for 100%-400% FPL Lowers cost of monthly premium Credit equals premium minus percentage of income Percentage ranges from 2% to 9.5% Additional cost-sharing subsidies (silver plan only) Bronze, Silver, Gold, Platinum Cost-sharing reduction: Reduction of annual cost-sharing up to 400% FPL (2\/3 100%-200%, \u00bd 201%-300%, 1\/3 301%-400% Reduction of out-of-pocket expense at time of service up to 250% FPL. 100% FPL = $11,6700 for an individual and $23,850 for a family of four 400% FPL = $46,680 for an individual and $95,400 for a family of four 7 Covered California Cont. If eligible for Medi-Cal, not eligible for Covered CA If you are lawfully present and would be eligible for Medi-Cal but for immigration status, you are eligible for coverage through Covered CA. If your income is below 100% FPL, you will be eligible for the same amount of financial assistance as if your income was 100% FPL Example is a non-immigrant status, such as temporary worker or student 8 Residency Requirement for Medi-Cal and Covered California Live in California and: Have the intent to remain indefinitely, or Entered the state with a job commitment or to seek employment. Different than immigration status (e.g., can be a resident and undocumented) May be more difficult to prove for non-immigrant statuses (especially Medi-Cal) Cannot own or lease a principle residence outside CA. A person's declaration along with residency evidence submitted shall be accepted as proof of residency unless there is evidence to the contrary. This may present problems where a person's visa will expire after a certain term. 9 Individual Mandate Most people must have coverage or pay a penalty 2014 - $95 per adult\/$47.50 per child (up to $285) or 1% family income,* whichever is greater 2015 - $325 per adult\/$162.50 per child (up to $975) or 2% family income,* whichever is greater 2016 - $695 per adult\/$347.50 per child (up to $2,085) or 2.5% family income,* whichever is greater Pro-rated by number of months w\/o coverage * Maximum is national average premium for a bronze plan All citizens, permanent residents, and foreign nationals in the US long enough to qualify as resident aliens under tax law must have minimum essential coverage. Coverage on one day of the month is sufficient to avoid the penalty for that month. If you are exempt one day out of the month, the whole month is exempt. 10 Exceptions to Individual Mandate Not lawfully present Not a resident alien under federal tax law Religious objection Incarcerated Member of Indian tribe Income below tax filing threshold ($10,150 for an individual and $20,300 for a married couple filing jointly) Insurance more expensive than 8% of income Insurance gap of less than 3 months Hardship (e.g., homelessness, death of family member, financial hardship) Resident alien not so much an exemption as in the definition of who the mandate applies to. Nonetheless, if you are not considered a resident alien, then you do not have to pay the mandate if you do not have coverage. There are two tests to determine if you are a resident alien (you must pass only one): The first test is the \"green card test.\" If at any time during the calendar year you were a lawful permanent resident of the United States, and this status has not been rescinded or administratively or judicially determined to have been abandoned, you are considered to have met the green card test. 2. To meet the substantial presence test, you must have been physically present in the United States on at least: 1. 31 days during the current year, and 2. 183 days during the 3 year period that includes the current year and the 2 years immediately before. To satisfy the 183 days requirement, count: All of the days you were present in the current year, and One-third of the days you were present in the first year before the current year, and One-sixth of the days you were present in the second year before the current year. Migrant workers: Days you commute to work in the United States from a residence in Canada or Mexico if you regularly commute from Canada or Mexico do not count. You are considered to commute regularly if you commute to work in the United States on more than 75% of the workdays during your working period. Even if you meet the substantial presence test, you can be treated as a nonresident alien if you are present in the United States for fewer than 183 days during the current calendar year, you maintain a tax home in a foreign country during the year, and you have a closer connection to that country than to the United States. Students and teachers temporarily in the US on visa are exempt from treatment as resident aliens for a certain amount of time. 11 Open Enrollment NO OPEN ENROLLMENT PERIOD FOR MEDI-CAL! Can apply at any point throughout the year First open enrollment for Covered CA ended March 31, 2014 The next open enrollment period is November 1, 2014 February 15, 2015 Special Enrollment Periods 60 day enrollment period triggered by Qualifying Life Event: Become a citizen, national, or lawfully present person Loss of coverage Marriage\/domestic partnership Change of address resulting in new plans available (including release from incarceration) Change in income Have or adopt a child, or place a child in adoption\/foster care Applied before March 31 but denied Medi-Cal after March 31 Wrong enrollment due to Covered CA, insurance, or CEC Case-by-case decision Loss of coverage = due to losing job-based coverage, divorce, the end of an individual policy plan year in 2014, COBRA expiration, aging off a parent's plan, losing eligibility for Medicaid or CHIP, death of policy holder, and similar circumstances For changes in income, you must have been enrolled in a plan before the change in order to take advantage of an SEP. 13 Resources ACLU: ACA & Immigrants ACLU and CIPC Fact Sheet in English and Spanish ACLU Cheat Sheet English and Spanish IRS: Information on Individual Mandate Center on Budget and Policy Priorities: Special Enrollment Periods and Exemptions National Health Law Program Immigrants and health care In California Gabrielle Lessard National Immigration Law Center 15 National Immigration Law Center Our mission is to defend & advance the rights & opportunities of low-income immigrants and their family members. We envision a U.S. society in which all people - regardless of their race, gender, immigration or economic status - are treated equally, fairly, and humanely, have equal access to justice, education, government resources and economic opportunities, and are able to achieve their full potential as human beings. ROAD MAP Immigrants in California Eligibility Requirements Barriers Immigrants in California Highest Share in US: 10.3 million foreign born (27% of state pop.) 4.8 million naturalized citizens (47% of immigrants) ~2.3 million undocumented (7% of state pop.) ~23% of national undocumented population Mixed status families 18 Mixed-Status Families In Families with Citizens: Half of California children have at least one immigrant parent 90.4% of these kids are citizens 13% of California children have an undocumented parent Insurance and Health Care Access Immigrants are more likely than the US-born to be uninsured Immigrants use fewer health care services than U.S. citizens with the same insurance status (MPI, 2013) Undocumented immigrants use fewer health care services than citizens and lawful permanent residents with the same insurance status (UCLA, 2014) Fewer services when compared with USC with same insurance status Source, Migration Policy Institute, health Care for Immigrant Families: Current Policies and Issues (June 2013). 20 ROAD MAP Immigrants in California Eligibility Requirements Barriers Immigration Process Noncitizens enter the US lawfully: As immigrants on a path to lawful permanent resident (LPR) status As nonimmigrants admitted for a temporary stay As refugees admitted because they face persecution due to race, religion, nationality, political opinion, or membership in a particular social group Can adjust to LPR status Asylees are similar to refugees but apply for the status after entering the US Undocumented Immigrants Entered without inspection Stayed past the expiration of a temporary visa Deferred Action for Childhood Arrivals Deferred Action for Childhood Arrivals (DACA) Undocumented immigrants who arrived in U.S. before age 16 ( Dreamers ) Enrolled in or completed education leading to employment Continuously present since June 15, 2007 Coverage Options in CA Covered California state health insurance marketplace\/exchange Premium tax credits for families earning up to <400% FPL, and cost-sharing reductions for <250% FPL Medi-Cal expansion to 138% of federal poverty level (FPL) Other safety net programs E.g., federally-qualified health centers (FQHCs), community clinics, migrant health clinics, public hospitals, charity care Each has their own immigrant eligibility rules 25 Federal Benefits Eligibility In 1996, Congress divided lawfully present immigrants into two categories for federal benefits eligibility purposes: qualified and not qualified Qualified Immigrants can receive federal benefits, but many are barred from receiving federal benefits until they have been in the U.S. for five years California uses state funds to provide benefits during this 'five year bar' as part of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), 26 Qualified Immigrants Lawful Permanent Residents (LPR) Refugees Asylees Certain domestic violence survivors and their family members Certain trafficking survivors and their family members Iraqi or Afghani