County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Medical Support Enforcement Program Number Page 041801 1 of 2 Revision Date 11012018 Background Title IVD of the Social Security Act established the child and spousal support enforcement program Legislative changes in the Federal Deficit Reduction Act of 1989 the Consolidated Omnibus Budget Reconciliation Act of 1985 and the Omnibus Budget Reconciliation Act of 1987 required that MediCal applicants and beneficiaries must cooperate in medical support enforcement as a condition of eligibility Effective July 1 1993 applicants and beneficiaries requesting MediCal for a child born out of wedlock see MPG 041806 for Voluntary Declaration of Paternity or with an absent parent must cooperate by assigning to the State the applicantsbeneficiaries medical support rights and payments establishing paternity and providing information on the absent parent or any third party liable for medical support In addition to the reformatting this section has been updated to include policy previously issued in Memo 1508 Purpose This section provides an overview of medical support enforcement requirements Policy Applicants and beneficiaries must cooperate in medical support enforcement as a condition of eligibility Three agencies are involved in San Diego Countys ChildMedical Support Enforcement Program The three agencies are 1 the Health and Human Services Agency HHSA 2 the Local Child Support Agency LCSA and 3 the Office of Revenue Recovery RR The duties and responsibilities of each agency are as follows A Health and Human Services Agency HHSA Informs each MediCal applicantbeneficiary of their support rights and responsibilities Provides and explains the necessary forms Reviews completed forms and Refers to the LCSA for child support action B Local Child Support Agency LCSA Locates absent parents Establishes through court action paternity and the absent parents support obligation Initiates through court action childspousal support collection activities Prosecutes absent parents for nonpayment of childspousal support obligations C Office of Revenue Recovery ORR Establishes the account for collection of a support obligation and Maintains the records for collection of the support obligations Procedure None County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Medical Support Enforcement Program Number Page 041801 2 of 2 References MEM 50185 ACWDL 1125 County Policy Sunset Date This policy will be reviewed for continuance by 11302021 Approval for Release Rick Wanne Director Eligibility Operations County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Condition of Eligibility Number Page 041802 1 of 2 Revision Date 11012018 Background Title IVD of the Social Security Act established the child and spousal support enforcement program Legislative changes in the Federal Deficit Reduction Act of 1989 the Consolidated Omnibus Budget Reconciliation Act of 1985 and the Omnibus Budget Reconciliation Act of 1987 required that MediCal applicants and beneficiaries must cooperate in medical support enforcement as a condition of eligibility In addition to the reformatting this section has been updated to include policy previously issued in Memo 1508 Purpose This section provides guidelines regarding medical support enforcement as a condition of eligibility Policy A Condition of Eligibility The applicantbeneficiary requesting MediCal for a child born out of wedlock or with an absent parent must be informed that as a condition of eligibility they must Assign to the State the applicants or beneficiarys rights to any medical support and payments Cooperate in obtaining medical support and payments Cooperate in establishing paternity for a child born out of wedlock for who aid is requested Cooperate in identifying and location the absent parent and Provide information about possible entitlement to medical support and payments available through any third party The Support Packet is not required prior to an eligibility determination MediCal benefits shall not be delayed if the applicantbeneficiary is otherwise eligible An individual who refuses to cooperate without good cause will be discontinued after allowing 30 days to provide This will not affect the childrens MediCal eligibility B Cooperation Cooperation includes the following Provide the name of the alleged or absent parent along with other known information such as o Address o Social Security number o telephone number o place of employment o school o names and addresses of relatives or associates Appear at interviews hearing and legal proceedings when adequate notice of the interview is provided MediCal applicantsbeneficiaries must have good cause for failure to appear If paternity is an issue submit to genetic test including tests of child if necessary Provide any additional information reasonably obtainable by the applicant or beneficiary necessary to establish paternity or to establish modify or enforce a child support order County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Condition of Eligibility Number Page 041802 2 of 