DPSS ePolicy

To revise existing policy and/or form(s).

What changed?

• Added the ending of the Medical Support Enforcement (MSE) waiver on June 30, 2025;
• Added the resumption of the MSE requirements effective July 1, 2025;
• The MSE requirements can be met after Medi-Cal (MC) eligibility is granted;
• Added the MSE requirements exception for individuals aided under Postpartum Care Extension;
• Incorporated procedures to generate the MC 355, Medi-Cal Request for Information form to request MSE compliance after MC eligibility has been granted;
• Added scenarios on the Examples section;
• Added screenshots to the System Pages section; and
• Modified gender-specific language to reflect gender-inclusive language.

MSE is a post-eligibility requirement for parents or caretaker relatives receiving MC with an aided child up to the age of 17 in a household (HH) where one parent is absent or both parents are in the home but are not married.  The MSE requirement will be enforced unless there are applicable exemptions and/or good cause is declared and granted.  MSE is applicable to Modified Adjusted Gross Income (MAGI) and Non-MAGI MC at application and renewal (RE).

MSE requirements are a condition for continued MC eligibility, and the requirements can be met after MC eligibility is granted.  Approval of MC eligibility must not be delayed if the individual who must cooperate with the MSE requirements is otherwise eligible for MC.

MSE was developed for the purpose of establishing paternity and enforcing medical support requirements under the MC Program.  The objective is to reduce MC costs by ensuring that absent parents are made responsible for their children's medical care.

Title IV-D of the Social Security Act established the child and spousal support enforcement program.  Assembly Bill 1422 added section 14008.6 to the Welfare and Institutions Code to adopt, at the State level, the federal requirements.  The MSE regulations for the Department of Health Care Services (DHCS) were implemented by county welfare departments on July 1, 1993.

On September 14, 2023, DHCS received an approved Section 1902(e)(14)(A) waiver from the Centers for Medicare and Medicaid Services (CMS) to temporarily suspend the MSE requirements during the Continuous Coverage Unwinding (CCU) period.

The temporary waiver to suspend the MSE requirements ended on June 30, 2025, and effective July 1, 2025, the MSE requirements for the MC Program are now resumed.

MSE Agreement

MSE regulations require MC applicants and beneficiaries to agree to the following:

1. Assigning the right to any payments received from the non-custodial parent(s) for medical support and/or medical care to the State;
2. Cooperating with the Local Child Support Agency (LCSA) in establishing parentage of a child born outside the marriage for whom MC benefits are requested; and
3. Cooperating with the State in identifying and providing information to assist the State in pursuing any third party who may be liable to pay for medical care and services under the MC Program.

Medical Support Cooperation

Cooperation with the State includes establishing parentage and identifying possible medical coverage available to the child(ren) through the non-custodial parent(s).

The applicant or beneficiary must cooperate with medical support by taking the following actions:

1. Complete and sign the CW 2.1NA, Notice and Agreement for Child, Spousal and Medical Support and the CW 2.1Q, Support Questionaire;
2. Provide additional information to help identify and locate the absent parent(s);
3. Provide additional information to establish paternity;
4. Provide information about other health coverage, if any;
5. Inform the county about medical coverage or money for medical services paid by the non-custodial parent(s);
6. Assist the LCSA in obtaining medical support and medical support payments;
7. Give the LCSA any medical support money from the non-custodial parent(s);
8. Appear at the LCSA office when requested; and
9. Appear as a witness in court if requested by the LCSA.

Exceptions from MSE Requirements

The following are exceptions from the MSE requirements:

1. Cases involving unmarried parents who reside together when both parents have signed the DCSS 0909, Voluntary Declaration of Parentage (VDOP) form;
2. Pregnant persons and PCE eligible individuals during the 12-month postpartum period;
3. Single parent adoption cases;
4. Cases where the aided child(ren) have no Satisfactory Immigration Status (SIS);
5. Child-only cases in which the child is the only MC applicant or beneficiary on the case;
6. Cases where the absent parent is incarcerated or institutionalized;
7. Minor Consent cases;
8. Cases in which at least one parent is a minor;
9. Transitional Medi-Cal (TMC) cases;
10. Cases in which the absent parent is deceased;
11. When MC is only requested for one month or for retroactive benefits only; and
12. When the absent parent is already providing health insurance for their child(ren).

MSE is required when the custodial parent or caretaker relative has no SIS and the children requesting MC have SIS.  In cases where there are children who are non-SIS and SIS in the same HH, a referral should only be made for the children with SIS.

Deceased Parent(s)

Verification of the non-custodial parent’s death is required and may include:

1. Electronically verified (e-verified) death record;
2. A copy of the death certificate;
3. An award letter from Social Security Administration (SSA) based on the death of the parent; or
4. An obituary.

If acceptable evidence that an absent parent is deceased is not available, the MSE requirements will apply.

Evidence to Support Good Cause Claims

The documents listed below can be provided as verification to support a good cause claim exemption:

1. For a claim that there will be an increased risk of physical, sexual, or emotional harm to the child for whom support is required, the verification can include:
   • Police, governmental agency, or court records;
   • Documentation from a domestic violence program, or a legal, clerical, medical, mental health, or other professionals from whom the applicant or beneficiary has sought assistance in dealing with the abuse;
   • Physical evidence of abuse or any other evidence that supports the claim of good cause; or
   • If unable to provide any of the above evidence, a statement under penalty of perjury from the applicant or beneficiary explaining the circumstances surrounding the claim for good cause can be accepted.
2. For a claim that the child was conceived due to incest or sexual abuse:
   • Birth certificates or medical, mental health, domestic violence program records; or
   • Law enforcement records that indicate the child was conceived as the result of incest or sexual abuse.
3. If legal proceedings for the adoption of the child are pending:
   • Court documents; or
   • Other records that indicate legal proceedings for adoption are pending.
4. If being assisted in resolving the issue of whether to keep or give up a child for adoption:
   • A written statement from a public or licensed private adoption agency stating that the agency is assisting to resolve the issue of whether to keep the child or relinquish the child for adoption.
5. If cooperating in good faith but still unable to identify or assist in locating the alleged father or absent parent:
   • A sworn statement under penalty of perjury explaining the circumstances surrounding the good cause claim is acceptable.