special immigrants (worked for US) Demonstrates that they were persecuted or fear persecution due to race, religion, nationality, political opinion, or membership in a particular social group 27 More Qualified Immigrants Other humanitarian entrants: Persons granted withholding of deportation or removal Certain conditional entrants (granted before 4\/1980) Certain Cuban\/Haitian entrants Humanitarian and Public Interest Parolees For a full list, see 'Lawfully Present' Individuals Eligible under the Affordable Care Act at http:\/\/nilc.org\/document.html?id=809 State Flexibility Under the unborn child option in CHIP, states can opt to provide prenatal services to pregnant women regardless of immigration status States can use their own funds to provide Medicaid\/CHIP to: Qualified immigrants during the five year bar People Permanently Residing Under Color of Law (PRUCOL) California has exercised all of these options Eligibility for Covered California lawfully present immigrants are eligible to purchase health coverage through state health care marketplaces no five-year bar exception: People who received deferred action through DACA are specifically excluded Lawfully Present Qualified Lawfully Present Immigrants All qualified immigrants People with permission to stay in the U.S. indefinitely temporary protected status (TPS) most with deferred action Applicants for LPR and certain other statuses People with valid nonimmigrant status not in violation of the terms of their visas Complete list: https:\/\/www.healthcare.gov\/immigration-status-and-the-marketplace\/ DACA Excluded from access to federally-facilitated, partnership, and state-run marketplaces\/exchanges No premium tax credits and cost-sharing reductions Exempt from the individual mandate No access to federally-matched Medicaid and CHIP California classifies DACA recipients as PRUCOL Can receive Medi-Cal if otherwise eligible For FAQ on DACA and Access to Health Care see http:\/\/nilc.org\/acadacafaq.html Undocumented Immigrants Undocumented residents can receive restricted-scope Medi-Cal Remain eligible for health programs that are available regardless of immigration status (e.g., public health programs) Hospitals must still provide emergency care regardless of insurance or immigration status Community health centers can continue to provide non-emergency health care regardless of immigration status Eligible to be covered by employer-sponsored group health insurance Insurance companies may offer insurance policies outside the state exchange(s) that are available to undocumented CA Programs Available Regardless of Status Emergency Medi-Cal Prenatal care (Medi-Cal) Access for Infants and Mothers (AIM) Long-term care Early Breast Cancer Detection Breast and Cervical Cancer Treatment California Children's Services (CCS) Children's Health Initiatives Health Programs in some counties (Healthy SF, Healthy Way LA Unmatched) Community clinics Child Health and Disability Prevention Program (CHDP) and CHDP Gateway Family PACT Minor consent services Mental health services Regional Center Services Women Infants and Children (WIC) School lunch and breakfast ROAD MAP Immigrants in California Eligibility Requirements Barriers Barriers Lack of information\/misinformation Concern that receiving benefits or having medical debt will interfere with ability to adjust immigration status ( public charge ) Fears about jeopardizing family members Belief that benefits will need to be repaid Confusion about eligibility Problems in application process Language barriers 36 Public Charge A public charge is a person considered primarily dependent on the government for subsistence, as demonstrated by: receipt of public cash assistance for income maintenance or institutionalization for long-term care at government expense A person who is found likely to become a public charge may be denied: Admission to the U.S., or Lawful permanent resident status Public charge is not a concern for: Medical benefits other than long-term care Other non-cash benefits (e.g., SNAP) People who are already LPRs Verification Citizenship or lawful presence is verified for all applicants Status is verified electronically through: Social Security Administration (SSA) for citizens. U.S. Citizenship and Immigration Services (USCIS) for noncitizens via the Systematic Alien Verification for Entitlements (SAVE) database. Income is verified electronically by the IRS If unable to verify status or income electronically, enrollees have an opportunity to provide other documents by upload, mail or fax. SSNs Only individuals who are applying for benefits are required to provide their immigration\/citizenship status. The Social Security Number (SSN) of a non-applicant may be requested to electronically verify household income. A non-applicant can be required to provide an SSN only if that person is: a primary tax filer, who has an SSN, and is applying for tax credits. Key Issues for Mixed-Status Families Undocumented people may apply for coverage on behalf of their dependent family members Applications should distinguish between applicants (e.g., U.S. citizen child) & non-applicants (e.g., undocumented parent) Non-applicants are not required to provide their immigration status Non-applicants without SSNs cannot be required to provide one Never provide an SSN unless officially issued by the Social Security Administration Individual Taxpayer Identification Numbers (ITINs) should not be used Information provided on an application may be used ONLY to determine eligibility for health insurance. 40 40 Immigration Enforcement Information about immigration status may be used only to determine an applicant's eligibility for health care coverage. ICE has released a notice stating that information provided in health insurance application process will not be used for civil immigration enforcement On October 25, 2013, U.S. Immigration and Customs Enforcement (ICE) issued a memo titled Clarification of Existing Practices Related to Certain Health Care Information, confirming that immigrant parents can enroll their U.S. citizen children and other eligible family members in health insurance programs under the ACA without triggering immigration enforcement activity. http:\/\/www.ice.gov\/doclib\/ero-outreach\/pdf\/ice-aca-memo.pdf \u00a1Now available in Spanish! http:\/\/www.ice.gov\/espanol\/factsheets\/aca-memoSP.htm Language Access Website is available in English and Spanish only https:\/\/www.coveredca.com\/espanol\/ Paper application is available in 11 languages Fact sheets are available in 12 languages, plus English Arabic, Armenian, Chinese, Farsi, Hmong, Khmer, Korean, Lao, Russian, Spanish, Tagalog, and Vietnamese https:\/\/www.coveredca.com\/fact-sheets\/ 42 Consumer Health Care Resources Stuck? Contact the Health Consumer Alliance: www.healthconsumer.org Direct access to Covered California 43 National Immigration Law Center: www.nilc.org National Council of La Raza: www.nclr.org National Health Law Program: www.healthlaw.org Center on Budget and Policy Priorities: www.cbpp.org California Immigrant Policy Center: www.caimmigrant.org Resources on Immigrants and Health Care 44 Undocumented & Uninsured SB 1005 (Sen. Lara) Health for All Betzabel Estudillo, MSW Health Policy Coordinator California Immigrant Policy Center 45 Founded in 1996, CIPC is a non-partisan, non-profit statewide organization that seeks to inform public debate and policy decisions on issues affecting the state's immigrants and their families in order to improve the quality of life for all Californians. CIPC engages in policy advocacy, and also provides technical assistance, training and education on immigrant issues. Why is Health4All important? Though the state provides health care services through programs with limited scope or duration, and some counties provide coverage regardless of immigration status, it is still not enough. Health Care system works better when everyone participates Emergency room treatment is expensive Cost Savings from other Health care spending Healthy Parents, Thriving Families Undocumented immigrants are a major economic engine for California, and contribute to the state's revenue Health is a Human Right Health For All-SB 1005 Introduced by Senator Ricardo Lara Press event on February 14th in LA Community members, advocates, and health providers were present supporting the bill Strong legislative support Co-authors: Senators Block, Calderon, De Leon, Evans, Mitchell, Padilla, Torres, Wolk Co-authors: Asembly Members Alejo, Ammiano, Bocanegra, Bonta, Campos, Dickinson, Fong, Garcia, Gonzalez, Roger Hernandez, Jones-Sawyer, Pan, V. Manuel Perez, Rendon, Skinner, Ting, and Yamada List of co-authorship continues to grow Health For All-SB 1005 What does the bill do? SB 1005 will expand access to health care coverage for all Californians, regardless of immigration status Full Scope Medi-Cal: authorize enrollment in the Medi-Cal program Mirror Exchange: offer insurance through a separate new health benefit exchange and provide premium subsidies and cost-sharing reductions to eligible individuals SB 1005 will ensure that everyone in our communities has access to quality, affordable healthcare. Undocu-CARE-Van Fighting for health justice! Inspired by the Undocubus CAREvan traveled over 600 miles to create awareness and advocate for SB 1005 Made 5 regional stops: San Ysidro, Santa Ana, Los Angeles, Pomona, Fresno Final stop in Sacramento on April 30th In each stop there was a townhall, press event, or community talking circle Where are we now? Senate Health Committee Hearing