2 An applicantbeneficiary is not required to sign a voluntary declaration as a condition of cooperation Procedures None References MEM 50379 Letter 200 Sunset Date This policy will be reviewed for continuance by 11302021 Approval for Release Rick Wanne Director Eligibility Operations County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Medical Support Referrals Number Page 041803 1 of 3 Revision Date 11012018 Background HHSA must take certain appropriate actions to complete medical support referrals The applicantbeneficiary is required to cooperate by providing all the information necessary to enable the Human Services Specialists HSS to complete medical support referrals In addition to the reformatting this section has been updated to include policy previously issued in Memo 1508 Purpose This section provides guidelines regarding medical support referrals Policy A Medical Support Referral Required Although the submission of the support packet is not required to determine eligibility at application request that the applicantbeneficiary complete the packet If the completed packet is not received MediCal benefits are not to be delayed if the applicantbeneficiary is otherwise eligible A referral is completed when an individual applies for MediCal on behalf of a child Who is born out of wedlock or Not residing with one or both parents or Whose parents are unmarried but living together and paternity has not been established B Medical Support Referral Not Required A referral is not required for the following Children over 18 years old Undocumented children OBRA Pregnant women and their other eligible children until the end of the 60day postpartum period Applicants for minor consent services Children in Foster Care or Adoptive Aid Programs Children removed from parental custody by court order Applications for retroactive MediCal only Situations where the absent parent is incarcerated or institutionalized Situations where the absent parent is already providing health insurance a referral is needed if the health insurance is later terminated unless paternity must be established Adult Children Adult children are children between the ages of 14 to 18 years who are not living in the home of a parent or caretaker relative and who do not have a parent caretaker relative or legal guardian handling any of their financial affairs The parents do not claim the children as dependents in order to receive a tax credit or deduction for state or federal income tax purposes Transitional MediCal or FourMonth Continuing MediCal Cases If a Medical Support Referral was completed at intake no referral is required at redetermination County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Medical Support Referrals Number Page 041803 2 of 3 C Referral Forms The applicantbeneficiary is required to provide all the information necessary to complete the following forms The forms must be signed by the applicantbeneficiary and filed in the case record 1 CW 21 Child Support Notice and Agreement The CW 21 Notice Agreement is to be used with the CW 21 Q Support Questionnaire The Notice Agreement explains the assignment of the support the benefits of Child Support Enforcement cooperation requirements the Attestation Statement and the right to claim good cause CW 51 Additional explanation of how to claim good cause is provided on the reverse side of the form The CW 21 Notice Agreement is to be completed by all applicants or beneficiaries in absent parent and paternity cases One CW 21 is required for each absent parent In cases with more than one absent parent modify the Agreement Section of the form by notating the name of each absent parent on each CW 21 Notice Agreement 2 CW 21 Q The CW 21 Q Support Questionnaire is completed and signed by the applicantbeneficiary in all absent parent and paternity cases It is completed on each absent parent or when the unmarried father is in the home and aid is requested for the common children Retain a copy in the case file Note The CW 21 Q is not completed if a good cause determination is pending CW 51 3 CW 371 Referral to the Local Child Support Agency LCSA The LCSA is required to conduct an interview with each applicant to obtain the necessary information to establish paternity To ensure this requirement is met the LCSA coordinates phone interviews with applicants 4 CW 51 Good Cause Claim and Determination Transmittal Form CW 51 is completed when the customer claims good cause for refusal to cooperate with LCSA in child support matters See MPG 041804 for Good Cause Procedures D Referral Procedures Follow the steps below to process a referral at intake Step Action 1 Explain that as a condition of eligibility the customer is required to cooperate with the LCSA by providing information appearing at the LCSA office when requested appearing as a witness in court and obtaining support or provide documentation to substantiate a claim of good cause for refusing to cooperate if they claim good cause 2 Obtain information from the applicant to complete the CW 21 and the CW 21 Q for each absent parent or unmarried