DPSS ePolicy

Revision of existing policy and/or form(s)

What changed?

1. Pregnant applicants/participants receiving a Pregnancy Special Need (PSN) payment are required to be referred to the Home Visiting Program (HVP).
2. The following Notices of Action (NOAs) were revised:
   • M44-211L – Pregnancy Special Needs, Approve
   • M44-211N – Pregnancy Special Needs, Change
   • M82-820D – No Longer Eligible, Discontinue
3. The M44-211O – Discontinue Pregnancy Special Needs Payment for Pregnant Person Only Assistance Unit NOA was newly released.
4. Clarification is provided on submitting fraud referrals for fraudulent pregnancy verifications.

Note: Changes are shown highlighted in grey throughout the document.

PSN

Effective May 1, 2022, a pregnant person who is eligible for CalWORKs can also receive a PSN payment in the amount of $100 instead of $47 per month from the date of the PSN request as long as medical verification of the pregnancy is received. This includes:

1. An eligible pregnant person in an Assistance Unit (AU) with other aided members;
2. An eligible pregnant adult age 19 or older with no other eligible children in the home, otherwise known as a Pregnant Person Only (PPO) case; and
3. An eligible pregnant person with a child who receives Supplemental Security Income (SSI) or Foster Care payments.

PPO – Start of CalWORKs Eligibility

Effective July 1, 2022, PPO applicants are eligible for CalWORKs from the beginning of the first trimester instead of the second trimester. For detailed information refer to 82-836 Pregnant Person policy.

Medical Verification of Pregnancy Flexibilities

A medical verification of pregnancy remains a required condition of eligibility for PPO applicants and pregnant persons with other eligible children. However, effective July 1, 2021, AB 135 and AB 172 extended verification flexibilities to PPO applicants and pregnant persons with other eligible children who can satisfy the medical verification requirement temporarily by providing a written sworn statement or verbal attestation and meet the other CalWORKs Program requirements.

Senate Bill (SB) 1083

With the implementation of SB 1083 (Chapter 715, Statutes of 2022):

1. Staff is required to refer pregnant applicants/participants who are receiving the PSN payment to the CalWORKs HVP. As a result, the PA 6275/CW 2224, Home Visiting Program, form was created and must be provided to pregnant persons who are receiving the PSN payment. Although staff is required to refer pregnant persons, the participant is not required to participate in the HVP as it is a voluntary program.
2. Pregnant persons can satisfy the pregnancy verification requirement with a written or verbal statement for CalWORKs Homeless Assistance (HA) applications. The flexibility of providing a written or verbal statement was only applicable to CalWORKs applications due to the passage of AB 135. SB 1083 extended this flexibility to the CalWORKs HA applications. For more information on HA, please refer to 44-211.52 Temporary Homeless Assistance policy.

With the implementation of AB 135 (Chapter 85, Statutes of 2021):

1. The monthly PSN payment increased from $47 to $100 effective May 1, 2022;
2. Eligibility for PPO applicants begins at the beginning of the first trimester effective July 1, 2022, once the medical verification of pregnancy has been received; and
3. PPO applicants can satisfy the medical verification requirement temporarily by providing a written sworn statement or verbal attestation for PPO applicants effective July 1, 2021, as long as certain requirements are met.

With the implementation of AB 172 (Chapter 696, Statutes of 2021), pregnant persons with other eligible children can satisfy the medical verification requirement temporarily by providing a written sworn statement or verbal attestation effective July 1, 2021, and meet the other CalWORKs Program requirements.

Review the Verification Documents Section for guidance in relation to the verification flexibilities for PPO applicants and pregnant persons with other eligible children.

PSN

A supplemental monthly payment issued to all pregnant persons who have applied for or are receiving CalWORKs with eligible children from the date of their PSN request.

Effective May 1, 2022, the PSN payment is $100. The $100 PSN payment is in addition to the Maximum Aid Payment for the AU. 

Good-Faith Effort

When the applicant/participant:

1. Has attempted to comply with the requirement, but is having difficulty obtaining the requested document from a third party; and
2. Is unable to provide the medical verification due to circumstances beyond their control.

