County of San Diego Health and Human Services Agency HHSA CalWORKs Program Guide Immunization Number Page 42100J 1 of 5 Revision Date 080118 Background State regulations require children under the age of six in the Assistance Unit AU to have received ageappropriate immunizations Purpose This section has been revised to include domestic violence as a reason to evaluate for good cause Policy Informing Requirements Inform customers of Their obligation to secure immunizations for all children in the AU under the age of six and the penalty for failure to comply The ageappropriate immunizations Their right to request an exemption due to their personalreligious beliefs or for medical reasons Their right to request an evaluation for good cause How to obtain immunizations through a feeforservice provider that accepts MediCal a MediCal managed care plan a county public health clinic or any other sources available to the county Explain the above information at application annual redetermination and when adding a child under the age of six to the AU Provide these forms when explaining the requirement CW 101 CalWORKs Immunization Rules Form CW 2209 Immunization Good Cause Request Form Also include the forms in the CalWORKs applicationredetermination form packets Age Appropriate Immunizations Age appropriate immunizations are those recommended by the Advisory Committee on Immunization Practices the American Academy of Pediatrics and the American Academy of Family Physicians Immunizations currently recommended for children under the age of six are Type of Immunization Dose Recommended at Age Polio OPV TOPV IPV Sabin Salk 1st 2nd 3rd 4th 2 months 4 months 618 months Before starting school 46 years Diphtheria Tetanus Pertussis DTP DTaP DT 1st 2nd 3rd 4th 5th 2 months 4 months 6 months 1518 months Before starting school 46 years County of San Diego Health and Human Services Agency HHSA CalWORKs Program Guide Immunization Number Page 42100J 2 of 5 Children Who Have Not Received Any Immunization In The First Year Of Life The following are immunizations recommended for children who have not received any immunizations in the first year of life First visit Hepatitis B DTaP DTP Hib Polio OPV TOPV IPV Sabin Salk MMR Varicella VAR VZV Second visit 12 months after 1st visit Hepatitis B DTaP DTP Hib Polio OPV TOPV IPV Sabin Salk Third visit 12 months after 2nd visit DTaP DTP Polio OPV TOPV IPV Sabin Salk Fourth visit 6 months after 3rd visit DTaP DTP Hepatitis B Note A health care provider will determine appropriate immunizations when some but not all were received during the first year after they were born Kinrix Combination Vaccine DTaP and IPV combined in a single shot Booster 46 years of age as a booster dose of DTaP and IPV before they start kindergarten to protect them against Diphtheria Tetanus Pertussis and Polio Measles Mumps Rubella MMR 1st 2nd 1215 months Before starting school 46 years Varicella Virus Vaccine VAR VZV chickenpox 1st 1218 months Only required for vulnerable children children who have not already had chickenpox Hepatitis B 1st 2nd 3rd At birth 3 months 15 months 618 months Hemophilus influenzae Type b Hib 1st 2nd 3rd 3rd or 4th 2 months 4 months 6 months may not be required 1218 months if any dose is given after 12 months no further doses are needed Pneumococcal 1st 2nd 3rd 4th 2 months 4 months 6 months 1215 months County of San Diego Health and Human Services Agency HHSA CalWORKs Program Guide Immunization Number Page 42100J 3 of 5 Verification The California Immunization Card yellow card is required to verify immunizations at application redetermination and when adding a child under the age of six to the AU Verification is not required after the child receives all ageappropriate immunizations is enrolled in school or reaches the age of six If the yellow card is not available any documentation completed and signed may also be accepted to verify immunizations A medical provider physician authorized member of physicians staff public health department etc A public agency which requires ageappropriate immunizations local school district the Head Start Program licensed day care center etc The worker is also required to assist customers in obtaining necessary verification This includes clearing the San Diego Immunization Registry SDIR or the California Immunization Registry CAIR2 to search for the pending verification When the immunization verification does not reflect ageappropriate immunizations Provide the customer with immunization referral information Ask the customer to take the child for immunizations Issue a CW 2200 Request for Verification checklist to the customer indicating the due date Timeframes Immunization verification must be provided as follows Applicant o If they are applying for CalWORKs and MediCal simultaneously within 30 days from the date eligibility for MediCal is granted normally the same date CalWORKs is