father in the home 3 Enter all the information received in CalWIN so that an accurate referral is sent electronically to the LCSA Note It is no longer necessary to forward paperhard copies of the CW 371 CW 21 and CW 21 Q to the LCSA at application New applications changes in case status updates of demographic County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Medical Support Referrals Number Page 041803 3 of 3 information or Good Cause when entered in CalWIN will create an electronic referral to the LCSA through the Child Support Enforcement CSE System The only transaction referrals that are not sent electronically are Termination of Parental Rights TPRs E LCSA Service Request Through the existing interface between CalWIN and CSE the LCSA receives Electronic Service Requests SRs that must be processed within 20 calendar days LCSA has three options to process the incoming SRs Reject the SR in CSE with a complete explanation of why it was rejected including referral to HHSA for updates if needed Update the existing case in CSE Open a new case and reopen closed case in CSE Within 10 days of openingreopening a LCSA case the HSS will contact the Custodial Parent CP by phone or letter to conduct an intake interview using the phone number and address listed in CalWIN CPs failure to respond to LCSAs request will result in NonCooperation NonCoop status NonCoop andor Rescission of NonCoop status are requested electronically via the interface between the LCSA and CalWIN as well as by LCSA to HHSA through a designated Supervisor Program Impacts Automation CalWIN sends an electronic referral to the statewide Child Support Enforcement CSE system as entries are entered in the Absent ParentChild Support screens References MEM 50185 MEM Ltr 200 202 MEM Proc 23D ACWDL 9569 Sunset Date This policy will be reviewed for continuance by 11302021 Approval for Release Rick Wanne Director Eligibility Operations County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Medical Support Enforcement Good Cause Number Page 041804 1 of 4 Revision Date 11012018 Background The applicantbeneficiary may claim good cause for noncooperation in establishing paternity medical support payments or identifying third party liability if heshe feels there is a risk of emotional or physical harm to himselfherself or a children if a referral is made This section has been updated to the current format no other changes have been made Purpose This section provides guidelines for establishing good cause when an applicantbeneficiary fails to cooperate with Medical Support Enforcement requirements Policy When good cause is claimed MediCal is granted pending the good cause determination if the applicant is otherwise eligible If the applicant chooses to withdraw or cancel a good cause claim the MediCal application is withdrawn or aid is discontinued before the final determination is completed A Good Cause Exists The county must determine if the applicantbeneficiary in fact has good cause for failure to cooperate with medical support requirements Good cause exists if Efforts to establish paternity or establish modify or enforce a support obligation would increase the risk of physical sexual or emotional harm to the child for whom support is being sought Efforts to establish paternity or establish modify or enforce a support obligation would increase the risk of physical sexual or emotional harm to the child for whom support is being sought The child for whom support is sought was conceived as a result of incest or rape A conviction of incest or rape is not necessary for this reason to apply Legal proceedings for the adoption of the child are pending The applicantbeneficiary is being assisted to resolve the issue of whether to keep or relinquish a child for adoption The applicantbeneficiary is cooperation in good faith but is not able to identify or assist in locating the alleged father or absent parent Any other reason that would make efforts to establish paternity or establish modify or enforce a support obligation contrary to the interest of the child B Claiming Good Cause To claim good cause the applicantbeneficiary must 1 Provide a written statement specifying the circumstances that the individual believes provides sufficient good cause for not cooperating and provide sufficient information such as the absent parents name and address to permit an investigation 2 Provide evidence that supports the claim of good cause within 20 days County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Medical Support Enforcement Good Cause Number Page 041804 2 of 4 3 Make a request if additional time is needed because of difficulty in obtaining the evidence A reasonable additional period of time will be allowed with approval from a supervisor Document the request and approvaldenial in the case file C Supporting Evidence Evidence supporting a claim of good cause includes Police governmental agency or court records documentation from a domestic violence program or a legal clerical medical mental health or other professional from whom the applicantbeneficiary