44-270.E. Determination of Eligibility

 

Table of Contents

Section

Topic

44-270.E.1

Determining Initial Eligibility

44-270.E.2

Determining Continuing Eligibility with the SAR 7 and at Annual Redetermination

44.270.E.3

Evaluating Mid-Period Changes

44-270.E.4

Changes in Deprivation

44-270.E.5

Household Composition Changes

44-270.E.6

Changes in Property

44-270.E.7

Meeting Conditions of Eligibility and Program Requirements

CPG Letter 308 (1/14)

 

44-270.E.1
Determining Initial Eligibility
Top

Applicant Assistance Units (AUs) must meet all CalWORKs eligibility criteria and comply with certain technical conditions, as outlined in CPG 44-300.F, before CalWORKs may be approved.

See CPG 40-100.B and 40-100.E for detailed information regarding applicant responsibilities and the CalWORKs application process.

REPORTING CHANGES PRIOR TO APPROVAL OF AID

CalWORKs applicants are required to report changes that affect their eligibility within 5 calendar days, per CPG 40-100.B.2.

If any changes occur before aid is approved, the Human Services Specialist (HSS) must consider the new information when determining initial eligibility and grant amount, regardless of whether the change occurred after the initial CalWORKs interview.

NEW HOUSEHOLD MEMBERS

If a new household member is reported in the application month after the CalWORKs date of application but before aid has been granted for the AU, the new member will be included in the AU effective the date of the CalWORKs application.

If a new household member comes into the home in the month following the month of application, prior to the approval of aid, the beginning date of aid (BDA) for the new member will be the first of the month following the month of application.

After CalWORKs has been approved, if a new household member is reported then the change will be considered a voluntary mid-period report.  The HSS will evaluate the new member in accordance with CPG 44-270.H.9 and will only add the new member mid-period effective the first of the following month if there will be an increase in CalWORKs.

REPORTING CYCLE AND BDA

All CalWORKs AUs are required to be assigned a reporting cycle upon initial approval.  The Semi-Annual Reporting (SAR) Cycle is based on the BDA.

The BDA starts on the date of the application for CalWORKs if the AU was eligible to aid on that date.  Benefits for the initial month of aid will be prorated per the CalWORKs Proration Chart.

If the AU was not eligible to CalWORKs in the month of application, the BDA will be the first month for which eligibility is established.

See CPG 44-270.B and 44-270.F.2.

NOTE:  If the applicant AU is receiving CalFresh, the CalWORKs reporting cycle must be aligned with the existing CalFresh reporting cycle when aid is approved.  See CPG 44-270.B.5.

See CFPG 63-281 regarding CalFresh eligibility determinations.

ACLs 12-25; 12-25 Errata

 

44-270.E.2
Determining Continuing Eligibility with the SAR 7 and at Annual Redetermination
Top

Once initial eligibility to CalWORKs is established and aid is granted to an AU, continuing eligibility is required to be evaluated once every six months based on information provided by the AU on the SAR 7 and at annual redetermination.  For mid-period eligibility evaluations, see CPG 44-270.E.3

In order to continue to be eligible to CalWORKs, the AU must meet all eligibility criteria, including, but not limited to:

·         Deprivation;

·         Household composition;

·         Income; and

·         Property.

Recipients are responsible for reporting all information necessary to determine CalWORKs eligibility for the AU on the SAR 7 and at annual redetermination.  The HSS will use the SAR 7 and annual redetermination to determine continuing eligibility and grant amount for the next SAR Payment Period.

REMINDER:  Timely notice is required before CalWORKs can be decreased or discontinued, even at redetermination.

See CPG 44-270.C and 44-270.D for information regarding processing the SAR 7 and CPG 44-270.F for income eligibility and budgeting.

ACLs 12-25; 12-25 Errata

 

44-270.E.3
Evaluating Mid-Period Changes
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COUNTY-INITIATED ACTIONS

When certain eligibility information becomes known, the HSS is required to reevaluate CalWORKs eligibility for the AU mid-period and take timely action, per CPG 44-270.I.

CHANGES REPORTED MID-PERIOD

CalWORKs recipients are required to report certain household changes within 10 calendar days, as outlined in CPG 44-270.G.  Only those CalWORKs mandatory reports require eligibility to be reevaluated and action to be taken mid-period.

For voluntary reports, as explained in CPG 44-270.H, recipients may report changes at any time; however, action will only be taken mid-period when:

·         The change results in an increase to the CalWORKs grant; or

·         There is a request for discontinuance of benefits.

