DPSS ePolicy

Revision of existing policy and/or form(s)

What changed?

1.  A SharePoint site has been developed to track referrals sent to Federally Qualified Health Centers (FQHCs).
2. The listing of FQHCs has been updated.
3. The listing of Department of Health Services (DHS) sites has been updated.
4. The Appointment Scheduling Representative (ASR) listing has been updated.
5. Instructions have been removed for staff to manually create a task to control receipt of the medical verification.
6. Updated instructions when updating the General Relief (GR) Health Assessment List page in California Statewide Automated Welfare System (CalSAWS) when there is an existing record. Entering a new record will automatically end the existing record one day prior to the new record’s date. 
7. Additional instructions have been added for the Eligibility Supervisors (ES) to monitor the FQHC SharePoint for referrals.
8. Updated instructions have been added to run GR and CalFresh together when running Eligibility Determination and Benefit Calculation (EDBC) when there is an active CalFresh segment.

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

A Medical Unemployable (aka Unemployable) status is a designation for an applicant/participant who is unable to work because of a physical health condition that prevents them from working or participating in employment related activities. Applicants/participants with a Medical Unemployable status are exempt from some GR Program requirements, including participating in the Skills and Training to Achieve Readiness for Tomorrow (START) Program and meeting work requirements.
 
GR applicants/participants who declare that they are not able to work because of a physical health condition may need a Physical Health Assessment (PHA) referral. The PHA is an assessment done by a medical health care provider to determine whether the individual’s physical health condition prevents them from working or participating in employment related activities.
 
GR applicants who disclose that they are not able to work due to physical health condition and do not have the medical verification available at the intake interview, will be granted a Temporary Unemployable status for 60 calendar days from the GR application date pending a receipt of the medical verification. The GR application will be approved if all other GR requirements are met.
 
GR participants who disclose they are unable to secure a timely medical appointment with their medical health care provider and/or provide a medical verification on or before expiration of their current Temporary/Permanent Unemployable status, will be deemed Temporary Unemployable for up to 60 calendar days from the current Unemployable status expiration date pending a receipt of the medical verification.

GR applicants/participants who disclose a disability will be offered a reasonable accommodation per current Americans with Disabilities Act Title II Accommodations policy.
 
GR applicants/participants have an option to provide a medical verification from their own medical health care provider or from a FQHC if they do not have Medi-Cal or an assigned physician. A designated GR district office representative is responsible for scheduling medical appointments for applicants who are assigned to a DHS hospital/clinic or need to provide a verification form from a FQHC.

The medical health care providers may use the ABP 1676-1, Physical Health Assessment for General Relief form, to document the applicant’s/participant’s physical health condition. However, an applicant/participant must sign the ABP 1676-2, Authorization For Use And Disclosure of Protected Health Information form and give permission to their health care provider to release their health information to the Department of Public Social Services (DPSS). A letter from the medical health care provider on the clinic’s/hospital’s letterhead indicating the applicant’s/participant’s inability to work due to their physical condition, limitations, and duration of the disability is also acceptable.
 
All GR applicants/participants must be provided with the ABP 1676-1C, A Guide to Your Physical Exam for General Relief form, which provides instructions on how to prepare for the assessment and what to expect during the PHA.
 
The applicant’s/participant’s employability status will be updated in CalSAWS by Eligibility staff based on the results of their recent PHA documented on the ABP 1676-1 form or physician’s statement.
 
If an applicant’s/participant’s disability is expected to last less than 12 months, they will be designated a Temporary Unemployable status. CalSAWS will automatically generate and centrally mail the ABP 23C, Notification of Your Employability Status, in the appropriate threshold language to the applicant/participant who has a mailing address other than the GR district office.
 
If the applicant’s/participant’s disability is expected to 12 months or more, they will be designated a Permanent Unemployable status. CalSAWS will automatically generate and centrally mail the ABP 23D, Notification of Your Employability Status, in the appropriate threshold language to the applicant/participant who has a mailing address other than the GR district office.

Note: If the ABP 1676-1 form or physician’s statement indicates that the applicant’s/ participant’s disability is expected to last more than 24 months, the Permanent Unemployable status in CalSAWS will be end-dated in 24 months, and the applicant/participant will be required to be re-evaluated before their employability status expiration date.