has sought assistance in dealing with abuse physical evidence of abuse or any other evidence that supports the claim of good cause Statements under penalty of perjury from individuals including the applicantbeneficiary with knowledge of the circumstances surrounding the good cause claim Birth certificates or medical mental health rape crisis domestic violence program or law enforcement records that indicate that the child was conceived as the result of incest or rape Court documents or other records that indicate legal proceedings for a pending adoption A written statement from a public or licensed private adoption agency that the applicant or beneficiary is being assisted by the agency to resolve the issue of whether to keep the child or relinquish the child to adoption D ApplicantBeneficiary Requests Assistance If requested Advise the applicant or beneficiary of how to obtain the necessary evidence andor make a reasonable attempt to obtain the specific information if the applicant or beneficiary is unable to without assistance Contact with the absent parent or putative father will not be made unless necessary to establish a good cause claim The applicantbeneficiary must be informed that the absent parent or putative father may be contacted unless they present evidence to support the claim of good cause withdraw the application or request discontinuance If a claim is based on the individuals anticipation of physical harm and evidence is not submitted make reasonable efforts to examine review and evaluate the good cause claim when o The claim is credible without corroborative evidence and o Evidence is not available Note Good cause can be found if the applicants statement and the investigation documents that the individual has good cause for refusing to cooperate Procedure E Good Cause Determination Process CW 51 Form 1 ApplicantBeneficiary Responsibility If the individual chooses to claim good cause for refusing to cooperate a CW 51 form must be completed Request the individual to indicate by checking the appropriate box the reason for the claim Obtain the individuals signature Enter the case name and number names and birthdates of the children and the absent parents name in the CountyUseonly section upper righthand corner County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Medical Support Enforcement Good Cause Number Page 041804 3 of 4 a Instruct the individual to provide documentation of the good cause claim per instructions on the reverse of the CW 21 Notice Agreement within 20 days b Proceed to grant the case with the parentcaretaker relative in the MFBU if otherwise eligible c If unable to obtain all the necessary documentation for the Good Cause Determination during the time the case is assigned to Intake complete the procedure to the fullest extent possible and indicate in the narrative that the Good Cause Determination is pending d The individuals statement is required to specify the circumstances heshe believes provide sufficient reason to claim good cause for not cooperating further Attach the statement to the CW 51 2 HHSA Responsibility If the individual requests more information about child support activities prior to claiming good cause heshe may be referred to LCSA for an information only interview A referral will be made by sending a CW 371 The good cause determination must be completed in 45 days This time standard may be extended in exceptional cases when the individual requests additional time because of difficulty in obtaining the evidence A reasonable additional period of time can be allowed with the approval of a supervisor The individual submits the request for additional time in writing for approval or denial by a supervisor The written request must be kept in the case file Justification for additional time must be fully documented in the case comments When all available documentation is obtained and a good cause claim is based on physical harm to either child or parent follow the steps below Step Action 1 Complete the Evidence Provided section of the CW 51 form on all cases and Check off No Investigation Acceptable evidence is identified on the back of the CW 21 Notice Agreement 2 Make a referral to the appropriate agency if the individual inquiries about or claims good cause for noncooperation with the LCSA or otherwise indicates that they or their children are at risk of abuse 3 Attach any supporting documentation to the form CW 51 and forward to the supervisor The supervisor will review and forward to the FRC Manager for the Proposed and Final determination to establish good cause existsdoes not exist Note The HSSs will not forward the form CW 51 to the LCSA for the Proposed Determination The Manager completion is considered sufficient 4 The Manager will sign the CW 51 and return the entire packet to the HSS Retain a copy in the case record Determine eligibility and send appropriate NOA County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Medical Support Enforcement Good Cause Number Page 041804 4 of 4 Once good cause is established it continues unless the