on April 30th at 1:30pm Status: 5\/1\/14- Do Pass and re-refer to Appropriations Committee (6 Ayes-1 Noes) Next Hearing: Appropriations Committee Date: Monday, May 19th Challenge: Fiscal impact, funding sources Greater challenge: Not providing access to care to ALL Californians How can I support? What can I\/my organization do to support? Get involved! Work with advocates Join community actions, town halls, Attend the hearing Share your story Share information in social media #Health4All #SB1005 For More Information www.caimmigrant.org www.undocumentedanduninsured.org www.undocuhealth.blogspot.com For Additional Information: Betzabel Estudillo, Health Policy Coordinator, [email protected] Ronald Coleman, Government Affairs Manager, [email protected] 55 Contact The Speakers Kellen Russoniello, Staff Attorney Health and Drug Policy, ACLU of San Diego & Imperial Counties [email protected] Gabrielle Lessard, Health Policy Attorney, National Immigration Law Center [email protected] Betzabel Estudillo, Health Policy Coordinator, California Immigrant Policy Center [email protected] ers Svinerer tes Q NATIONAL IMMIGRATION ea NAG 4 has: : ' CALIFORNIA IMMIGRANT e@ POLICY CENTER NDER EMPLOYER ACOA HEA BASED ON, FEE FOR SERVICE Saif ge DERTEING RNMENT GUARANTEED Issue i TLINSURANCE EXCHANGE (aXe ra en NATION NAL HEAL ERTIFI IFETERIA PLAN DEI E FLEX PLAN Eee eet RX aeons X PLA PD Meai-Cat COVERED CALIFORNIA CK OBAHA Noy Uh ray co a Como tatey de ymigrantes en California \u2014\u2014 | < Won ROUT Tn 'e CALIFORNIA IMMIGRANT e@ POLICY CENTER SS CALIFORNIA IMMIGRANT e POLICY CENTER eal AN ea meV i ia sd CAR UNDOCU-CARE-WAN :m wealth 'e CALIFORNIA IMMIGRANT e@ POLICY CENTER Healthcare Reform and Immigration Status in California May 13, 2014 "

” CCWRO.ORG 1901 Alhambra Blvd., Sacramento, CA 95816-7012 Tel: 916-736-0616 Cell: 916-712-0071 Email: [email protected] ATTENTION : This powerpoint presentation is intended to be presented with an oral presentation to fill in the blanks left vacant. If you want a presentation, please contact CCWRO at 916-736-0616 or complete our training request form at: http:\/\/www.ccwro.org\/index.php?option=com_content&view=article&id=47&Itemid=55 To determine eligibility for programs. To make it hard for people to get benefits. How much is spent to verify? Outcomes of verification requirements – procedural ineligibility. Housing. Identify. Birth. Marriage. SSN. Check stubs, letter from employer, 100 hour rule. Checking Account. Car Registration Estimates. Alien Status. Pregnancy Verification. School attendance for school age kids. Immunization Records Religious Exclusion. Get a Receipt When Turning in Verification to the CWD. WIC 1023.5 WIC 11275.et.seq. MPP 40-105, 40-107, 40-115.22 & 40-157.2. MPP 40-126.et.seq ACIN -91-88 ACIN-09-01 IEVS. SAVE. UIB. MEDS. Be Nice To Applicants, Recipients MPP 40-101.12 It is the responsibility on all who are concerned with the administration of aid to do so with courtesy, consideration, and respect toward applicants and recipients and without attempting to elicit any unnecessary information. Administrative duties should be performed in such a manner as to secure for every applicant and recipient the amount of aid to which he or she is entitled under the law. Only ask for what folks have. Clients are not required to produce verification they do not have. MPP 40-105.1 Assuming Responsibility Within His\/Her Capabilities During the determination of initial and continuing eligibility, the applicant or recipient shall assume as much responsibility as he\/she can within his\/her physical, emotional, educational, or other limitations. Within his\/her capabilities, the applicant\/recipient is responsible for: .11 Completing or participating in the completion of all documents required in the application process or in the determination of continuing eligibility. .12 Making available to the county all documents that are in his\/her possession or available to him\/her which are needed to determine eligibility or ineligibility. .13 Reporting all facts known to him\/her which he\/she believes to be material to his\/her eligibility or which the county has identified to him\/her as affecting eligibility. Verification is a joint responsibility of client and county. CWD shall tell client what is needed and how it will be used. When client cannot get it, the county shall assist. MPP 40-157.213 MPP 40-157.210 The gathering of evidence necessary to make an eligibility determination of an applicant is a joint responsibility of the applicant and the county. .211 The county shall inform the applicant what evidence is desired, why it is needed and how it will be used. .212 The applicant shall cooperate with the county in the evidence gathering process to the fullest extent possible. .213 When it is not possible for the applicant to obtain necessary evidence, \ufffdthe county shall obtain it for him. No card Just Social Security Number 40-105.2 Social Security Number (SSN) .21 As a condition of eligibility, each AFDC-FG and U applicant or recipient member of the AU shall: .211 Furnish his\/her Social Security Account Number (SSN) or numbers, if more than one, within 30 days following the date of the application for assistance; or MPP 40-105.4(f) Exemptions. The immunization requirement does not apply if the parent(s)\/caretaker relative submits: (1) An affidavit stating that the immunization requirement is contrary to his\/her personal\/religious beliefs and the reasons for his\/her objection. If the applicant\/recipient cannot get the requested verification the county shall help the client: (a) Assisting the Applicant The county is responsible for assisting applicants or recipients in understanding their rights and responsibilities in relation to application for aid; for evaluating the capacity of the applicants or recipients to discharge their responsibilities as set forth in MPP 105; for assisting them as needed in establishing their eligibility and helping them to realize the maximum personal independence of which they are capable, including self-care and self-maintenance. Sworn statement Except for proof of pregnancy & Alien status MPP 40-115.22 Acceptable evidence must be obtained concerning the linking and nonlinking factors of eligibility. (See each Eligibility Chapter for what is acceptable evidence.) When such evidence does not exist, the applicant’s sworn statement under penalty of perjury will be considered sufficient, except in the areas of verification of U.S. citizenship or alienage status and\/or medical verification or pregnancy. See Section 42-433 for verification of citizenship or eligible alien status and 80-300(m)(2) for verification of pregnancy. Past eligibility that is relevant to determining current eligibility. Current Eligibility. MPP 40-126.31 The county shall require only evidence necessary to determine past or present eligibility for the amount or delivery of aid. Within 10 days CWD shall provide applicant with a written notice of required verification. The notice must include examples of alternative evidence. MPP 40-126-32 Within ten calendar days of application, the county shall provide written notice to the applicant of the required evidence and examples of alternative evidence, if any, to determine eligibility. CWD shall assist applicant\/recipient to get verification. Client shall make a Good Faith Effort to get written requested verification. If the client cannot, county shall. Also see MPP 40-107. MPP 40-126.331 – The county shall assist the applicant in obtaining evidence of eligibility from a third party when the county has determined that the applicant has made a good faith effort to obtain the evidence and the third party fails or refuses to provide the evidence. CWD shall pay for third party fees if the county is going to get the verification. CWD shall provide Notice that they will pay for the third-party fees. MPP 40-126.332 – If necessary, the county shall pay a third party fee to obtain existing evidence of eligibility on behalf of the applicant. MPP 40-126.333 – The county shall notify the applicant, in writing, of the requirements of MPP 40-126.33 at the time that such evidence is requested. County forms for verification illegal. Client primary source of verification. Confidentiality Violation. CWD has to document in case file client’s alleged failure to make a good faith effort. CWD rarely does this. Best defense in an application denial due to alleged failure to provide verification case. MPP 40-126. 334 – The county shall document an applicant’s failure to a good faith effort in obtaining necessary evidence of eligibility in the case file. After the application is denied applicant has 30 more days to get the verification in. Once the verification is received, the county shall continue to process the application. COUNTY ILLEGAL PRACTICE Telling applicants they must reapply. MPP 40-126-324 The county shall rescind a denial and grant aid if the applicant is otherwise eligible based on the original application when: (a) The denial is based solely on the applicant’s failure to cooperate in providing evidence of eligibility; and (b) The county receives the needed evidence within 30 calendar days of the date of denial. NOA shall say that the applicant has 30 days to submit the verification. Notice must specify what verification is requested. Most NOA’s are failure to provide requested verification . MPP 40-126.343 When the county denies an application based on failure to cooperate in providing needed evidence of eligibility, the notice of action must advise the applicant of his\/her rights to submit evidence within 30 calendar days of the date of denial for the denial to be rescinded. When the application is filed within a 1 year of prior termination of benefits, CWD shall retrieve the prior case file. CWD can only ask for verification that is not in the old case file such as Social Security Card, Birth Certificates, Marriage Certificate, Alien Status Verification. CWD shall notify the applicant in writing of the rules for getting verification from the old file. Rarely are applicants given notice of this requirement. MPP 40-126.37 – At the time an applicant (described in MPP 40-125.93 and 40-126.35) applies for aid, the county shall inform the applicant in writing of the requirements of MPP 40-125.93, 40-126.35, and 40-126.36. 