CalSAWS will generate a referral for applicants/participants with a Permanent Unemployable status to Countywide Benefits Entitlement Services Team (CBEST) Advocates to apply for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI).
 
GR applicants/participants with a Medical Unemployable status who choose to participate in the START Program will be considered Unemployable Volunteers. They will not be penalized for failing to comply with START requirements.
 
If the ABP 1676-1 or physician’s statement indicates that an applicant/participant is able to work without restrictions, they will be designated an Employable status in CalSAWS. If the medical health care provider indicates employment related restrictions, the applicant/participant will be designated an Employable with Restrictions status in CalSAWS. The employment related restrictions are:

1. Occasional 20 pounds lifting;
2. Occasional 50 pounds lifting;
3. Frequent standing/frequent walking; or
4. Other (needs to be specified).

CalSAWS is programmed to generate and centrally mail the ABP 23B, Notification of Your Employability Status, in the appropriate threshold language to the applicant/participant when their employability status has been updated/changed to Employable in CalSAWS. The ABP 23B will also be provided to applicants/ participants any time a co-located/remote Department of Mental Health Clinician or an applicant’s/participant’s medical/mental health care provider has conducted a PHA/Mental Health Assessment and has made a determination.     
 
Applicants/participants with an Employable or an Employable with Restrictions status will be required to participate in the START Program. However, START staff will adjust employment activities to address an individual’s health-related restrictions.
 
CalSAWS will automatically generate the ABP 23E, 60-Day Employability Status Change Notice, and/or ABP 23A, 10-Day Employability Status Change Notice, 60 calendar days and ten business days prior to Medical Unemployable status expiration date, respectively.
 
The notices inform the participants that their Medical Unemployable status is ending, and they are required to comply with the employability requirements unless they provide proof of continuing disability. The participant is responsible for contacting their medical provider to schedule an appointment and return the medical verification to Eligibility staff on or before the Medical Unemployable status expiration date.
 
The ABP 23A and ABP 23E notices include the ABP 1676-1 and ABP 1676-2 forms. The ABP 1676-1 and ABP 1676-2 are available for DHS/FQHC providers and for the public on the GR website under the General Relief Application Packet tab. In addition, the forms can be mailed to the participant upon their request. 

Note: CalSAWS will not mail the notices if the applicant’s/participant’s mailing address is the district office address. When the homeless GR applicant/ participant is in the office for an office visit or to check their mail, the appropriate notice will be printed and given to the homeless GR applicant/ participant. In addition, applicants/participants can view the notices issued by CalSAWS via their BenefitsCal account.

GR participants who fail to provide a medical verification or contact DPSS on or before the expiration of their Unemployable status will be considered Employable and will be required to comply with the START Program requirements until the medical verification is received. If the participant then fails to comply with employability requirements including participation in the START Program, the aid may be discontinued for failure to comply with program requirements. Applicants’/ participants’ disputes and/or Good Reason determination on failure to provide medical verification timely will be assessed on a case-by-case basis by the ES or District’s Hearing Officer.

Effective January 2014, with the implementation of the Affordable Care Act (ACA), Medi-Cal coverage is now available to all GR applicants/participants who meet the eligibility requirements. GR applicants/participants with Medi-Cal coverage may now receive a full range of medical services, including a PHA and/or treatment services. With this change, GR applicants/participants who disclose that they are unable to work due to their physical health condition are able to provide documentation from their own health care provider about their health condition and specific functional issues that are relevant to their ability to work.
 
As a condition of eligibility for GR, applicants/participants are required to participate in employment related activities (such as employment, education and/or training) offered by the START Program unless the individual has a physical health condition that prevents them from obtaining or retaining employment.

ABP 1676-1

A verification completed by the applicant’s/participant’s medical health care provider indicating individual’s inability to work, limitations and disability duration.

Physician’s Statement

A letter from the medical health care provider which includes the clinic’s/hospital’s letterhead indicating the applicant’s/ participant’s inability to work, limitations, and disability duration.

 The applicants/participants have the following options to return the medical verification:

1. By United States (U.S.) mail or fax;
2. In person to the district office; or
3. Upload via BenefitsCal