California Department of Social Services - State Hearings Division
Notes from the Training Bureau - May 1, 2003

This ACWDL provides answers to county questions regarding implementation of the SB 87 process. The SB 87 process consists of three steps; ex parte review, direct contact and the MC355 form. The county must follow each step until it has determined the beneficiary's eligibility or ineligibility. The county is not permitted to substitute any step in the process with another county procedure.

Answers to a few of the questions in this ACWDL are as follows:

Failure of a beneficiary to complete a CalWORKs monthly income report does not necessarily signify a change in circumstances affecting 1931(b) Medi-Cal only eligibility. If CalWORKs is discontinued because the beneficiary failed to return a monthly income report, Medi-Cal eligibility is not affected and no redetermination is needed unless the county has information that there is a change in circumstances affecting 1931(b) Medi-Cal-Only eligibility.

If a Medi-Cal beneficiary is being discontinued, but alleges disability as a basis for Medi-Cal eligibility, the county must refer the case to the Disability and Adult Programs Division (DAPD) for a disability evaluation. The county must also continue Medi-Cal pending the disability determination. The county is not required however, to allow for disability income deductions unless the county receives a determination from DAPD that the beneficiary is disabled.

There is no need for the county to take the third step of the SB 87 process if the county is able to establish the beneficiary's eligibility or ineligibility in the ex parte or direct contact steps. The eligibility worker will have to take the second step (i.e., reach the recipient by telephone) before discontinuing Medi-Cal to make a determination of eligibility or ineligibility because the beneficiary may allege pregnancy or disability or provide other relevant information not in the beneficiary's file. If the eligibility worker completes a thorough telephone interview and determines that the beneficiary is not eligible for Medi-Cal-Only benefits, there is no need for the eligibility worker to send the MC355 form.

ACWDLs 90-07 and 97-48 establish that counties are required to make two contacts prior to denying Medi-Cal for an applicant or discontinuing Medi-Cal for a beneficiary. SB 87 applies to beneficiaries only. SB 87 thus supercedes the two contact requirement stated in 90-07 and 97-48 as they apply to beneficiaries. The two contact requirement stated in 90-07 and 97-48 still applies to applicants.