7 U.S.C. 2020(e)(3) 7 C.F.R. 273.2(f) MPP 63-300.5 Income. Alien Status. Identify; third party verification acceptable sponsor forms. Assets; i.e. checking account, vehicle, etc. Give county the SS number or apply for one. SS number does not mean a Social Security Card. CWD can check the SSN in their computers. Residence Address or mailing address is not a requirement for FS or CW. MPP 63-401.5 Utility. No verification required for SUA. CWD has to have a countywide policy to verify an optional item; or Only when the information is questionable MPP 63-3005(g) To be considered questionable, the information on the application must be inconsistent with statements made by the applicant, inconsistent with other information on the application or previous applications, or inconsistent with information received by the county welfare department. When determining if information is questionable, the county welfare department shall base the decision on the household’s individual circumstances. Liquid Resources and Loans. Household Size. Shelter Costs. Household (HH) Composition. Citizenship. Another county LIE. NOTE: MPP 42-400. Residence in the state, but not in the county, is a requirement for receipt of aid. However, it is necessary to determine the county in which the applicant lives in order to establish county responsibility for payment of aid. (See MMP 40-125.) The form provides: 1. Due Date. 2. Item needed to verify. 3. Who is the verification for?, i.e. Birth certificate for Mary? 4. What program is the verification for? 5. Check if you can’t get proof and need help. 6. Check if you already turned the verification in. 7. If you can’t get the verification, there is a release form so the county can get it. 8. The form is not mandatory. Only when eligibility is questionable. Immediate Need apparent eligibility cannot be determined without a home visit. HOME VISIT. MPP 40-161. A home visit prior to approval of aid and prior to completion of periodic redetermination of eligibility pursuant to MPP 40-181.1 is required when living arrangements or other factors affecting eligibility, or apparent eligibility in cases of immediate need or diversion, cannot be satisfactorily determined without such a visit. However, the recipient’s failure to comply with the provisions of MPP 40-181.22 will result in the termination of the recipient’s grant without the requirement of a home visit. Home visit can be done, always scheduled in advance. When interview is waived. When recertification is more than annual. To get documentation not provided, the county can do collateral contact or home visit. Home visits may be used as verification when documentary evidence is insufficient to make a determination of eligibility. Bad Case Law Expensive Sanchez v. County of San Diego (9th Cir. 2006) 464 F.3d 916 Smith v. Los Angeles County Board of Supervisors (2002) 104 Cal.App.4th 1104 Give the applicant a list of items needed. Tell them to get it in within 10 days. Deny application if the county does not get the verification. Force applicants to reapply when denied due to no verification. Not giving applicants a form requesting verification that meets the statutory and regulatory requirements. Not telling applicants\/recipients in writing what is needed. MPP 40-126.32 Not telling applicants\/recipients in writing why it is needed. MPP 40-126.32 Not telling applicants\/recipients in writing what items will satisfy the CWD request. MPP 40-126.32 Not telling applicants\/recipients in writing what alternative documentation may be acceptable. MPP 40-126.32 Not telling applicants\/recipients in writing that the county will help him or her get the needed verification. MPP 40-126.331 Not telling applicants\/recipients in writing that the C W will pay for third-party verification. MPP 40-126.333 Not telling applicants\/recipients that an adequate NOA states exactly what was not provided and that if it is submitted within 30 days, the application will be processed. MPP 40-126.333 Forcing clients to use county forms to verify information. ACIN 91-88 Not giving applicant\/recipients an adequate NOA. 40-126.343 \ufffdNot telling applicants\/recipients in writing what is needed. 40-126.32 \ufffdNot telling applicants\/recipients in writing why it is needed. 40-126.32 \ufffdNot telling applicants\/recipients in writing what items will satisfy the CWD request. 40-126.32 \ufffdNot telling applicants\/recipients in writing what alternative documentation may be acceptable. 40-126.32 \ufffdNot telling applicants\/recipients that the county will help him or her get the needed verification. 40-126.331 \ufffdNot telling applicants\/recipients in writing that the CWD will pay for third-party verification. 40-126.333 \ufffdNot telling applicants\/recipients that an adequate NOA states exactly what was not provided and that if it is submitted within 30 days, the application will be processed. 40-126.343 \ufffdForcing clients to use county forms to verify information. ACIN 91-88 \ufffdNot giving applicant\/recipients an adequate NOA about 30 days to submit verification. 40-126.343 Collect cases terminated for not providing verification. Access the validity of the termination. > WELFARE VERIFICATION Why Verification? A CalWORKs Case Verification List A CalWORKs Case Verification Laws & Regulations Other Means of Verification MPP 40-101.12 MPP 40-105.12 Methods of Gathering Evidence MPP 40-157.2 Social Security Card Immunization Religious Exception MPP 40-107-CWD Helping Clients Affidavit if Verification Not Available MPP 40-115.22 What Type of Verification Can The CWD Ask For? MPP 40.1 26.31 Written Notice of Verification MPP 40-126.32 Assist the Applicant to Get Verification – MPP 40-126.331 Third-Party Fees – MPP 40-126.332 Third-Party Verification\u2014ACIN 91-88 Document in Case File of Client’s Failure to Make a Good Effort 30 Days to Get Verification in After Application Denial Notice of Action Contents Retrieve File for Verification Notice Requirement for Looking at Old Case File Food Stamp Verification FS – What Has To Be Verified? FS – Optional Verification Optional Verification Items You Have To Have An Address. True or False? ACL-09-01 Home Visit for CalWORKs Home Visit for Food Stamps Home Visit Court Cases Current Practice List of Law Violations More Violations And More Violations Violation Checklist ACTION ”

” CCWRO.ORG 1901 Alhambra Blvd., Sacramento, CA 95816-7012 Tel: 916-736-0616 Cell: 916-712-0071 Email: [email protected] ATTENTION : This powerpoint presentation is intended to be presented with an oral presentation to fill in the blanks left vacant. If you want a presentation, please contact CCWRO at 916-736-0616 or complete our training request form at: http:\/\/www.ccwro.org\/index.php?option=com_content&view=article&id=47&Itemid=55 California Welfare and Institutions Code 18937 et.seq. – http:\/\/www.leginfo.ca.gov\/calaw.html DSS Regulations Division 49 http:\/\/www.dss.cahwnet.gov\/ord\/entres\/getinfo\/pdf\/16EAS.pdf CAPI ACLs and ACINs – http:\/\/www.dss.cahwnet.gov\/lettersnotices\/default.htm SSI laws, regulations and POMS https:\/\/s044a90.ssa.gov\/apps10\/ Policy Interpretations CAPI forms CAPI provides cash assistance to immigrants who are either aged, blind or disabled and not eligible for SSI due to their immigration status. To be eligible for the Cash Assistance Program for Immigrants you must: Be at least 65 years old, OR Meet Social Security’s definition of disability or blindness Be a qualified alien or PRUCOL Live in California Have income and resources below SSI limits Show proof that they have applied and been denied SSI Same as SSI Can’t work for more than 12 months anywhere in the USA You can apply at the local welfare office Which office in the county? County Consortia $2,000 single\/$3,000 for couple liquid resources One car is exempt The house you’re living in is exempt CAPI is paid from the first of the month, following the month of application Disabled CAPI benefits can take months or years to receive just like SSI Meanwhile get GA\/GR and Food Stamps No. You cannot get CAPI and SSI. CAPI is only for people not receiving SSI Yes. If you are eligible for CAPI, you are eligible for Medi-Cal. Yes. Unlike SSI, you can get food stamps when you get CAPI. CAPI benefits count income for the food stamp household Yes. To stay enrolled in CAPI, you will need to continue to meet the income, asset and residency requirements. CAPI is redetermined every 12 months. $10 a month less that SSI for single persons and $20 for couples. When the sponsor dies Becomes disabled The CAPI applicant\/recipient is being abused by the sponsor Can meet the requirements for indigence exception for those with a I-864 Applicant\/recipient becomes disabled after entering the USA The indigence exception is available to persons