County of San Diego Health and Human Services Agency HHSA County Medical Services CMS Program Guide Grant of Lien Number Page 0606 1 of 3 Background Effective 12107 all CMS and CMS Hardship applicants are required to execute a lien naming the County of San Diego as grantee to secure any and all real property of the applicant as security for repayment of the cost of claims paid by CMS on the beneficiarys behalf Liens are not initiated until the beneficiary is no longer active on CMS and CMS has paid claims in total of 5000 or more on the beneficiarys behalf Policy A Welfare Institutions CodeDeputized HHSA Staff The Welfare Institutions Code WIC 17109 and Article V of the San Diego County Administrative Code Section 92 authorizes the County to assert liens for any and all claims paid on behalf of a CMS or CMS Hardship beneficiary The County Clerk has deputized Human Service Specialist HSS as Deputy County Clerks for the limited purpose of witnessing CMS applicantbeneficiary lien signatures If no deputized worker is available at the site the applicant can come back to the office when one is available go to another CMS site or get the lien form notarized at their own expense Health Coverage Access HCA will maintain a log for all additions deletions and updates of all Deputy County Clerks The updates are to be recorded on the CMSGR Transmittal to AddDelete Deputized Workers form This form is to be forwarded to the County Clerks office as personnel changes occur HCA will also conduct annual reconciliations with the County Clerks office to ensure the County Clerk has an accurate listing of all HHSA deputized staff Requirements B Signed and witnessed The CMS Grant of Lien must be signed by the applicantbeneficiary and witnessed by either a Deputy County Clerk or Notary Public at initial application or reapplication If the applicantbeneficiary is married both are required to sign in front of a Deputy County Clerk or Notary Public Failure to complete the CMS Grant of Lien process will result in the denial of their application Each applicantbeneficiary will also complete the CMS Lien Information and the CMS Lien Information Acknowledgement forms or the CMS107 in lieu of the CMS Lien Information and CMS Lien Information Acknowledgement forms Failure of the applicantbeneficiary to cooperate will result in the denial of their application The CMS Lien Information form explains the repayment terms of the CMS Program This form must be explained to the applicantbeneficiary prior to hisher signing and acknowledging that they understand the repayment terms The CMS Lien Information and the CMS Lien Information Acknowledgement forms are not required to be completed at recertification as long as the forms obtained at initial application were Signed Are in the case record and The applicantsbeneficiarys marital situation has not changed A Certificate of Acknowledgement is acceptable in lieu of a Notary Public signature on the CMS Grant of Lien if the Certificate is signed dated and stamped by a Notary Public and County of San Diego Health and Human Services Agency HHSA County Medical Services CMS Program Guide Grant of Lien Number Page 0606 2 of 3 Contains the CMS Grant of Lien form title Note All CMS lien forms are available in Spanish to give to Spanish speaking applicants for information however all lien forms must be signed in English Exception to the lien requirement An applicantbeneficiary confined to the hospital for active tuberculosis TB is not required to sign the CMS Grant of Lien If the applicantbeneficiary is in the hospital for other reasons the fact that they have TB does not exempt them from signing the CMS Grant of Lien Exemptions C Sworn statement exemption This sworn statement exemption applies to Applications dated July 1 2009 and ongoing or Applicants who applied on March 25 2009 through June 30 2009 who were denied solely for failure to submit the lien and who a Submitted a declaration in the Alford v County of San Diego court case who were denied solely for failure to submit the lien or b Timely requested either a First Level Administrative Review or an Administrative Hearing challenging the denial Applicantsbeneficiaries who state that they are unable to obtain the required spouses signature on the CMS Grant of Lien due to the following a Legal documentation of their divorce legal separation nullity of marriage deceased spouse or b Represents that they are no longer residing with their spouse and c Have completed the Resource Handout and federal tax return requirements including credit check and property search See processing guide for Sworn Statement Exemptions steps Victim of domestic violence If the applicant claims she is a victim of domestic violence and provides a restraining order against hisher spouse expired restraining orders are acceptable the spouses signature is not required If the applicantbeneficiary never obtained a restraining order but provides a police report regardless of how old the police report is regarding the domestic violence the spouses signature is not required D Applicant Unable to Complete the Lien Form Competency When an applicant is incompetent she may not sign herhis own signature on the lien form When this occurs then herhis spouse or person with hisher power of attorney may sign for himher If there is no spouse or person with power of attorney available to sign the lien form the case is denied County of San Diego Health and Human Services Agency HHSA County Medical Services CMS Program Guide Grant of Lien Number Page 0606 3 of 3 To be incompetent of acting on ones behalf does not mean the applicant does not understand English the application process or that the applicant just prefers to have someone else act on hisher behalf The term incompetence generally refers to an applicants mental condition Physical Limitations When an applicantbeneficiary is unable to sign the CMS Grant of Lien form because of a physical limitation and the applicantbeneficiary is competent then she may sign the CMS Lien form with a mark of any kind The mark shall be considered their full signature The mark must be witnessed in accordance with CMS lien requirements Returned Grant of Lien Form A CMS Grant of Lien form not meeting the completion guidelines as outlined in the CMS and GR Grant of Lien EPPG will be returned to the worker to take the necessary corrective action to obtain a new CMS Grant of Lien from the beneficiary The original completed signed CMS Grant of Lien form is sent to the Office of Revenue Recovery ORR Do not send the CMS Grant of Lien form for pending or denied cases to ORR these forms may be properly destroyed after it is scanned into AuthMed Other Program Impacts None References None Sunset Date This policy will be reviewed for continuance by August 31 2018 Release Date August 14 2015