For instance, their doctor has not been able to schedule an appointment during the 30-day period.

Eligibility Requirements

To be eligible to a PSN payment, the applicant/participant must:

• Have a verified pregnancy; and
• Be eligible to receive CalWORKs and be included in the AU, if an applicant; or
• Be active in the CalWORKs AU, if a participant.

Note: Excluded Members are not eligible to a PSN payment because they are not part of the AU. Refer to 82-832 Excluded Member policy for details. 

Pregnant person age 19 or older

PPO applicant – Intake

• Eligible to receive CalWORKs because of the pregnancy at the beginning of the first trimester effective July 1, 2022; and
• Eligible to receive PSN payment from the CalWORKs eligibility begin date.

Pregnant person with other eligible children - Approved Cases

• Receiving CalWORKs in an AU with other eligible children for themselves, if eligible; and
• Eligible to receive PSN payment from the date of the PSN request date.
  
  Note: Verification of pregnancy remains a required condition of eligibility. 

Pregnant Teens

May be eligible to CalWORKs at any time during the pregnancy when the medical verification has been received. This includes:

• 18-year-old pregnant teens that have graduated high school or equivalent; and
• 19-year-old pregnant teens or younger that have not graduated high school or equivalent and therefore eligible to Cal-Learn.

Refer to 82-836 Pregnant Person policy for details.

PSN Requests

A participant can report a pregnancy and request a PSN:

• Mid period (in writing, via telephone, or in person);
• On the SAR 7, Eligibility Status Report; or
• At Renewal (RE).

PSN Payment Time Frames

When to start a PSN payment depends on:

• Whether the pregnant person is an applicant for or participant of CalWORKs;
• Whether a pregnant person is a teen or an adult;
• If others are aided in the AU; and
• The anticipated Date of Birth (DOB) of the child, also known as estimated delivery date.

New Applicant

A pregnant applicant (adult or minor) is eligible to receive PSN payments from the date of application, if they have applied for CalWORKs as:

• Part of an AU with at least one other eligible child; or
• The needy caretaker relative of a child that receives SSI/State Supplementary Payment (SSP), or Foster Care benefits (Kin-GAP, AB 110, Emergency Caregiver, Approved Relative Caregiver); or
• A PPO with no other eligible children. Refer to Eligibility Requirements Section for details.

Approved case

A pregnant participant in an AU, regardless of age, is eligible to receive PSN payments from the first of the month of the request once required verification has been received.

The PSN will continue:

• Through the end of the Semi-Annual Reporting (SAR) Payment Period in which the child is expected to be born; or
• Through the end of the month prior to the newborn being added to the AU. 

Refer to the Examples Section for details.

PSN Stop Date – Child Added to AU

PSN payment will stop:

• At the end of the SAR Payment Period in which the child is expected to be born once the required verification is provided; or
• At the end of the month prior to the month in which the newborn is added to AU, if the birth of the child is voluntarily reported mid-period.

Refer to the Examples Section for details.

Adding Newborns

The following rules apply when adding a newborn to the AU:

After the application, CW 8A – Statement of Facts for Children Under 16 or SAWS 2 PLUS – Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs, is completed and all other eligibility criteria are met, the newborn must be added to the CalWORKs AU effective the first of the:

• Month after the birth was reported, only if the addition results in an increase in benefits;
• Next SAR Payment Period following the SAR 7/RE on which the birth is required to be reported, if the addition results in a decrease or no change in benefits; or
• Month after the newborn has been released from the hospital, if the addition results in an increase in benefits in an Annual Reporting/Child Only (AR/CO) case.

Upon notification of the newborn’s name, DOB, and gender, the County must take action to approve Medi-Cal and issue a Medi-Cal card for the newborn effective the child’s DOB when the parent(s) has already been determined CalWORKs eligible and the newborn is a mandatorily included person.