For all other voluntarily reported changes, the HSS will send a “No Change” Notice of Action (NOA) to the AU and make note of the information as a Held Change for follow-up at the next SAR 7 or annual redetermination, whichever comes first.  Case comments are required to document the actions taken.

NOTE:  A recipient may report multiple changes within the same SAR Payment Period.  When multiple changes are reported, the HSS is required to evaluate each change separately and sequentially, per CPG 44-270.J.

ACL 12-25

 

44-270.E.4
Changes in Deprivation
Top

When there is a change in deprivation due to information reported on the SAR 7 or at the annual redetermination, the HSS is required to reevaluate eligibility for the AU and take action effective the next SAR Payment Period.

Deprivation for an AU may change at any time; however, mid-period action will only be taken when the change in deprivation is a result of:

·         A mandatory report listed in CPG 44-270.G;

·         A voluntary report that will increase the CalWORKs grant, as outlined in CPG 44-270.H; or

·         There is a request for discontinuance, per CPG 44-270.H.

Example 1:  Deprivation Change (No Mid-Period Action)

Scenario

An AU of 3, Mom and her two children, receives CalWORKs based on Absent Parent deprivation.

Mom makes a voluntary mid-period report that Dad has returned home and is working full-time.  The HSS determines that Dad is the Primary Wage Earner (PWE).

Deprivation no longer exists for this AU.

Outcome

Since adding Dad to the AU will result in a loss of deprivation for the AU, the HSS will not add Dad to the AU mid-period.

CalWORKs will not be discontinued for the AU until the end of the current SAR Payment Period after Dad’s income has been reported on the SAR 7 or annual redetermination.

The information will be noted as a Held Change and a “No Change” NOA will be issued to the AU.

ELIGIBILITY TO EXEMPT MAXIMUM AID PAYMENT (MAP)

If a change in deprivation qualifies the AU to receive exempt MAP, then the HSS will make the change from non-exempt to exempt MAP effective the first of the month following the report of the change.

Example 2:  Deprivation Change – Eligible to Exempt MAP

Scenario

An AU of 3, Mom and her two children, receives CalWORKs based on Absent Parent deprivation.

Mom makes a voluntary mid-period report that she has been approved for SSI/SSP.

Outcome

Mid-period action will be taken to change the deprivation from Absent Parent to Disabled Parent.

The AU will receive the higher exempt MAP amount effective November 1st.

NOTE:  For CalWORKs, it is not considered duplicate aid if a recipient begins receiving SSI mid-period per CPG 44-270.I.  However, CalFresh rules are different.  See CFPG 63-285.

ACL 12-25

 

44-270.E.5
Household Composition Changes
Top

Recipients are only required to demonstrate continuing eligibility regarding household composition based on information reported on the SAR 7 and at annual redetermination.  Mandatory inclusion rules apply, as explained in CPG 41-500.A. 

Unlike Annual Reporting/Child Only (AR/CO) AUs, SAR AUs are not required to report household composition changes mid-period. A voluntary report of a change in household composition that would result in a decrease or ineligibility to CalWORKs cannot be acted on mid-period unless there is a request for discontinuance.  Action will be taken when the SAR 7 or annual redetermination has been submitted and processed.  See CPG 44-270.H.8.

However, any change in household composition must be reported on the SAR 7 or at the annual redetermination following the change, unless the information was previously reported and verified mid-period, as outlined in CPG 44-270.D.5.

NEW HOUSEHOLD MEMBER BECOMES INELIGIBLE

When a new household member is reported on the SAR 7 or at annual redetermination and is initially determined eligible to CalWORKs, but prior to the granting of aid, is subsequently found ineligible due to information voluntarily reported during the SAR Submit Month, he/she will be treated as an excluded person for the next SAR Payment Period.

If adding the new household member to the AU results in CalWORKs ineligibility for the entire AU, CalWORKs will be discontinued for all AU members at the end of the SAR Payment Period in which the new individual was treated as an excluded person.

Example:

Scenario

An AU is in the January – June Payment Period (SAR Cycle 1).  Deprivation is Absent Parent.

In March, Dad returns home and is reported for the first time on the May SAR 7.  Dad is receiving unemployment insurance benefits (UIB).

The HSS determines that Dad is the PWE and is eligible to CalWORKs based on Unemployed Parent deprivation.  He will be added to the AU effective the next SAR Payment Period beginning July 1st.

In the Submit Month June, Dad reports that he accepted a full-time job offer on June 15th and provides verification of his anticipated earnings.

Outcome

Since Dad has not yet been approved for aid, his new employment must be considered in his eligibility determination.  The application to add Dad for the upcoming Payment Period will now be denied since Unemployed Parent deprivation no longer exists for the AU.

