Article 4 Section 9 –   Diligent Search

 

Table of Contents

 

Title

MPG Cite

Diligent Search

04.09.01

Processing Diligent Search Applications in CalWIN

Appendix A

 


 

4.09.01 Diligent Search

 

A. 
General

The diligent search process involves the "search" for an applicant's available income and resources when the applicant is unable to assist in the application process.  Diligent search shall be completed on all Medi-Cal applicants who are deceased, comatose, amnesiac, or otherwise mentally incompetent and no one else is authorized to complete the Statement of Facts as specified in MPG Article 4, Section 2.

 

MPG LTR 11 (4/88)

 

 

B.
Process Overview

The diligent search process requires the worker to take the following actions:

 

Step

Action

1

Determine and document applicant’s competency

2

Refer to the State Programs-Disability and Adult Programs Division (SP-DDSD) for a disability determination, excluding applicants who appear to be under age 21 or over 64.

3

Conduct reasonable search

4

Determine eligibility based on diligent search findings

5

Refer to Public Administrator applicants who are ineligible to Medi-Cal due to excess property

 

MPG LTR 11 (4/88)

 

 

C. 
Determine and Document Competency

Medi-Cal applicants who, in the judgment of the worker, are unable to adequately respond to routine questions asked as part of the eligibility determination process should be considered incompetent.  The determination of "incompetency" is based on individual judgment.  It is not a legal or medical determination.

 

Most referrals from a hospital, which will require a diligent search process, involve persons who are deceased, comatose or have amnesia.  When the worker determines that the person is incompetent, the worker will obtain a written confirmation of his/her determination of "incompetency" by either the hospital social worker or other medical personnel.  The worker's determination of "incompetence" shall be noted in the case narrative.  The confirmation of the worker's determination of "incompetence" is to be stated in writing by the confirming person and filed in the case file.

 

MPG LTR 11 (4/88)

 

 

D.
Refer for a Disability Determination

A referral to the SP-DDSD is required for all applicants who have been determined "incompetent" except for persons who appear to be under age 21 or over age 64.  The worker making the referral will sign Form MC 220, Authorization for Release of Information, and write "person is comatose" or "person is deceased" as applicable on the face of the form.  Forms MC 221, Disability Determination and Transmittal, and MC 223, Statement of Facts for Medi-Cal Regarding Disability, will be completed by the worker with all available information.

 

MPG LTR 11 (4/88)

 

 

E. 
Reasonable Search – Identity

When a member of the hospital staff has attempted to establish the identity of a person who is comatose, amnesiac, or mentally incompetent and the person's identity remains unknown, the worker will document in the case narrative that reasonable efforts were made by hospital staff to establish the identity of the person.  If the person is deceased and law enforcement officials are involved, information on identity should be requested from the appropriate agency.

 

Refer to MPG Article 4, Section 9 Appendix A for case processing instructions when the identity of the applicant remains unknown.

 

MPG LTR 651 (01/09)

 

 

F. 
Reasonable Search – Income and Property

For applicants whose identity is known, the worker will conduct a reasonable search to include the following. 

 

1.       MEDS "known to Welfare" search by Social Security number (SSN) or, if the SSN is not available, by name and county.

 

2.       Verification of Social Security benefits via Form 07-94 DSS or IEVS abstract.

 

3.       Verification of Veteran's Administration benefits via Form CA‑5.

 

4.       Verification of wage, UI/DI information via the IEVS abstract.

 

5.       Verification of vehicle registration through written request to the Department of Motor Vehicles.         

 

6.       Property search via County Assessor's Office.  The worker may call the County Assessor's Office to determine if the applicant has any real property in San Diego County, or use SS screens by following the instructions in the Operations Handbook, Section I.VI.

 

7.       If the personal effects of the individual indicate an account at a specific banking institution, the worker will request the bank to search for all accounts belonging to the person.  If the bank refuses to provide the requested information, the worker will document the effort in the case narrative.  If information contained in the personal effects, e.g., passbook or check register, provides an account balance, the worker will use this information in determining eligibility.

 

When requesting any of the above information, include a cover letter indicating the circumstances, i.e., the person is comatose or deceased, and therefore cannot sign a release of information form, there is no person authorized to act on behalf of the person, and the County is trying to establish Medi-Cal eligibility.

 

MPG LTR 11 (4/88)

 

 

G. 
Determine Eligibility Based on Findings

Eligibility determinations based on the results of diligent search procedures will be completed in the same manner as any other determination. Residency requirements will be considered to be met in the absence of information to the contrary.  Only the income and resources discovered through the search will be considered available.  Restricted/limited scope will be granted if the worker is unable to obtain acceptable citizenship/identity documents and prove legal residence or citizenship status at the end of the diligent search process.   

 

Upon completion of the Medi-Cal eligibility determination resulting from the diligent search process, the Eligibility Supervisor will approve the worker's determination by countersigning the Statement of Facts.

 

MPG LTR 651 (01/09)

 

 

 

 

 

 

Clarification DHCS

 

H. 
Refer to Public Administrator

A referral to the Public Administrator shall be made when the diligent search results in the denial of Medi-Cal benefits because the applicant was found to have excess property or the applicant was found to have real property which must be utilized.

 

MPG LTR 11 (4/88)

 

 

I. 
Acting on Changes

At any time during the application process, if the person's condition changes or a friend or relative is found so that information can be obtained in the usual manner, the diligent search efforts are to be ceased.  Case record shall be updated to reflect the person’s true identity and eligibility status.

 

If the person…

Action

Remains eligible and a Medi-Cal Client Index Number (CIN) has been assigned

Retain the CIN and update the Aid Code if there is a change in eligibility status

Is found to be ineligible

Discontinue the case with timely and adequate notice.

 

MPG LTR 11 (4/88)

 

 


APPENDIX A. PROCESSING DILIGENT SEARCH CASES IN CALWIN

 

For cases where the identity of the applicant remains unknown, CalWIN entries are completed in the same manner as any other cases with the following exceptions:

 

1.       Name

 

If the person’s name is unknown, use either John C. Doe or Jane C. Doe for the case name.

 

2.       Birth Date

 

If unknown, use “01” for the month and “01” for the day; use the following for the year of birth:

 

If the estimated age is…

Then use…

Under 21

Current year minus10 years

Between 21 and 64

Current year minus 40 years

65 or over

Current year minus 70 years

 

3.       Social Security Number

 

If unknown, enter zeros.  A pseudo number will be assigned by MEDS.

 

4.       Health Insurance Claim Number

 

If unknown, leave blank.

 

5.       Address

 

Since MEDS will produce a reject message if the address field is blank, use the address of the FRC in which the case is being processed.