who were sponsored with an I-864. It is not available to persons sponsored with a I-134 The indigence exception form is the SOC 809 To be eligible the sponsored alien cannot be living with their sponsor and not able to meet their needs for food and shelter with the support they get from their sponsor No. CAPI recipients receive welfare hearings and Aid Paid Pending just like welfare hearings Fair Hearings like welfare hearings W&IC 10950 et.seq EAS Division 22 Overpayment rules are just like SSI. There is a overpayments waiver form SOC 807 & 807A To download the form go to: http:\/\/www.dss.cahwnet.gov\/cdssweb\/PG168.htm#soc End Any questions contact CCWRO for assistance Overview of CAPI 2011 CAPI Legal Resources More CAPI Resources What is the Cash Assistance Program for Immigrants (CAPI)? Who ts eligible for CAPI? What are the disability eligibility requirements to receive CAPI? How to Apply for CAPI What are the Resource Limits ? How soon can! be eligible for benefits from CAPI? Can I qualify for CAPI while lam eligible for the Supplemental Security Income (SSI) program? Can I get Medi-Cal with CAPI? Can I get Food Stamps with CAPI? Does CAPI have annual redeterminations? What is the difference between CAPI and the Supplemental Security Income (SSI) program? When will my sponsor and sponsor’s spouse’s income and resources not be considered when determining my eligibility for CAPI? How about Indingence Exception? Do CAPI Recipients have to tile for reconsideration then an appeal? What are the Overpayr Rules for CAPI ”

” ATTENTION : This Power Point presentation is intended to be presented with an oral presentation to fill in the blanks left vacant. If you want a presentation, please contact CCWRO at 916-736-0616\/916-712-0071 or complete our training request form at: http:\/\/www.ccwro.org\/index.php?option=com_content&view=article&id=47&Itemid=55 Over income Over resources (CalWORKs no longer for Food Stamps) Changes in household composition Allegation that children not in home Man in the house Child support direct payments CalWORKs 44-350 Overpayments — Causes IEVS New hire registry Bank records Quarterly reports Reassessments EDD reports Credit Reporting Tax Intercept Grant Adjustment Court on Civil Judgment Voluntary Cash Recovery CalWORKs Collection Methods Adults in Assistance Unit Children only after turn 18 if overpayment hasn’t been paid County incorrectly budgeted income County did not consider resources County failed to removed members of the AU CalWORKs Administrative Errors Property overpayments good faith v. non-good faith Good faith overpayment is the lesser of asset value or the OP amount Equitable Estoppel Administrative error v. fraud Latches Incorrect budgeting (QR 7 reporting mistakes) Worker can refer cases to Fraud Unit on hunch Cases are referred to Fraud Do not talk to the fraud investigators or anyone at the county welfare department about overpayment Paying it back will not stop fraud prosecution Stopping benefits will not stop fraud prosecution Be careful at hearing, self incrimination v. collateral estoppel The burden of proof is on the DA CalWORKs Fraud 3 type of overissuances Administrative error Inadvertent Household Error Intentional Program Violation County Errors – 36 months to recoup No recoupment any month under $35 Food Stamps allotment Maximum collected for county errors is 5% Food Stamps collected from recipients current benefits at 10% each month. 7 CFR 273.18(f)(1),(g)(1)(iiii) and MPP 63-801.736(a) Can be requested to enter an agreement to collect more Fraud Cases Separate hearing procedures Be very careful Offsetting underissuances to collect overissuances Tax intercepts for Franchise Tax Board, Lottery Winnings, IRS returns Three year statute of limitations No intercepts are allowed if: The current food stamp allotment is being adjusted The time to ask for a hearing has not expired There is a hearing request and no final decision Regular restitution is being paid Food Stamp Overissuance Collection Methods Before a tax intercept the county has to: Issue a Notice of Action (NOA) about the referral to intercept The amount of the overpayment The right to contest the referral for an Intercept The name, address and phone number of the county’s contact to contest the intercept The right to an administrative review at anytime Possible reasons to disagree with the proposed action Pre-Intercept Rights Always ask for a hearing Analyze case prior to hearing to determine self incrimination If the county does not have a case file, then they should lose the hearing because you need the case file to prove their case Ongoing issues about access to SIU file The burden of proof is on the county Look for underpayments, such as sanctions, transportation for working persons, failure to pay mileage. How to Fight Overpayments County can use own agency or contract with a third party Make sure underlying overpayment\/overissuance exists Make sure notices were issued Challenge county to prove its case CalWORKs and Food Stamp Overpayments Kevin Aslanian Coalition of California Welfare Rights Organizations, Inc. 1901 Alhambra Blvd. Sacramento, CA 95 Tel. 916-736-0616 Fax 916-736-264: 916-712-0071 [email protected] = ccwro.Oorg 7 Overpayments – Discovery CalWORKs – Responsible Party for Overpayment CalWORKs Excess Property Overpayments CalWORKs Overpayment Defenses Food Stamp(also known as CalFresh) Overissuances Food Stamps Inadvertent Household Error Food Stamp Intentional Program Violation Note on Collection Agency Actions ”

” CCWRO.ORG 1901 Alhambra Blvd., Sacramento, CA 95816-7012 Tel: 916-736-0616 Cell: 916-712-0071 Email: [email protected] ATTENTION : This PowerPoint presentation is intended to be presented with an oral presentation to fill in the blanks left vacant. If you want a presentation, please contact CCWRO at 916-736-0616 or complete our training request form at: http:\/\/www.ccwro.org\/index.php?option=com_content&view=article&id=47&Itemid=55 Goldberg v. Kelly 397 U.S., 254 Yee-Litt v. Richardson 353 F.Supp. 996 Morales v. McMahon 223 Cal.App.3d, 184 Federal State John Wagner Robert Garcia Manuel Romero County Appeals Unit County Appeals Supervisor County Appeals Representatives When to ask for a State Hearing (SH) Who can ask for a SH Timelines for asking for a SH Timelines for asking when APP applies What issues are covered in SH What issued are not covered- ADA, worker treatment, etc. Fax the request to 916-229-4110 or 916-229-4143 The County action is wrong Yee-Litt v. Richardson Blankenship v. Saenz http:\/\/www.ccwro.org\/index.php?option=com_docman&Itemid=172 Filing a request before the effective date of the NOA APP is due within five (5) working days MPP 22-073.1 APP Appeals to DSS History What does the Position Statement include: Facts The law Documents Available 2 working days before the hearing (Welfare and Institutions Code 10952.5) Case file available prior and during SH MPP 22-051.1 No case file, claimant should prevail Know your case Talk to the CWD before the hearing, get all the information you can County Appeals Worker can resolve the case You can always lose an easy case with a bad ALJ Use stipulated decisions Get maximum information Ask about past hearing Explore potential for underpayment to off set overpayments Review the case file Sometimes the CWD resolves the case What is an adequate NOA MPP 22-071 Language issues Must be in the claimants primary language See MPP 22-001.(l)(1) Notice at Issue 22-0494.52 Great Resource for what is an adequate NOA – ACIN-151-82 Burden of proof is on the county-MPP 22-073.36 Burden of proof is on claimant who is an applicant or is seeking approval of benefits, e.g. child care, transportation Hearsay can only be used to support direct evidence Always object to hearsay evidence See 1100-9 http:\/\/www.dss.cahwnet.gov\/shd\/res\/htm\/ParaRegs-Legal-Principles-Legal-Principles.htm Make a written request after you get the date of the hearing If CWD presents new evidence at the hearing you can ask for a Subpoena and Subpoena duces tecum MPP 22-051.4 DSS will pay for mileage if the witness was served with subpoena MPP 22-052.1 Hearing is tape recorded ALJ explains the hearing process CWD and claimant and witnesses take the oath Who can come to the hearing County goes first Claimant can cross examine the county Claimant presents case CWD can cross examine the claimant Leaving the record open Position Statement should contain: Issue of the hearing Background facts Argument with legal citations Attachments in support of position State provides interpreters You must identify the language when asking for the hearing ALJ is suppose to examine the interpreter For APP purposes To win the hearing e.g., sanctioned for not going to good cause determination appointment Adequacy of NOA First postponement requires no verification Second time must have doctor verification Position Statement not available timely Time Waivers – King and Ball Call 1-800-743-8525 Fax a request to 916-229-4110 or 916-229-4143 You can reopen the case if the county has fails to comply Never withdraw the case MPP 22-054.211(b)(3) If the claimant does not appear at the hearing but asks to reopen the hearing with good cause within 10 days, then APP will be restored A rehearing is routinely granted for hearing dismissed. The ALJ must disqualify themselves It Rarely happens Food Stamp issues-60 days All other issues-90 days Statement of facts Statutes and regulations Reasons for the decision You can request a copy of the hearing tapes – It is free If you file for judicial review you must