Deemed Eligibility

Infants born to mothers who are eligible for and receiving Medi-Cal at the time of birth may be enrolled in Medi-Cal without an application. This is referred to as Deemed Eligible (DE). Medi-Cal eligibility for the DE infant must be established no later than ten calendar days after the birth is reported and is effective as of the first of the month of birth.

The birth of the newborn may be reported to the County via:

• MC 330 – Newborn Referral form;
• Telephone call;
• Letter;
• MEDS alert; or
• Any other contact with the County.

Only the following information regarding the infant must be provided to add the DE infant to Medi-Cal:

• Name;
• DOB; and
• Gender.

Refer to 40-103.44 Medi-Cal for CalWORKs Ineligible Members policy for details.

COVID-19

In response to COVID-19 and to assist Californians in meeting their basic needs, multiple Executive Orders temporarily suspended the requirement that medical verification of pregnancy had to be provided before approving benefits for PPO Intake cases; these COVID flexibilities were not applicable for Approved cases.

During this timeframe, a written sworn statement or verbal attestation was accepted in lieu of the medical verification as a result of the following Executive Orders:

• N-59-20: May 1, 2020 – June 30, 2020
• N-69-20: July 1, 2020 – August 30, 2020
• N-71-20: September 1, 2020 – December 31,2020
• N-08-21: January 1, 2021 - June 30, 2021

The temporary flexibilities ended when AB 135 and AB 172 were implemented on July 16, 2021, which provided permanent flexibilities when a pregnant person is unable to provide medical verification.

CalWORKs HVP

The CalWORKs HVP is a voluntary program administered by participating counties throughout California to support positive health, development, and well-being outcomes for pregnant and parenting individuals, families, and infants born into poverty.

As a result of the implementation of AB 135, effective July 1, 2022, pregnant persons may be considered eligible for CalWORKs during the first trimester of pregnancy. To be eligible for the HVP, an individual must meet both of the following criteria:

1. The individual is one of the following:
   • A member of a CalWORKs AU;
   • The parent or caretaker relative for a child-only case; or
   • An individual who is apparently eligible for CalWORKs (including those who are newly eligible because of their first trimester pregnancy).
2. The individual is:
   • Pregnant; or
   • A parent or caretaker relative of a child less than 36 months of age at the time the individual enrolls in the program.

Effective October 1, 2023, as a result of SB 1083 (Chapter 715, Statutes of 2022), pregnant persons receiving a PSN payment must be referred to the HVP upon case approval by providing the PA 6275/CW 2224 to the participant.

Note: This form is included in the CalWORKs Intake and RE packets sent to applicants/participants. When PSN is evaluated during SAR 7 or mid-period, the PA 6275/CW 2224 must be provided manually.

Pregnancy Verification

Medical verification of pregnancy is a required condition of eligibility for CalWORKs.

Option 1

Acceptable forms of pregnancy verification are:

1. Written statement from one of the following that includes the estimated delivery date.
   • Physician;
   • Physician’s Assistant;
   • Authorized member of a health facility;
   • State certified nurse mid-wife;
   • Nurse Practitioner; or
   • Designated medical or clinic personnel with access to the patients’ medical records.
2. Ultrasound or sonogram from a health clinic that contains:

Note: The verification must specify the pregnant person’s name and estimated delivery date.

Verification Exceptions Due to AB 135 and AB 172

Option 2

Pregnant applicants/participants who cannot provide medical verification (Option 1) at the time of application or when a pregnancy is reported (Approved cases) may submit a written sworn statement signed under penalty of perjury. An acceptable written sworn statement must include the following information: 

• Applicant’s/Participant’s name;
• Date of application (for PPO cases);
• Declaration of pregnancy;
• Date; and 
• Signature.

Option 3

A verbal attestation and a signed SAWS 2 PLUS are acceptable only when a written sworn statement cannot be provided. Question 6m on the SAWS 2 PLUS must be completed.

Note: Applicants/Participants who reported the pregnancy or provided a written sworn statement or verbal attestation must provide a medical verification of pregnancy within 30 working days following the declaration date or submittal of the sworn statement or verbal attestation for benefits to continue.