parentcaretaker parent rescinds the claim for good cause and is able to cooperate with medical support enforcement Review at redetermination to see if circumstances have changed it is not necessary to process another claim for good cause F Good Cause Does Not Exist When good cause does not exits Step Action 1 Complete and send Good Cause Determination for Child Support Enforcement Denial NOA 07292 informing the customer of the denial of the good cause claim 2 Inform the applicant that there will be a referral to the LCSA and the applicant will be given the opportunity to cooperate The applicant also has the option to withdraw the application for aid or to have the case closed The applicant is to be informed that continued refusal to cooperate will result in ineligibility of hisher MediCal however the childrens MediCal will continue 3 Notify the LCSA using the existing referral procedures in MPG 041803 and the following forms CW 371 CW 51 and CW 21 Q and CW 21 4 Review the cooperation determination from LCSA and verify the evidence that the applicantcustodial parent failed or refused to cooperate without good cause If this is the case the applicant will be discontinued from MediCal This determination does not affect the eligibility of the children Procedures in MPG 041805B will be used for applicants determined noncooperative by LCSA Program Impacts None References ACWDL 1125 MEM 507715 Sunset Date This policy will be reviewed for continuance by 11302021 Approval for Release Rick Wanne Director Eligibility Operations County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Assignment of Medical Support Rights Number Page 041805 1 of 2 Revision Date 11012018 Background Assignment of Support Rights means that upon receipt of MediCal the individual agrees to transfer all medical support rights to the county The County Office of Revenue Recovery ORR will collect and forward to HHSA Fiscal Division all medical support money as long as the individual remains on MediCal This section has been updated to the current format no other changes have been made Purpose To provide policy guidelines for the assignment of medical support rights Policy As a condition of eligibility each beneficiary is required to assign support rights and to cooperate with the HHSA and the Local Child Support Agency LCSA A Cooperation Requirements Assignment of Support Rights An applicant will be presumed to be cooperative with LCSA when heshe completes the required forms and the referral is made to the LCSA Refusal to Assign Support Rights Intake If the parentrelative caretaker does not wish to or refuses to agree to the assignment of medical support rights heshe must make refusal in writing on the CW 21 Notice Agreement or provide a separate statement to this effect When written refusal is made the parentrelative caretaker is an ineligible member of the MFBU Continue referral to LCSA by making appropriate entries in CalWIN Continuing For granted cases if a beneficiary contacts HHSA and indicates hisher refusal to assign medical support request they provide a written statement Within timely notice limitations the noncooperative parentrelative caretakers is determined ineligible to MediCal LCSA will continue to pursue the absent parent for the payment of a medical support contribution When a contribution is secured it will go directly to ORR Procedure B NonCooperation LCSA Determination When the LCSA indicates that a customer has not cooperated and has not established good cause for failure to cooperate LCSA will notify HHSA by entering a Noncooperation Status in the Child Support Enforcement System CSE which will generate a Child Support Noncooperation Alert in the CalWIN system HHSA Determination Review the Child Support Noncooperation Alert in the CalWIN and verify whether the beneficiary failed to cooperate and whether heshe had good cause for hisher failure LCSAs standardized responses and the good cause actions required are as follows County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Number Page Assignment of Medical Support Rights 041805 2of 2 Refuses to appear for appointment Make an effort to contact the client by phone If no contact then send a timely NOA and remove the caretaker from the MFBU If contact is made within this timeframe or prior to discontinuance a good cause determination must be completed Refuses to provide verbal written or documentary information Follow the guidelines for noncooperation with Medical Support Note Send NOA which advises the beneficiary that hisher MediCal will be restored when heshe cooperates with LCSA Removal of Child Support Noncooperation Once the beneficiary reestablishes cooperation with the LCSA the LCSA Officer will enter in the CSE system a Cooperation Status which will generate a Child Support Cooperation Alert in the CalWIN system Immediately reinstate MediCal eligibility the month cooperation was obtained C Disagrees with LCSA Determination When determined that the beneficiary has cooperated to the fullest extent possible or has good cause for refusing to cooperate Obtain a sworn statement