County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Diligent Search Number Page 040901 1 of 4 Revision Date 09012019 Background The diligent search process involves the search for an applicants available income and resources when the applicant is unable to assist in the application process This section is being updated to align with the MPG 0402 Purpose This section provides criteria for processing an application using a diligent search 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 DDSD if appropriate have been completed A Diligent Search Overview The diligent search process requires the following actions 1 Determine and document applicants competence 2 Refer to the State ProgramsDisability and Adult Programs Division 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 B Determine and document applicants competency MediCal 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 incompetence is based on workers 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 obtain a written confirmation of hisher determination of incompetency by either the hospital social worker or other medical personnel The determination of incompetence is noted in the case narrative The confirmation of the workers determination of incompetence is stated in writing by the confirming person and filed in the case file C 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 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 County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Diligent Search Number Page 040901 2 of 4 and Transmittal and MC 223 Statement of Facts for MediCal Regarding Disability are completed with all available information D Reasonable SearchIdentity 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 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 E Reasonable Search Income and Property For applicants whose identity is known 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 IEVS abstract or by calling 18007721213 3 Verification of Veterans Administration benefits via Form MC05 4 Verification of wage UIDI information via the IEVS abstract 5 Verification of vehicle registration through written request to the Department of Motor Vehicles 6 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 7 If the personal effects of the individual indicate an account at a specific banking institution request the bank to search for all accounts belonging to the person If the bank refuses to provide the requested information document the effort in the case narrative If information contained in the personal effects eg passbook or check register provides an account balance use this information in determining eligibility When requesting any of the above information include a cover letter indicating the circumstances ie 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 MediCal eligibility F 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 search will be considered available If the incompetent individual is the only person who has access to the income or resources these accounts should be considered as unavailable until the worker is notified otherwise Restrictedlimited scope will be granted if unable to obtain acceptable citizenshipidentity documents and prove legal residence or citizenship status at the end of the diligent search process Upon completion of the MediCal eligibility determination resulting from the diligent search process the Eligibility Supervisor approves the workers determination by countersigning the Statement of Facts County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Diligent Search Number Page 040901 3 of 4 G Refer to Public AdministratorPublic Guardian A referral to the Public AdministratorPublic Guardian is made when the diligent search results in the denial of MediCal benefits because the applicant was found to have excess property the applicant found to have real property which must be utilized no individual authorized to act on behalf of the applicantbeneficiary Refer to HHSA Public Guardian website to submit online investigation referrals If deceased submit online investigation referral to HHSA Public Administrator H Acting on Changes At any time during the application process if the persons condition changes or a friend or relative is found so that information can be obtained in the usual manner the diligent search efforts cease The case record is updated to reflect the persons true identity and eligibility status Also previously disregarded income and property should be considered available If the Person Action Remains eligible and a MediCal 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 Note If the friend or relative is unable to supply the information or is noncooperative they do not meet the Representative Key Person criteria and the diligent search effort continues Refer to MPG 040205 Procedure I 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 And Then use aid code Under 21 82 Between 21 and 64 DDSD has been denied 53 if in an Intermediate Care FacilitySkilled Care Facility ICFSNF If not in ICFSNF then deny DDSD is approved 64 67 or if in LTC use 63 65 or over 14 17 or 13 when in LTC County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Diligent Search Number Page 040901 4 of 4 3 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 minus 10 years Between 21 and 64 Current year minus 40 years 65 or over 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 FRC in which the case is being processed Program Impacts None References ACWDLs 1111 1217 MEPM 4I 22C 22C1 22C7 Sunset Date This policy will be reviewed for continuance by 09302022 Approval for Release Rick Wanne Director Eligibility Operations