request a transcript AB 921- Chapter 502 statutes of 2007 http:\/\/www.leginfo.ca.gov\/cgi-bin\/postquery?bill_number=ab_921&sess=CUR&house=B&author=krekorian 30 days to ask for a rehearing Generally counties get rehearing and claimants do not except for no shows. History Who may ask for an ESH using a CCWRO ESH form http:\/\/www.ccwro.org\/index.php?option=com_docman&task=doc_download&gid=454&Itemid=173 How to ask for the hearing What issues are covered by ESH Hearing to be held within 5 days Decision in 10 days http:\/\/www.ccwro.org\/index.php?option=com_docman&Itemid=173 CCP 1094.5 Welf. & Inst. Code 10960 Consultation and Assistance with Hearings Consultation and Assistance with Administrative Writs End State Welfare Hearings State Hearings Authorities Laws & Regulations State Actors County Actors Asking For a State Hearing Reasons For Requesting a SH How to File for a SH What to Put on the Request Aid Paid Pending Cases Aid Paid Pending County Position Statement Case File Availability Negotiating with the CWD Interview the Client and Spotting Issues Adequate NOA Burden of Proof Hearsay Evidence Subpoena & Subpoena Duces Tecum Witness Mileage What Happens At the Hearing Authorized Representative Position Statement Interpreters Framing the Issue Postponements & Continuances How to Get a Postponement Conditional Withdrawals No Shows Disqualification of an ALJ Hearing Decision timelines Hearing Decision Hearing Record Rehearing Expedited Hearings Judicial Review CCWRO Assistance Available ”

” CalWORKs Application Process CCWRO.ORG 1901 Alhambra Blvd., Sacramento, CA 95816-7012 Tel: 916-736-0616 Cell: 916-712-0071 Email: [email protected] ATTENTION : This powerpoint presentation is intended to be presented with an oral presentation to fill in the blanks left vacant. If you want a presentation, please contact CCWRO at 916-736-0616 or complete our training request form at: http:\/\/www.ccwro.org\/index.php?option=com_content&view=article&id=47&Itemid=55 Rights to Apply MPP 40-109 Any person has the right to apply. It is unlawful to refuse an application. Who May Apply? MPP 40-117 Mom, dad, relatives. The authorized representative. Where to Apply By zip code. For Food Stamps, any office. Interview at assigned office. What is an Application? An application is the SAWS-1. Complete the SAWS-1. Ask for Immediate Need. What Else Is Handed to the Applicant In Los Angeles 5 page Home Interview Waiver papers. PA 2020 – Pre-Interview Worksheet. SAWS-2. SAWS-2A. CW2.1. Child Support Agreement. PA 1920 New Child Support Rules. More Paper PA 129.1- Child Care Payment Requirements. GN 6140 Screening for Substance Abuse & Mental Health. QR-7A How to Complete a QR7. FS8- Food Stamp Verification Information. PA651 Citizenship & Alien Status. PA 161 FS Work Requirement AFDC. More Paper Important Notice for Immigrants about public charge . Good Information CW 61- Medical Release. Notice of 2 800-numbers. Information about the NET program- a dead program. Vaccination fact sheet. PA 1650 Another Immunization Notice. More Paper PA 129. GAIN 53 PA 481- Language Designation Form. PA 481-A Interpreter Service Statement. Temp 2173 – SFIS Notice. PA 2457 Civil Rights Information Notice. Diversion Program Information. PA 1953 CAlWORKs Time Limits Notice More Paper CalLearn Eligibility Criteria. PA 392-3 – Medi-Cal Information Notice PA 6010 About Child Support. CW 2102LA MFG Notice. PA 1914 DV Referral Sheet. PA 1913 DV Confirmation Information CalLearn Referral Form. PA 860 Notice to give warrant to cashier. More Paper Cal-1- Pamphlet and MH & SA. How to get documents. Community resources referral. PA 160 SFIS Notice. CalLearn Program Information. Temp 2232 12 month rental subsidy for CalWORKs families. More Paper TEMP 2215 EBT Information. PA 1680 How to get money for transportation. PA 90 – How to settle a question, concern or complaint. PA 440 Housing relocation program fact sheet. PA 4028 Money to help you move. More Paper PA 4027 Emergency money to prevent eviction. Medi-Cal citizenship\/immigrant information. CHDP Pamphlet. PUB 13. EBT 25. PA 175 Child Support Guide. PA 83- Your Bill of rights & responsibilities What’s Missing? The SAWS-1. If the county completes the SAWS-1 and then has the client sign it. UNLAWFUL ! Case Opening Clerk completes the SAWS-1 in LA. MPP 40-129.33 The county shall not complete the Immediate Need section of the application or the Immediate Need Payment Request (CA 4, 9\/90), except at the applicant’s specific request. WRL. v. Woods consent decree available from CCWRO. Verification for CalWORKs Application APPLICANT AND RECIPIENT RESPONSIBILITY MPP 40-105 .1 Assuming Responsibility Within His\/Her Capabilities During the determination of initial and continuing eligibility, the applicant or recipient shall assume as much responsibility as he\/she can within his\/her physical, emotional, educational, or other limitations. Within his\/her capabilities, the applicant\/recipient is responsible for What Verification Is Needed Birth certificates for AU members Medi-Cal. Rent verification. Utility verification. What Verification Is Needed-More School attendance for children. Immunization, unless they don’t believe in it or for religious reasons. Car registration estimates. SSN numbers-not cards. What Verification Is Needed- More Income verification. UIB\/DIB verification. Alien status verification. Pregnancy verification. Bank statement. County Required to Give Notice of Needed Verification MPP 40-126.32 the county shall provide written notice to the applicant of the required evidence and examples of alternative evidence, if any, to determine eligibility. County Shall Help The Applicant MPP 40-126.331 The county shall assist the applicant in obtaining evidence of eligibility from a third party when the county has determined that the applicant has made a good faith effort to obtain the evidence and the third party fails or refuses to provide the evidence. County shall pay third party fees MPP 40-126.332 If necessary, the county shall pay a third party fee to obtain existing evidence of eligibility on behalf of the applicant. Documents Previously Submitted County cannot ask for documentation already in their possession if the applicant was on aid in the past year and the documentation is not readily available to the applicant. MPP 640-126.35 What if there is no verification? MPP 40-115.22 The applicant will be given a Statement of Facts (SAWS 2) to complete and sign under penalty of perjury except for alien status or pregnancy verification. 100 Hour Rule for Two-Parent Applicants Applicants have to show that they are working less than 100 hours a month during the month of application and the next month. Treatment of Earned Income for Applicants Gross income minus $90 cannot exceed the MBSAC of the Assistance Unit to be eligible for CalWORKs. Region 1 Alameda,Contra Costa, Los Angeles, Marin, Monterey, Napa, Orange, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Solano, Sonoma, Ventura Region 2 All other counties 1- $548 6- $1,696 1- $520 6- $1,614 2- $899 7- $1,864 2- $854 7- $1,770 3-$1,114 8- $2.030 3-$1,058 8- $1,932 4-$1,322 9- $2,202 4-$1,258 9- $2,088 5-$1,509 10- $2,390 5-$1,435 10- $2,273 Transfer of Property Transfer of property rules do not apply to applicants, only to recipients. Application is Approved CalWORKs 45 days MPP 40-101.11 – Assistance is to be administered promptly and humanely, with due regard to the preservation of family life and without discrimination. MPP 40-126.1 – The determination of eligibility, including the gathering of any necessary evidence, shall be completed promptly. The End Questions? ”

” ATTENTION : This PowerPoint presentation is intended to be presented with an oral presentation to fill in the blanks left vacant. If you want a presentation, please contact CCWRO at 916-736-0616 or complete our training request form at: http:\/\/www.ccwro.org\/index.php?option=com_content&view=article&id=47&Itemid=55 * Garbage in Garbage Out Programmers have to understand welfare regulations in order to program the computer system Most of the programmers understanding ccame from counties County interpretations of the regulations are not always correct * LEADER in Los Angeles LEADER II coming soon CalWIN Alameda, Contra Costa, Fresno, Orange, Placer, Sacramento, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Solano, Sonoma, Tulare, Ventura & Yolo (17 counties) C-IV- All remaining 40 counties * 2.5 million cases 43% of the State’s caseload CalWIN was fully functional in December 2007 Ross Perot Electronic Data Systems (EDS) and Deloite Consulting Colorado Welfare Computer System LEADER in Los Angeles 1st County Placer County January 2005 2nd County Sacramento March 2005 Thereafter 1 county each month * Workers introduced to CalWIN knew the welfare regulations Workers knew that the applicant\/recipient was entitled to benefits, the amount of benefits and when the benefits should be issued Worker did not understand CalWIN To get the computer to issue benefits, workers had to input information to get CalWIN to issue proper benefits * CalWIN is programmed to reevaluate information automatically going back several years Recipients and applicants have been receiving notices of overpayments due to the false information submitted to the computer Periodically new releases modifying the computer programming are issued to comply with new legal requirements and procedural improvements Each new release can cause new problems When Advocates identify a new pattern of client problems they must evaluate to see if it is