County of San Diego Health and Human Services Agency HHSAMediCal Program Guide Number Page Diligent Search 040901 1 of 4 Revision Date 11012020 Background The diligent search process involves the search for an applicants identity available income and available resources when the applicant is unable to assist in the application process Purpose This section provides criteria for processing an application using a diligent search It has been updated to provide additional ways to verify income property and updated presumed age aid codes Policy Diligent search is completed on all MediCal 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 0402 No action is taken on the application until a determination of ineligibility has been established or the diligent search and a referral to the State ProgramsDisability Determination Services Division SPDDSD if appropriate have been completed 040901A Diligent Search Overview The diligent search process requires the following actions 1 Determine and document the applicants competence 2 Refer to the SPDDSD 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 applicants to the Public AdministratorPublic Guardian if appropriate 040901B Determine and document applicants competency MediCal applicants who in the judgment of the Human Services Specialist HSS are unable to adequately respond to routine questions asked as part of the eligibility determination process should be considered incompetent The determination of incompetence is based on the HSSs judgment A determination of incompetence is not a legal or medical determination See MPG 040205B for steps to take when conducting a determination of incompetence Most referrals from a hospital which will require a diligent search process involve persons who are deceased comatose or have amnesia The determination of incompetence is noted in case comments The confirmation of the HSSs determination of incompetence is stated in writing by the confirming person and stored in the case file 040901C Refer for a Disability Determination A referral to the SPDDSD 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 HSS 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 MediCal Regarding Disability are completed with all available information County of San Diego Health and Human Services Agency HHSAMediCal Program Guide Number Page Diligent Search 040901 2 of 4 040901D Diligent 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 persons identity remains unknown HSSs are to document in the case comments 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 040901E Diligent Search Income and Property For applicants whose identity is known conduct a diligent search to include the following MediCal Eligibility Data System MEDS search by Social Security Number SSN or if the SSN is not available by name and county Verification of Social Security benefits via Income and Eligibility Verification System IEVS abstract or by calling 18007721213 Verification of Veterans Administration benefits via form MC05 Verification of wage Unemployment InsuranceDisability Insurance UIDI information via the IEVS abstract Bank statements which show an automatic deposit which identifies the source of the income Additional thirdparty contacts must be fully documented in case comments Verification of vehicle registration through written request to the Department of Motor Vehicles Property search via County Assessors Office website or by calling the County Assessors Office to determine if the applicant has any real property in San Diego County If the personal effects of the individual indicate an account at a specific banking institution use form CW 60 Release of InformationFinancial Institution to request information from the banking institution to search for all accounts belonging to the person If the banking institution confirms that the customer owns stocks bonds or mutual funds contact a recognized stock exchange broker to determine their current sales value or establish the current selling price through listings in a current newspaper If information contained in the personal effects for example a passbook or check register provides an account balance use this information in determining eligibility If the bank refuses to provide the requested information document the effort in the case comments Identify the existence of any interestbearing accounts via IEVS abstract When requesting any of the above information include a cover letter indicating the circumstances detailing that the person is comatose or deceased and therefore cannot sign a release of information form Also include that there is no person authorized to act on behalf of the customer and the County is trying to establish the individuals MediCal eligibility 040901F 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 Consider residency requirements to be met in the absence of information to the contrary Only the income and resources discovered through the diligent search will be considered available If the individual deemed incompetent is the only person who has access to the income or resources then these accounts should be considered as unavailable until the HSS is notified otherwise Restrictedlimited scope benefits will be granted if unable to obtain acceptable citizenshipidentity documents and prove Satisfactory Immigration Status SIS or citizenship status at the end of the diligent search process County of San Diego Health and Human Services Agency HHSAMediCal Program Guide Number Page Diligent Search 040901 3 of 4 Upon completion of the MediCal eligibility determination resulting from the diligent search process the Supervising Human Services Specialist SHSS approves the HSSs determination by countersigning the Statement of Facts 040901G Refer to Public AdministratorPublic Guardian A referral to the Public AdministratorPublic Guardian is made when the diligent search results in A denial of MediCal benefits because the applicant was found to have excess property The applicant was found to have real property which must be utilized No individual is authorized to act on behalf of the applicant Refer to Health and Human Services Agency HHSA Public Guardian website to submit online investigation referrals If deceased submit an online investigation referral to HHSA Public Administrator 040901H Acting on Changes At any time during the application process if the persons condition changes or a friend or relative is found so that MediCal eligibility information can be obtained in the usual manner then the diligent search efforts stop The case record is updated to reflect the persons verified identity and eligibility status Also previously disregarded income and property will need to be reviewed for availability If the Person Remains eligible and a MediCal Client Index Number CIN has been assigned Is found to be ineligible Then Retain the CIN and update the aid code if there is a change in eligibility status Discontinue the case with timely and adequate notice Note If the friend or relative is unable to supply the information or is noncooperative then they do not meet the representative criteria and the diligent search effort continues Refer to MPG 040205 Procedure 040901I Processing Diligent Search Cases 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 persons name is unknown use either John C Doe or Jane C Doe for the case name 2 Aid Codes if the age is unknown use the following to determine the MediCal aid code If the individuals age appears to be Under 21 Over 2164 Over 2164 and in an Intermediate Care FacilitySkilled Nursing Facility ICFSNF 65 or over Then use aid code 82 38 53 14 17 or 13 when in ICFSNF 3 Birth Date if unknown use 01 for the month and 01 for the day use the following for the year of birth County of San Diego Health and Human Services Agency HHSAMediCal Program Guide Diligent Search If the estimated age is Under 21 Between 21 and 64 65 or over Number Page 040901 4 of 4 Then use Current year minus 10 years Current year minus 40 years Current year minus 70 years 4 Social Security Number if unknown leave blank A pseudo number is assigned by MEDS 5 Health Insurance Claim Number if unknown leave blank 6 Address since MEDS will produce a reject message if the address field is blank use the address of the Family Resource Center FRC in which the case is being processed Program Impacts None References ACWDLs 9462 0228 1111 1217 MEPM 4I 22C 22C1 22C7 MEDILs 2033 2033E Sunset Date This policy will be reviewed for continuance by 11302023 Rick Wanne Director Eligibility Operations