in which the beneficiary explains the circumstances surrounding the noncooperation determination by the LCSA or the reasons heshe cannot cooperate or believes heshe cannot cooperate Obtain verifications whenever possible Submit all documents to Manager for review Managers Review If the Manager determines that the beneficiary is Noncooperative then follow HHSA determinations for actions taken Cooperating to their fullest ability then no action is to be taken to delete the parentrelative caretaker from the budget and the beneficiary is considered cooperative Program Impact None References MEM 507715 ACWDL 9822 0508 1604 Sunset Date This policy will be reviewed for continuance by 11302021 Approval for Release Rick Wanne Director Eligibility Operations County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Voluntary Declaration of Paternity Program Number Page 041806 1 of 2 Revision Date 11012018 Background Effective January 2 1997 unmarried parents applying for MediCal are informed of the availability of the voluntary declaration of paternity and given the option of both signing the forms to establish paternity In addition to the reformatting this section has been updated to include information previously issued in Memo 1508 Purpose To provide guidelines for a voluntary declaration of paternity Policy Unmarried parents have the option to voluntary declare paternity The support packet is not required prior to granting MediCal eligibility A Choose Not to Sign When unmarried parents choose to voluntary declare paternity and not sign the declaration of paternity they must still cooperate with the LCSA in establishing paternity for MediCal eligibility purposes B Paternity Opportunity Program POP The Paternity Opportunity Program POP is a statewide database which is administered by the Department of Child Support Services DCSS and processes voluntary declarations of paternity A declaration signed by both the biological father and the unmarried mother filed with the DCSS establishes a legal parentchild relationship between the father and the child Effective May 3 2002 it became mandatory for the LCSA to review this database prior to filing any court action in child support cases The name of the absent parent listed on the CW 21 Q or electronic referral through the interface must match the POP database in order for the court action to proceed When the parents volunteer paternity and there is no conflicting information forms must be signed by both parents and witnessed by HHSA Appropriate entries must be made in CalWIN to electronically refer correct information to the LCSA who reviews the POP database DCSS will forward the declaration to the State Office of Vital Records in Sacramento After 60 days the Declaration of Paternity will have the same force and effect of law as a judgment rendered by a court No DCSS referral for paternity establishment should be made if the Declaration is signed by both parents C FRC Medical Support Liaison Each FRC office will designate a Supervisor to serve as the Medical Support Referral contact person for their office DCSS will return incomplete or incorrect referrals received from district staff to the supervisor designated as the Medical Support Referral Liaison County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Voluntary Declaration of Paternity Program Number Page 041806 2 of 2 Any questions related to medical support should be discussed with their respective supervisor and not with DCSS ORR or Fiscal Services D Conflicting Information In the event there is a discrepancy the LCSA will return the CW 21 Q to the FRC Child Support Liaison for action and followup The customer is required to provide information necessary to complete a new CW 21 Q listing the absent parents name as indicated on the POP database The revised CW 21 Q is then to be forwarded to LCSA at Mail Stop C77 ATT Case Intake The customers failure to provide new information necessary to complete a new CW 21 Q or electronic referral through the interface if POP information is disputed does constitute noncooperation with the LCSA and action will be taken to discontinue the customer after allowing 30 days to provide E Minor Parents When either parent is a minor the Declaration of Paternity does not establish paternity until 60 days after the minor parent or if both parents are minor then both parents is are emancipated or 60 days after the 18th birthday of the minor parents whichever occurs first F Unmarried Father Residing in the Home When the unmarried father is in the home and aid is requested for the common children still complete all the entries in the Absent ParentChild Support Screens in order to generate the information through the interface to the Child Support Enforcement System CSE Although in the home the parents will sign the CW 21 and the CW 21 Q Add the CW 21 CW 21 Q to the case file Procedure None Program Impact None References MEM 507715 ACWDL 9822 0508 1604 Sunset Date This policy will be reviewed for continuance by 11302021 Approval for Release Rick Wanne Director Eligibility Operations