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