Because his ineligibility was determined after the SAR Data Month but before the authorization of his benefits, Dad will be treated as an excluded person  and his reasonably anticipated UIB income and needs will be considered for the July – December Payment Period.

Since the grant amount is being recalculated for the new SAR Payment Period to include Dad’s UIB income, the IRT will also be recalculated using Dad’s UIB income.  A new SAR 2 must be issued to the AU if there is a change in IRT.

The existing Absent Parent deprivation for the AU will not be affected until the annual redetermination in December when Dad’s full-time employment income is reported and evaluated.

If at annual redetermination the AU is no longer eligible to CalWORKs, then benefits for the entire AU will be discontinued at the end of December with timely and adequate notice.

ACLs 12-25; 12-25 Errata

 

44-270.E.6
Changes in Property
Top

Property eligibility is only evaluated every six months at the SAR 7 and at annual redetermination.  AUs must meet the CalWORKs resource limit as specified in CPG 42-200.B.

·         CalWORKs will be discontinued at the end of the SAR Submit Month with timely and adequate notice when the AU exceeds the resource limit based on information reported on the SAR 7 or at annual redetermination.

·         If the AU provides verification that their resources are within the resource limit prior to the effective date of discontinuance, the discontinuance will be rescinded and CalWORKs reinstated without a break in aid.

NOTE:  Recipients are not required to report any property changes mid-period and the HSS will not take mid-period action on any voluntarily reported change in property that will result in a decrease or discontinuance of CalWORKs.

Example 1:  Change in Property reported Mid-Period

Scenario

An AU voluntarily reports mid-period that an inheritance was received.  No verification is provided.

The HSS makes note of the information as a Held Change and sends a “No Change” NOA to the AU.

The AU does not report the inheritance on the next SAR 7 and the HSS contacts the recipient by phone to clarify the discrepancy.

The recipient was notified of an inheritance but has not actually received any money because the estate is still in probate.

Outcome

Unless there is conflicting information, the SAR 7 will be considered complete and the HSS must document how the discrepancy was resolved.

Case comments must indicate what was reported, what happened, and what actions were taken based on these reports.

 

Example 2:  Change in Property reported at SAR 7

Scenario

An AU is in the May - October Payment Period (SAR Cycle 5).

The September SAR 7 is submitted timely on October 8th and the AU reports that a $4,000 inheritance was received in the Data Month.

The HSS issues a timely NOA to discontinue CalWORKs effective October 31st due to excess resources.

On October 25th, the AU provides verification that the inheritance was put into a restricted account.

Outcome

The HSS will rescind the CalWORKs discontinuance and issue November benefits at the previous level.

Information from the September SAR 7 will be used to calculate benefits for the November – April Payment Period.

An overpayment (OP) will be established for any overpaid benefits.

TRANSFERS OF PROPERTY

Recipients may voluntarily report mid-period when property or income was sold, traded, or given away; however, this information is only required to be reported on the SAR 7 and at annual redetermination.  CalWORKs may not be decreased or discontinued mid-period due to a voluntary report of a transfer of property or income.

When a transfer of property or income is reported on the SAR 7 or at annual redetermination, the HSS must determine whether the property or income was transferred for fair market value (FMV).

·         If the transfer was for less than FMV and the property or income would have affected the AU’s eligibility or grant amount, a period of ineligibility (POI) must be established, per CPG 42-200.N.

·         The POI will be effective the next SAR Payment Period and will continue for the determined number of months.

REMINDER:  Transfer of property rules do not apply to CalWORKs applicant AUs, per CPG 42-200.N.

ACL 12-25

 

44-270.E.7
Meeting Conditions of Eligibility and Program Requirements
Top

CONDITIONS OF ELIGIBILITY

When a recipient fails to meet a condition of eligibility within the Payment Period that is not part of the SAR 7 or annual redetermination reporting requirement, no action will be taken to decrease or discontinue CalWORKs until the end of the SAR Payment Period with timely and adequate notice.

Example:

Scenario

A recipient loses his/her job mid-period but fails to apply for UIB.  Using EDD Real-Time Match, the HSS determines the recipient has a potential UIB claim.

Outcome

No action will be taken to discontinue benefits until the end of the SAR Payment Period.

The information will be noted as a Held Change and a “No Change” NOA will be issued to the AU.

CALWORKS PROGRAM REQUIREMENTS

When a recipient fails to provide information needed to meet CalWORKs program requirements, such as school attendance, immunization, or child support cooperation, timely action must be taken to impose a county-initiated sanction or penalty against the AU member(s), as required per CPG 44-270.I.

ACL 12-25