granted o If they are applying for CalWORKs and are already receiving MediCal benefits within 45 days from the CalWORKs application date Recipient Within 45 days from the annual redetermination date Adding a Child Follow the applicant time frames Intercounty transfer cases Not required if the first county has determined the immunizationsverification to be adequate Exemptions The immunization requirement does not apply when The child cannot be immunized for medical reasons A doctormedical providers writtensigned statement describing the type and duration of the medical condition is required An affidavit indicates that the immunization requirement is contrary to the applicantrecipients religious or personal beliefs The CW 2209 form may be used to verify an exemption County of San Diego Health and Human Services Agency HHSA CalWORKs Program Guide Immunization Number Page 42100J 4 of 5 Good Cause Customers may use a CW 2209 form to explain why their childrens immunizations are not uptodate Customers are also allowed to verbally inform the Eligibility Worker of their good cause request Making a verbal request is the same as completing the CW 2209 form The verbal request and required information must be recorded in case comments Good cause for failure to submit verification includes Lack of reasonable access to immunization services o The child does not currently have MediCal o There is no nearby public clinic which offers free immunizations o The family does not have adequate transportation The child is too sick to receive immunizations o The customer or the child was sick and could not go to the doctor The customer could not get a timely appointment with the doctor The immunization the child needed is unavailable The records do not correctly show all the immunizations the children received and the customer is trying to correct the records There are language barriers Domestic violence if the abuse occurred in the past the issue causing the noncooperation or inability to comply must be related to the current situation A good faith effort has been made to cooperate with requirement o A child is considered to have received ageappropriate immunizations when the customer has made a good faith effort to begin immunizations for the child but the series cannot be completed at the time of verification due to spacing requirements between the doses in the series In these instances a penalty will not be imposed Allow the customer additional 30 days to submit immunization verification Assist the customer in obtaining verification of immunizations Failure to Cooperate When an AU fails to provide the required immunization verification determine whether good cause exists If good cause exists allow 30 days as specified in the Good Cause section above If no good cause exists o The customer is considered noncooperative with the immunization requirement o If both parents are in the AU both must have the penalty applied o Their needs are not considered for both financial eligibility and grant computation o Any nonexempt income the penalized customer receives is counted in the familys income calculation o In a minor parent case the aided senior parent is considered the responsible caretaker relative and is therefore penalized if ageappropriate immunizations are not verified for the minor parents child When there is a breakinaid and the penalized customer reapplies the penalty remains unless any of the criteria described under the Removing a Penalty section is met County of San Diego Health and Human Services Agency HHSA CalWORKs Program Guide Immunization Number Page 42100J 5 of 5 Notice of Action NOA Use M40105C NOA to Specify which child is not current in their immunization records or lacks proof of uptodate immunizations List possible good cause reasons Explain why a penalty will apply Tell customers how and when cash aid would be restored to the AU Provide a CW 2209 form together with NOAs pertaining to grant changes due to the failure to meet immunization requirements Removing a Penalty The penalized parentscaretaker relative will be added to the AU Effective the first of the following month in which any of the following situation occurs o Documentation is obtained verifying all age appropriate immunizations have been received by the child o An exemption or good cause is met Effective the first day of the month of the childs sixth birthday Example if the childs sixth birthday is 060517 the penalty ends 053117 and aiding the parents as of 060117 Note The penalty must not be removed if verification is still needed for other children in the AU for whom the penalty is imposed and exemptiongood cause criteria are not met Procedure Refer to Processing Guide 42100J1 Immunization Impacts None References EAS 401054 ACL No 1787 1834 Sunset Date This policy will be reviewed for continuance by 083121 Approval for Release Rick Wanne Director Eligibility Operations