County of San Diego Health and Human Services Agency HHSA County Medical Services CMS Program Guide CMS Hardship for Individuals Over 165 FPL Number Page 1303 1 of 2 Background When the applicants monthly net nonexempt income is over 165 but not over 350 FPL the worker continues the CMS eligibility process by evaluating for a CMS Hardship as long as the applicant meets all other eligibility requirements PolicyProcedure A Hardship Application AuthMed has been programmed to determine Hardship eligibility and will complete the CMS Hardship application during the intake interview The applicant is given the opportunity to sign the completed CMS Hardship application and the Agreement to Reimburse the County of San Diego form to continue the CMS Hardship evaluation In situations where a manual budget is required workers are to follow the steps below B Allowable Expenses See Desk Aid 02 for the Maximum Allowable Expense chart Documentation is required for the following allowable expenses Rent Utilities Transportation Taxes Court ordered support and payments Payments on previously incurred medical debt Documentation NOT required for the following expenses Food Miscellaneous C Good Cause Eligibility staff are required to evaluate for good cause if the applicant has not returned the required documentsverification by the end of the second 10day period Other Program Impacts None Step Action 1 Determine whether the applicants monthly net nonexempt income is at or below 350 FPL 2 If the applicants monthly net nonexempt income is Then 350 FPL or less Applicant is eligible to apply for CMS Hardship Provide applicant a CMS Hardship application and the Agreement to Reimburse the County of San Diego form in excess of 350 FPL Deny the case for excess income County of San Diego Health and Human Services Agency HHSA County Medical Services CMS Program Guide CMS Hardship for Individuals Over 165 FPL Number Page 1303 2 of 2 References None Sunset Date This policy will be reviewed for continuance by April 30 2019 Release Date April 25 2016