Special Needs in CalWORKs Overview

Transcription

1 Page 1 of 6 Special Needs in CalWORKs Overview Introduction This Department Policy (DP) provides instruction on special need payments in California Work Opportunity and Responsibility for Kids (CalWORKs). During unusual and special circumstances, the CalWORKs (CW) program allows for certain special need payments. These payments are based on either recurring or non-recurring needs. A special need is described as a need not common to a majority of customers for certain goods or services that are essential for their support. In this section This DP contains the following topics: Topic Page 1. Recurring Special Needs Non-Recurring Special Needs Request for Special Need Payments 6

2 Page 2 of 6 1. Recurring Special Needs Definition A recurring special need is a need that results in added cost to the family and is expected to occur during two (2) or more months in a calendar year. Verifications and time limits Actual costs must be reported every six (6) months on the SAR 7, Semi- Annual Reporting, or the SAWS 2, Statement of Facts. Customers are required to verify the expense and provide evidence of the need, the customer s portion of the expense (if shared by others) and the duration of the need. The customer s statement alone is not acceptable. Acceptable verification consists of itemized bills or receipts that show the increased cost to the customer. The Eligibility Technician (ET) can accept other written documentation if in the worker s judgment the documentation satisfactorily shows the increased cost to the customer. The customer has ten (10) days to provide necessary verification. If the special need is time limited, allow the special need payment until the end of the SAP in which the special need expires, except for Pregnancy Special Needs (PSN). See DP , Pregnant Women, for complete information on PSN. Inform the customer in writing when new verification is required to verify a continuing need for the special needs payment. Include the effective date the special needs payment will discontinue. Maximum allowable amount The amount of the special needs payment cannot exceed the actual increase in costs to the family as a result of the special needs. Recurring special need payments are the lesser of the actual cost or an amount not to exceed the amount resulting from multiplying $10 by the number of Assistance Unit (AU) members. ETs approve recurring special need payments up to the specified amounts. Continued on next page

3 Page 3 of 6 1. Recurring Special Needs, Continued Therapeutic diets Authorization for a therapeutic diet requires the recommendation of a physician. Use the DPSS 345, Therapeutic Diet Sheet, to obtain this recommendation. The ET can authorize any of the diets printed on the DPSS 345. A special diet, other than those listed on the DPSS 345, are allowed when reasonable and based on the customer s primary diagnosis. Regional Manager (RM) approval is required for special diets not listed on the DPSS 345 prior to approval of the special needs payment. Authorize the special diet allowance once verification has been provided. Allow the special need payment for the remainder of the SAP in which verification for the special need expires. Example: The customer s SAP is April through September. The customer was approved for a therapeutic diet beginning February and ending in May. The special need payment continues until September 30 th as that is the last month of the customer s SAP. Notify the customer in writing of the discontinuance of the special needs payment and the request for new verification to verify a continuing need for the special needs payment. If the customer provides proof that they continue to have the need of the therapeutic diet, approve the special needs payment for the next SAP of October through March. Other recurring special needs Examples of other recurring special needs include, but are not limited to, special: transportation need laundry service, or telephone service. Additional examples, along with approval criteria, are found in Manual of Policies and Procedures (MPP) Continued on next page

4 Page 4 of 6 2. Non-Recurring Special Needs Sudden and unusual circumstances Non-recurring special needs are granted due to sudden and unusual circumstances beyond the control of the AU. An AU is entitled to receive a non-recurring special needs payment to: repair or replace clothing or household equipment provide assistance for damages to the home, or pay for interim shelter when the AU s home is destroyed or made uninhabitable or inaccessible. An AU is not eligible to receive a non-recurring special needs payment if it has more than $100 in non-exempt liquid resources, with the exception of funds deposited in a restricted account. Determine the total amount of the special need using the actual cost for the authorized items or the maximum allowable, whichever is less. The total amount for non-recurring need cannot exceed $600 for each incident and is issued as a single payment. The ET documents the basis on which a non-recurring special needs payment was authorized in the journal. Based on district procedure, the RM or designee approves all non-recurring special need payments. See MPP for more examples of non-recurring special needs. Example A fire occurred in the home of a customer and her three (3) children. They lost all their bedding, dishes, clothing, stove, refrigerator and three (3) beds (two [2] double and one [1] single). The lease verifies that the stove and refrigerator belong to the customer. The customer has no way to verify the cost of any item, so values listed in MPP are used to figure the total non-recurring special needs payment as follows: Clothing four (4) in the AU 4 x 25 = $100 Bedding, dishes, utensils 4 x 12 = $ 48 Stove $142 Three (3) beds (located at yard $350 sale) Refrigerator (same yard sale) $190 $830 The total is $830, however the maximum that can be issued is $600 for this incident of a non-recurring special need. See MPP for additional information. Continued on next page

5 Page 5 of 6 2. Non-Recurring Special Needs, Continued Interim shelter An AU may receive a non-recurring special needs payment for the cost of interim shelter when the AU s home has been destroyed, made uninhabitable or inaccessible. An AU is not eligible to receive a non-recurring special needs payment for the costs of interim shelter if it is eligible to homeless assistance. Note: Homeless Assistance Special Needs may be authorized as an oncein-a-lifetime benefit payment of temporary shelter and/or permanent housing, unless the customer meets a homeless exception. See DP A, CalWORKs Homeless Assistance, for homeless assistance regulations.

6 Page 6 of 6 3. Request for Special Need Payment Voluntary midperiod report of a Special Need Special need requests are treated as voluntary customer mid-period reports that result in increased benefits. Adjust benefits, if eligible, effective the month that the request was made, once required verification has been provided. Issue the special needs payment for that month and the remainder of the SAP. Discontinue at the end of the SAP in which verification for the special need expires, except for PSN. Overpayments An overpayment is not determined unless receipt of the recurring or nonrecurring special needs payment was the result of fraud. Refer to DP , Overpayments in CalWORKs. LE:le