• If the medical verification is not provided within 30 working days from the date of the written sworn statement or verbal attestation and the participant is making a good-faith effort, then the PSN payments will continue; and a second 30-working-day period is granted.
• If the medical verification is not provided within 30 working days from the date of the written sworn statement or verbal attestation and the participant is not making a good-faith effort, then the PSN payment will be discontinued at the end of the month of the 30-day period and the M44-211O or M44-211N will be provided to the participant. 
• If the participant provides the verification after the PSN request was discontinued and NOA was sent, then the date the verification is received is considered a new request and the PSN payments may start in the month the new request/verification was received, if otherwise eligible.
• If the medical verification is not provided, and/or the pregnancy does not result in the birth of a child, then the PSN payment will be discontinued, and an overpayment will be established for any subsequently aided months.

Note: If a form or NOA is not available in the applicant’s/participant’s preferred language, the English form or NOA must be provided along with the GEN 1365, Notice of Language Services, and must be verbally translated in the applicant’s/participant’s preferred language using a telephone language interpreter or by bilingual staff, without undue delay. Staff must also offer free interpretive services to Non-English and Limited English Proficient applicants/participants and document in the case Journal whether services were accepted or rejected and the method of interpretation provided.

Additionally, should an applicant/participant provide any disability information, staff must offer a reasonable accommodation. Staff must also review the case information to determine if any reasonable accommodations exist.

Eligibility Worker (EW) failure to request verification

If the EW fails to request a pregnancy verification, then the participant is entitled to PSN payments for the previous months when they reported the pregnancy, no matter when the pregnancy verification is signed or when it was submitted.

Pregnancy continues beyond estimated delivery date

The participant is required to verify pregnancy initially (when the pregnancy is reported) and when the pregnancy continues beyond the estimated delivery date.

PPO applicants applying for Immediate Need (IN) or Homeless Assistance (HA)

PPO applicants who are unable to provide medical verification of pregnancy at the time of application are allowed to provide a written sworn statement or verbal attestation of their medical verification in order to be determined eligible for IN or HA.

Reporting Requirements – Loss of Child

Any time a pregnancy does not result in the birth of a child, CalWORKs participants are required to report, verbally or in writing, within 30 calendar days following the end of their pregnancy.

When pregnancy ends due to the loss of a child, the case is discontinued at the end of the month following the month in which the loss was reported with timely and adequate notice. For example, the loss occurred on November 28, the case should be discontinued end of December.

Mental Health Referral

In these instances, staff must provide information about, and a referral to, mental health services, including but not limited to, services provided by the Department of Mental Health (DMH) that include grief and loss resources.

The information about mental health services must be provided to the participant either by:

1. Providing the DMH 24/7 Help Line number: (800) 854-7771; or
2. Providing the DMH web address: https://dmh.lacounty.gov/resources/grief-loss/

Overpayment

CalWORKs eligibility stops at the end of the month of the 30-working-day period with timely and adequate notice when medical verification is not provided within the 30-working-day period and there is no good-faith effort.

In situations where the benefits continue beyond the end of the month of the 30-working-day period, an overpayment will be established for any ineligible month. The PSN payments will resume upon receipt of medical verification of pregnancy effective the month in which the verification was provided.

Example: A pregnant participant with an active CalWORKs case has a due date of January 5 to provide pregnancy verification. They fail to provide the pregnancy verification by the due date and the system fails to terminate the PSN payment timely by end of January and issued PSN for February and March. An overpayment will be created to collect the PSN payments for each additional month (February -March).

Loss of Child

If the participant fails to report the loss within 30 calendar days and benefits continued, an overpayment must be established according to current policies for any subsequently aided months.

Example: A participant with an active CalWORKs case has a pregnancy due date of June 1. The participant lost the child on January 2 and continued receiving the PSN payments. During the RE in April, the participant reports the loss which should have been reported by February 2 (30 calendar days). Eligibility includes the month in which the loss occurred and the month after. As such, in this instance, the case should have been discontinued February 28. As a result, the EW informs the participant that the overpayment will be established to collect the PSN payments for March-April.