Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) The county
shall conduct residential and financial eligibility and enrollment fee
determination for applicants upon initial application to CCS for treatment
services and shall annually thereafter redetermine financial eligibility and
enrollment fees for clients continuing to receive treatment services under
Sections 123870 and 123900 of the Health and Safety Code. Such determination
shall be made within 30 calendar days of receipt by the county of the
information needed to make the determination.
(b) The county shall submit written
notification of financial eligibility and enrollment fee requirements to the
parents, legal guardian of a minor applicant or applicant 18 years of age or
older within five calendar days of receipt of a completed application form or
to the parents, legal guardian of a minor client or to a client 18 years of age
or older a minimum of 30 calendar days before the annual redetermination is
scheduled.
(1) The written notification at a
minimum, shall include the following:
(A) A
statement that the parents, legal guardian of a minor applicant or
applicant/client 18 years of age or older must, within 30 calendar days of the
date of written notification, provide the information needed for the county to
determine residential and financial eligibility and enrollment fee.
(B) A list of documentation which must be
provided, including:
1. Necessary income
documents including:
a. California state
income tax form (540 or 540A) and federal income tax form (1040 or 1040A) for
the previous tax year.
b. Pay
stubs, W-2 forms, copies of cash grant award letters or warrants, employee
confirmation letters, and other substantiating documentation if the family did
not file tax returns or the tax return forms are
unavailable.
2.
Residential eligibility information, if any, specified by the county.
3. Guardianship and custody information and
documentation, if appropriate.
(C) Either:
1. The date, time, and place of a scheduled
eligibility interview, or
2.
Instructions for submitting the necessary documents by
mail.
(c) If the county has not received a response
to the first notification, the county shall, 15 calendar days after the first
notification, send a second notification to the parents, legal guardian of a
minor applicant/client or applicant/client 18 years of age or older. Such
notification shall include the following information at a minimum.
(1) A statement that the county will not open
an applicant's case or will close a client's case if the family does not appear
at a rescheduled eligibility interview or submit necessary financial documents
no later than the due date contained in the first notification.
(2) A request for information as set forth in
subsection (b)(1)(B).
(3) Either,
(A) The date of a rescheduled eligibility
interview with instructions to submit required documents, or
(B) Instructions for submission of necessary
income documents by mail.
(d) If the county has not received a response
to the first or second notification the county shall send a third written
notification to the parents, legal guardian of a minor applicant/client or
applicant/client 18 years of age or older if these parties do not appear at a
rescheduled interview or do not submit necessary documents. Such notification
shall at a minimum include the following:
(1)
A statement that the parents, legal guardian of a minor applicant/client or
applicant/client 18 years of age or older has not appeared at a rescheduled
interview or has not submitted necessary financial information.
(2) A statement of the disposition the county
made of the case.
(e) The
county shall use an eligibility worksheet which is either provided by the State
or prepared by the county to determine residence in the county, financial
eligibility and enrollment fee status and shall require at a minimum
information covering the following areas:
(1)
Residence, including current address, length of time at that address, previous
address, address from which last year's state or federal taxes were filed,
county of voter registration, if any.
(2) Insurance, including third-party coverage
under Medi-Cal, Medicare, private or group insurance, type of coverage, name of
carrier and description of covered benefits, including limitations, if any, on
that coverage.
(3) Family status,
including at a minimum:
(A) Name and address
of parents and indication of which parent has legal custody, if
applicable.
(B) Name and address of
person, if any, with whom applicant/client resides other than the natural or
adoptive parent(s).
(4)
Income information including at a minimum:
(A) Income source for the mother, father and
applicant/client.
(B) Family size
as reported on each income tax form.
(C) Medi-Cal eligibility
information.
(D) Adjusted gross
income computation.
(E) Estimated
out-of-pocket costs for care if Adjusted Gross Income is greater than
$40,000.
(5)
Documentation of payment of the annual enrollment fee as required by Section
123900(e) of the Health and Safety Code.
(6) Financial eligibility or annual
enrollment fee exemption criteria as specified under Section 123900(f) of the
Health and Safety Code.
(7) Legal
agreement, between the county and the parents, legal guardian, or
applicant/client 18 years of age or older. At a minimum the agreement shall
include:
(A) CCS eligibility
determination.
(B) Annual
enrollment fee determination.
1. Effective
dates of annual enrollment fee.
2.
Due date(s) of the annual enrollment fee.
3. Agreement to fully utilize any health
insurance, and assign insurance rights.
4. Agreement to repay CCS costs if found not
eligible.
5. Prompt notification of
any change.
6. Repayment from
lawsuit, etc.
(C)
Statutory conditions under which CCS authorizes and pays for services and
requires families to reimburse CCS for payments made to families by insurance
or lawsuits, for services paid by CCS. The county shall determine the legal
relationship of the person(s) with whom a minor applicant/client resides and
who applies for CCS services on behalf of the child in order to determine
residential and financial eligibility, and enrollment fee.
1. If the person is a legal guardian, the
county shall specify on the agreement the county with legal jurisdiction and
shall request verification of guardianship. If guardianship is verified the
county shall determine the family is eligible to proceed with residential and
financial eligibility and enrollment fee determination.
2. If the person is not a legal guardian, the
county shall determine the family is not eligible to proceed with residential
and financial eligibility and enrollment fee determination. The county shall
give written notification to the person that only a parent, legal guardian, or
persons legally designated to represent the client or applicant, may apply for
CCS and the county shall give appropriate information regarding
guardianship.
(D)
Effective dates of the legal agreement.
(E) Privacy notification conforming to Civil
Code Section 1798.17 requirements.
1.
Change without regulatory effect pursuant to Section
100, Title 1, California Code of
Regulations adding new section filed 3-9-90 (Register 90, No. 13). For prior
history, see Title 17, Part I, Subchapter 3, Sections 2890-2923, not
consecutive.
2. Change without regulatory effect relocating chapter
2 and article 1 headings from preceding section 41610 to preceding section
41510.2, renumbering former
section 41610 to section
41510.2 and renumbering former
section 42000 to section 41610, including
amendment of section and NOTE, filed 1-28-2009 pursuant to section
100, title 1, California Code of
Regulations (Register 2009, No. 5).
Note: Authority cited: Sections
20,
100275,
123805
and
123990,
Health and Safety Code. Reference: Sections
123865,
123870,
123895,
123900,
123930,
123965
and
123990,
Health and Safety Code; and Section
1798.17, Civil
Code.
