DPSS ePolicy

• To convert existing policy to the new webpage - No content changes
• To revise existing policy and/or form(s)

What changed?

1. Effective January 1, 2024, assets are no longer counted to determine eligibility under Non-Modified Adjusted Gross Income (Non-MAGI) Medi-Cal (MC).  The steps referencing property evaluation and property investigation request were removed from this document;
2. Discontinued use of the PA 621, Property Investigation Request form; and
3. The Department cover letter that is included with the request for Verification of Veteran's Benefits was updated with the most recent version and all references to resources were removed.

Diligent Search is a set of procedures used as guidelines in determining eligibility for persons who are incompetent, comatose, amnesiac, or deceased, and there is no spouse, conservator, guardian, executor, relative or friend available to provide the information needed to conduct a MC eligibility determination.  Diligent Search procedures can be applied during the initial application, retroactive months, and at Renewal (RE).

The County will assume total control of the MC application and perform a Diligent Search to obtain any available information about the applicant’s circumstances to determine MC eligibility.  A referral to the Office of the Public Guardian must also be submitted, except for deceased applicants, to determine if this office should become the responsible agency.  If not, the County must continue the Diligent Search of known information to determine eligibility.

At any time during the application process, if the spouse, an adult child, an adult relative, or a friend is found or contacts a Department of Public Social Services (DPSS) office, the Diligent Search must end, and the information or documentation provided by them can be accepted for the purpose of making an eligibility determination.  However, only a spouse is obligated to cooperate in providing such documentation, and the application can be denied if the spouse fails to cooperate. 

The application must not be denied due to non-cooperation of the adult child, adult relative, a friend or a public agency acting on the incompetent individual’s behalf.   When a relative, a public agency, or a friend is unable or unwilling to provide information necessary for a MC eligibility determination, the Eligibility Worker (EW) must continue processing the application following the Diligent Search procedures.

Written authorization is not required for an individual or an organization to assist an incompetent or deceased person to apply for MC benefits.  An MC applicant who is incompetent/deceased is presumably incapable of having the required knowledge or the ability to designate an Authorized Representative (AR).  In these instances, the AR forms would not be appropriate, and the appointment is not valid when the forms are signed by the individual or the public agency assisting the incompetent applicant.

California Code of Regulations, Title 22, Section 50163, stipulates that when applicants are incompetent, comatose, amnesiac, or deceased, and there is no spouse, conservator, guardian or executor, the MC application can be completed and signed on their behalf by a person who has knowledge of the applicant’s circumstances, a representative of a public agency or the County.  Furthermore, Sections 50166, 50167, and 50173 state that the Diligent Search process involves the “search” for an applicant's available demographic and financial information to make an eligibility determination when the applicant is unable to assist in the application process. 

The Diligent Search referral letter is used as the MC application to open a case for the incompetent/deceased person.  Therefore, sending the CCFRM604 Single Streamline Application is not required.

Diligent Search referrals originate when a hospital or other medical provider submits verification to the County that a search was conducted by the facility.  Verification may also come from agencies contracted by a hospital or other medical provider (i.e., Health Care Legal Services, etc.).  To meet the requirements, the verification:

1. Must be in the form of a letter written on letterhead from the hospital, medical provider, agency contracted by the hospital.  The letter must be signed by a medical provider/hospital/contracted agency staff member.
2. Must state that an attempt was made to establish the identity of the patient, which includes seeking individual(s) who are able to act on the patient’s behalf.
3. Must contain all available information gathered by the hospital, medical provider, or contracted agency staff as it relates to the applicant, including the person’s presumed age.

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