CalWIN caused Advocacy activities are important in resolving CalWIN problems CalWORKs based system Different rules for different programs within CalWIN Sometimes CalWIN applies CalWORKs requirements to Food Stamps and Medi-Cal Acts on each individual reported change NOA language problems Not allowing the computer to be a computer * Many good workers retired as a result of CalWIN Post CalWIN workers, training consists of mostly CalWIN trainings and little training on regulations Workers defer to CalWINs determinations and don’t independently determine eligibility Bad NOA Violates Turner v. Anderson that standardized NOAs- ACL 86-57 Applicant not allowed to complete SAWS-1 Paperless – Impact on Due Process Not getting benefits on time Delay in application CalWIN overrides manual instructions School attendance-immunizations * Infringes on Recipients’ Right to Privacy CalWIN tracks EBT usage Use of EBT card outside of county may trigger termination for whereabouts unknown CalWIN does not track recipient entitlement to WtW transportation CalWIN miscalculates CalWORKs 0-month time limit General CalWIN problems (con’t) General CalWIN problems (con’t) CalWIN is administered by WCDS WCDS Consortia consists of representative of 18 CWD that use CalWIN It is governed by: WCDS Board of Directors By-Laws WCDS Policy Board By-Laws WCDS Integration Oversight Committee By-Laws WCDS Information Technology Agreement for the CalWORKs Information Network WCDS Manual CSAC Agreement Meetings with local CWD Meetings with DSS Demand letter meetings Who is in charge? The State? The County? The Consortia? Change request derive from state, federal or county mandated policy or regulations, changes in county business practice needs, or technology changes WCDS consortia operates and administers CalWIN The consortium issues instructions for the issuance, continuance and termination of public assistance benefits Change request are presented to the Change Control Board (CCB) without DSS involvement CCB prioritizes requires changes to CalWIN. Lower rated changes may not occur for years DSS has no role in determining what gets priority Non-System Determined Issuance What is it used Why is it used * Contact the help desk Submit a trouble ticket * Meetings with DSS Demand Letter meetings Meeting with CWD * YY CCWRO 1901 Alhambra Blvd. Sacramento, CA 95816-7012 Tel. : (916) 736-061 6Fax: (916) 736-2645Cell: (916) 712-0071le email: [email protected] ccwro.org Overview of CalWIN Why Do Advocates Need to Know About Computer Systems California’s Welfare Computer Systems CalWIN Consortium CalWIN History CalWIN Start Why is This History Important? CalWIN Releases What is wrong with CalWIN? Workers’ Level of Competence General CalWIN problems CalWIN Bureaucracy (con’t) Advocacy Activities CalWIN Bureaucracy Who Controls Changes in CalWIN? Who Controls Changes in CalWIN? (con’t) What does CalWIN do when there is a problem Advocacy Activities ”

” Medi-Cal Evidence of Citizenship Kevin M. Aslanian, Executive Director CCWRO COALITION OF CALIFORNIA WELFARE RIGHTS ORGANIZATIONS 1901 ALHAMBRA BLVD. SACRAMENTO, VA 95816-7012 TEL.: (916) 736-0616 CELL: (916) 712-0071 Federal Authorities Deficit Reduction Act of 2005 42 USC 1396b(I)(22) & 1396b(x) 42 CFR 435.407 Federal Register 7\/12\/06, page 39214 State Laws & Rules AB 1807, Statutes of 2006, Ch. 74 W&IC 14100.2; 14011.2 & 14043.46 DHS ACL 07-12, June 4, 2007 http:\/\/www.dhs.ca.gov\/mcs\/mcpd\/MEB\/ACLs\/Index\/2007ACWDLs\/10thru19.htm Before DRA Certify citizenship No verification required Coming Soon- Now Many born in the USA have to provide proof. Federal law – Effective 7\/1\/06. DHS recently issued the ACL 6\/4\/07. Most counties are gearing up. LEADER, CalWIN, C-4 has to be programmed – millions need to be spent. What About Immigrants? Good News Equal Treatment. Immigrants already have to verify alien status. No new documentation needed- stay the course. Who Does Not Have To Verify Immigrants. SSI recipients. SSA recipients. Deemed eligible infants born to a U.S. Citizen. Foster care. Adoption Assistance \/ KinGAP recipients. Who Does Not Have To Verify Presumptive Eligibility for 1. Pregnant Women. 2. Breast & Cervical Cancer Treatment. 3. Healthy Families Medi-Cal Applicants Applicants have to prove citizenship. Applicants who provide verification will receive full-scope Medi-Cal. Applicants who refuse to provide verification are ENTITLED to restricted Medi-Cal benefits. How Often To Verify? This is a one-time activity. CWD’s shall check CA birth records. Once verified, it is in MEDS – which is not LEADER, CalWIN or C-4. What Do Counties Have To Do? Provide all applicants with a DHCS 0001. Provide all applicants with a DHCS 0002. Provide these forms in all MC 210 RV packets. Acceptable Verification Tier 1 – Passport or Naturalization certification. Tier 2 – Birth certificate. Tier 3 – Hospital record or life \/ health insurance record. Tier 4 – Statement signed by doctor\/ midwife. Written affidavit of person having personal knowledge of the birth. Opportunity to Provide What is reasonable opportunity to provide ? Case by case time frame determination. If refusing to get verification, then eligible for restricted benefits. County Assistance CWD’s required to assist. CWD not required to pay for documents. Tell clients how to get the information. CWD required to look into MEDS to see if the county has the verification after the applicant fails to provide. ADVOCACY CHALLENGE: CWD shall check the MEDS screen for all applicants before asking applicants to get the information that the county already has. Redetermination SB 87 still stands. Benefits continue so long as recipient is making a good effort . CWD required to check MEDS if the recipient dos not have the verification. What Does CWD Have To Do? If recipient ( R ) born in CA, do the MEDS inquiry. If former R , review welfare case files for verification. If received welfare in other county, contact other county. Telephone R , ask for verification. What Does CWD Have To Do? If R does not respond to TC, mail a DHCS 0006. If R does not respond, CWD has to do another TC to R . All this has to be documented in the case file by the welfare worker. If no verification and no good effort – CWD mails a 10-day NOA stopping Medi-Cal. Outreach to Medi-Cal R CDHS will be mailing R a form explaining the change and what is needed. Document Establishing Identity Persons who do not have Tier 1 have to have tier 2 through 5 and verify identity. Driver’s License. U.S. military I.D. Tribal documents with a picture. School I.D. card with a picture. Affidavit of parent\/guardian for children under 16. ”

” CCWRO.ORG 1901 Alhambra Blvd., Sacramento, CA 95816-7012 Tel: 916-736-0616 Cell: 916-712-0071 Email: [email protected] ATTENTION : This powerpoint presentation is intended to be presented with an oral presentation to fill in the blanks left vacant. If you want a presentation, please contact CCWRO at 916-736-0616 or complete our training request form at: http:\/\/www.ccwro.org\/index.php?option=com_content&view=article&id=47&Itemid=55 State Department of Social Services John Wagner, Director. Telephone: 916-657-2598 Eva Lopez, Deputy Director, Adult Services. Telephone: 916-653-5403 Welfare & Institutions Code 12300-12317.2 14132.951 IHSS Plus Waiver 14132.95 IHSS Personal Care Services Program (PCSP) MPP 31-700 et.seq.- IHSS State Regulations MPP 30-009.22 Application for IHSS MPP 30-009.23 Eligibility Determination How to access state regulations? http:\/\/www.dss.cahwnet.gov\/ord\/PG310.htm All County Letter http:\/\/www.dss.cahwnet.gov\/lettersnotices\/PG931.htm All County Information Notices- http:\/\/www.dss.cahwnet.gov\/lettersnotices\/PG1011.htm Policy Interpretation California Public Records Act County Welfare Director Deputy Director for IHSS Program Specialist State Hearings Representative Social Worker Supervisor Social Worker Counties are given a certain amount to spend every year. This drives the mentality of cutting benefits to the poor by SW who were trained to help people, but are now the slashers of benefits. IHSS Residual PSPC Medi-Cal IHSS-Plus Medi-Cal Domestic Services Related Services Non-Medical Personal Services Protective Supervision Paramedical Services Domestic Services in house cleaning. Related Services are: 1. Meal Preparation 3.02 to 7.00, MPP 30-757.131. 2. 1.17 to 3.50, MPP 30-757.132. Meal cleanup does not include general cleaning of the refrigerator, stove, oven, counters, or sink which is covered under domestic services. 3. Laundry. 4. Other Shopping Errands. 5. Medical Appointment. Bowel, Bladder Care -.58 to 8.00, MPP 30-757.14(a) Feeding – .70 to 9.33, MPP 30-757.14(c) Routine Bed Baths-.50 to 3.50, MPP 30-757.14(d) Dressing – .56 to 3.50, MPP 30-757.14(f) Menstrual Care-.28 to .80, MPP 30-757.14(j) Ambulation-.58 to 3.50, MPP.30-757.14(k) Bathe, Oral Hygiene, Grooming-.50 to 5.10, MPP 30-757.14(e) Rub Skin, Massage, Assistance with Prosthesis-.75 to 2.80, MPP 30-757.14(g) Protective Supervision. Gets up to 283 hours a month. Or 195 hours a month if the nonmedical personal services is less than 20 hours a week. MPP 30-009.22 governs IHSS applications. Application can be made by the applicant or any person on his or her behalf by phone, letter referral. The application form CA 295 is only signed by the applicant during the face-to-face assessment for services. MPP 30-759.11 provides for 30 days to determine IHSS hours from the date that the CA 295 is signed. PRACTICE POINTERS: Widespread county violation of due process of law. County does a home visit. Don’t allow a in the house without an appointment. Watch out for: Counties asking applicants to sign blank releases of information; HIPPA releases. Clients should provide the information, especially medical information. Rank 1- Does not need help. Can do the task without any assistance. Rank 2. Able to do the task, but needs verbal assistance. Rank 3. – Able to do task with human assistance. Rank 4. Able to do task with substantial human assistance. Rank 5. Can’t perform task without human assistance. PRACTICE POINTER: Get a copy of the county rankings. Counties reassess every 12 months. IHSS clients have a right to ask for reassessment anytime. Hours cannot be reduced at assessment unless there is a change. MPP 30-761.28 Hours cannot be changed without an assessment. If the IHSS applicant has a spouse, IHSS will be denied for those services that the spouse is able to provide. PRACTICE POINTER Get a statement from the doctor that the spouse cannot do x y and z tasks. Counties have forms for these. Counties often prorate services solely based on the number of people living in the house for related services. Counties can only prorate Domestic Services and cannot prorate related services. Always challenge the proration – an element of widespread county abuse in California. Persons who need PS can get 195 hours a month or 283 hours a month. A person is eligible for PS is he or she wanders and gets lost, turns on the water and forgets, turns on the stove and forgets, etc. Needs a completed SOC 821 by the doctor. Make sure the doctor says the person needs 24 hours a day PS. Children can get protection supervision services. Children are often denied unlawfully by counties. Get a doctor’s statement and do not allow the county to go fishing for information to make the child ineligible. Counties can prorate protective supervision if two clients are living in the same house and receiving services from the same provider. Not allowing persons to sign the CA 295 until the social worker (SW) comes to the house. Not allowing children to apply. Denying applications with a NOA. Prorating based on assumption not verified. Reducing hours without appropriate cause to save money. CWDs can use alternative resources to reduce hours. Defense The alternative hours have to be voluntary. Judicial Relief. Legislative Advocacy. Administrative Advocacy. Sue. Current litigation efforts. IHSS NOA potential lawsuit. Types of litigation: 1094.5. 1085. Class Action. LSC programs can performs legislative advocacy if invited by a legislator to do so. There are many IHSS bills. SEIU is a big supporter of IHSS. Meetings with DSS Every three months Meetings with the CWD State Hearings Every two (2) months For more information visit ccwro.org and look at the calendar. Goldberg v. Kelly, 397 U.S., 254 Calderon v. Anderson, l996) 45 Cal. App. 4th 1841 Yee-Litt v. Richardson, 353 F. Supp. 996 Dowling v. David, (1994) 19 F 3d 445 Madrid v. McMahon, 183 Cal. App. 3d, 151 Marshall v McMahon, (1993) 17 Cal. App. 4th, ,1841 Morales v. McMahon, 223 Cal. App. 3d, 184 Miller v Woods, (1983) 148 Cal. App. 3d 862 Bonnette v California Health and Welfare Agency, (1976) 414 F Supp 212 Federal CFR Title 45, Section 210 -Governing all hearing except for CalWORKs. State Welfare and Institutions Code 10950 et.seq. State regulations. Division 22. http:\/\/www.dss.cahwnet.gov\/ord\/CDSSManual_240.htm All County Letter and All County Information Notices http:\/\/www.dss.cahwnet.gov\/lettersnotices\/default.html. Training Notes and Paraphrased Regulations. http:\/\/www.dss.cahwnet.gov\/shd\/default.htm Any NOA is a Request for a FH. Anytime an application is not taken. Anytime an assessment is not done. Anytime the application is not processed within 30 days. Authorized Representative (5 days to get an A.R. form) 22-001.(5) Authorized Representative – An individual or organization that has been authorized by the claimant or designated by the Administrative Law Judge or Department pursuant to Sections 22-085 and 22-101 to act for the claimant in any and all aspects of the state hearing or in an administrative disqualification hearing. 90 days from the date of the NOA. Before the effective date of the action or ten (10) days for Aid Paid Pending. 22-001.d. (1) Days – Days shall refer to calendar days unless otherwise specified. 22-001 h. (1) Holiday – A Saturday, Sunday, and the holidays as specified in Government Code Sections 6700 et seq. which result in a postal holiday or the closing of Department or county offices. FAX TO 916-229-4110 or 916-229-4131 A general statement to keep your options open. For example: The county is wrong . Also specificity, like where you think there should be additional hours, if you want to to resolve hearings. Background Yee-Litt v. Richardson 5 working days to restore- 22-073 .1 APP does not have to be paid back unlike Food Stamps and CalWORKs County has to do a position statement. The position statement shall be available 2 working days before the hearing – 22-073.252, Know your case. Talk to the CWD before the hearing. Remember, the County Appeals Worker can tell the District what to do in many cases. You can always lose the slam dunk case depending on which Judge you get. There are always Stipulated Decisions in lieu of CWs. Get maximum information from the claimant. Ask about past hearings. How long have they been on aid? Explore for underpayments. Underpayments can be used to off set overpayments. Have they talked to the CWD about these issues? DV Waivers? Review the case file if necessary. MPP 22-001.a(1) Adequate NOA. ACIN 81-151- Great ACIN. 22-049.52 – Attack the NOA to get jurisdiction or a better Judge. 22-073.3 At the hearing, the county representative shall assume full responsibility for presentation of the county’s case. 22-073.36 Having the burden of going forward in the hearing to support its determination. Hearsay by itself is not enough. Always make an objection on the record to preserve the hearsay objection on a 1094.5 22-049.5 The issues at the hearing shall be limited to those issues which are reasonably related to the request for hearing or other issues identified by either the county or claimant which they have jointly agreed, prior to or at the state hearing, to discuss. Adequacy of the NOA. Standards for Postponements. No Position Statement. King and Ball penalties Never withdraw a hearing request. Always do a CW if you want to withdraw. If the withdrawal is conditional: (A) The withdrawal shall be accompanied by an agreement signed by the claimant and by the county. (B) Any agreement under this provision shall provide that the actions of both parties will be completed within 30 days from the date the conditional withdrawal form is signed by both parties and received by the county. See Section 22-071.14 regarding adequate notice with conditional withdrawal. (C) After the county issues notice of its redetermination, if the claimant does not reinstate the hearing request within the time limits set forth in Section 22-009, the request shall be dismissed. Use this option when the county does not have the proof, rather than giving the CWD time to gather evidence. Benefits of the Stipulated Decision. Reopen within 15 days APP is back on. Second time has to show good cause. 22-062.3 The decision of the Director shall be in writing. .31 The decision shall include: .311 A statement of the facts; .312 The statutes and regulations involved .4 The decision shall determine only those circumstances and issues existing at the time of the county action in dispute or otherwise agreed to by the parties. 30 days to ask for a rehearing AB 921- Chapter 502 statutes of 2007 http:\/\/www.leginfo.ca.gov\/cgi-bin\/postquery?bill_number=ab_921&sess=CUR&house=B&author=krekorian CCP 1094.5 W&IC 10962 One Year from the date of hearing decision No filing fee required Prevailing party is entitled to attorney fees Questions & Answers IHSS State Hearings Operators of the IHSS Program The Law State Regulations DSS Underground Policies County Welfare Department Funding of IHSS IHSS Programs The Types of Services Domestic & Related Services Non-Medical Personal Services Protective Supervision Application Process Assessment Rankings Reassessment IHSS Client With a Spouse Proration of Services Protective Supervision (PS) Protective Supervision & IHSS for children IHSS Major Problems Alternative Resources What Is The Remedy ? Judicial Relief Legislative Advocacy Administrative Advocacy IHSS Hearing Authorities Fair Hearing Laws When to Ask for a Hearing Who Can Ask for a State Hearing Timelines for Asking a FH Where To File The State Hearing? What To Put On The NOA Aid Paid Pending Position Statement e 22-049.75 Examine all documents prior to and during the hearing. 22-051.1 Upon request, the CWD shall allow the claimant to examine the case record during regular working hours (see Section 19-005). .11 If portions of the case record are privileged under the provisions of Section 19-006, the claimant shall be entitled to inspect such material only if the claimant is the holder of the privilege. .2 The claimant shall have the right prior to and during the hearing, to examine nonprivileged information which the county has used in making its decision to take the action which is being appealed. Case File Availability Negotiating with the CWD Interviewing Client & Spotting Issues Adequacy of the NOA Burden of Proof Hearsay Framing the issue Postponements Time Waivers Conditional Withdrawals Stipulated Decisions No shows Content of the Hearing Decision Rehearings Judicial Review The End ”