General Assistance Handbook
page 14-1
Reinvestigations
14. Reinvestigations
14.1 Annual Reinvestigation Requirement
14.1.1
Policy
GA Policy [106] - Investigations and Re-Investigations and
GA Policy [107] - Records
A face-to-face reinvestigation (RRR) of all circumstances affecting the eligibility of a
recipient must be made at least once every 12 months. RRRs may be scheduled
more frequently if unexpected changes in income, property or other circumstances
occur which affect the eligibility or grant level of the recipient.
14.2 Purpose and Objectives
The purpose of the reinvestigation is to accomplish the following objectives:
• To determine that the recipient continues to meet all eligibility requirements.
• To complete all necessary forms and documentation required to establish
ongoing eligibility.
• To explain all rights, responsibilities and requirements of the General Assistance
(GA) Program to the recipient, including the right to appeal any action or non
action by the Department.
• To discontinue all ineligible recipients.
• To refer recipients to other programs or resources.
Update # 2014-09
Revised: 10/29/14
General Assistance Handbook
page 14-2
Reinvestigations
14.3 CalWIN Terminology
CalWIN introduces new terminology. Previously, Reinvestigations were referred to
as RV’s. In CalWIN they are called RRR. When referring to CalWIN procedures the
term RRR will be used.
14.4 RRR Due Date
In most instances, the CalWIN system will automatically determine the correct
initial RRR due date on new or restored cases. If for some reason the dates are not
correct, the EW can manually change the date (refer to the OLUM for procedures to
align the RRR date). The EW must review the RRR Detail Listing window in the
RRR subsystem to ensure that the RRR due date is correct before authorizing.
Example:
If a “Statement of Facts for Medi-Cal” (MC 210) or “Statement of Facts for
General Assistance” (GA 100) is completed in February 2010, a new MC 210
or GA 100 is required in February 2011. The 12 months begins with the first
month after the RRR is completed.
HOWEVER, if the case has food stamps, the Quarterly Reporting/Prospective
Budgeting (QR/PB) system requires that the RRR be done in a SUBMIT month.
Therefore, it may be necessary for the EW to manually align the RRR due date with
the Food Stamp RRR date.
14.4.1
Batch Processes
The RRR due date is determined when EDBC results are authorized. CalWIN
determines the RRR due date from the beginning date of aid or the previous RRR
date, based on individual program requirements. There are four distinct batch
process that are run in CalWIN to support the RRR processes.
Revised: 10/29/14
Update # 2014-09
General Assistance Handbook
page 14-3
Reinvestigations
Batch
Process
Occurrence
Process
1.
Monthly
Determines cases due for RRR within the next 80 days,
and generates an "Alert" to the EW to align RRR dates for
all programs in the case if necessary.
2.
Monthly
Runs on the 10th and 15th of each month and initiates the
RRR process either 75 or 50 days before the RRR due
date. The process begins 50 days before the due date for
Food Stamps only cases and 75 days before due date for
all other programs.
3.
Daily
Reviews the past five days to determine if RRRs have
been initiated. It triggers the appointment letter and an
interview checklist and forms list which is printed during the
batch process.
4.
NOA Cutoff
Date Each
Month
Is the Final RRR process that triggers the system to run
EDBC on all cases for which the RRR is not completed by
the NOA cutoff date of the RRR due month. It triggers
discontinuances on cases if the RRR is not complete or the
mail-in due date is past due.
Note:
RRR for GA only cases may be scheduled one month in advance. However, if
the GA RRR appointment is scheduled in advance; clients who “No Show”
must be rescheduled as the case cannot be discontinued until the end of the
month in which the RRR is due.
14.5 Scheduling Appointment
During the Batch process # 3 of the Batch Process table above that runs daily, the
system looks back five days to determine what RRRs have been initiated. The
system then:
• Triggers Client Correspondence subsystem to generate the appointment letter,
which includes the interview checklist information and the forms list. This
correspondence is printed during the nightly batch process.
Update # 2014-09
Revised: 10/29/14
General Assistance Handbook
page 14-4
Reinvestigations
Note:
These processes do not produce the actual forms. The RRR packet must be
compiled from shelf-stock forms that are listed on the forms list in Section 14.7
and the forms must be mailed to client along with the RRR Appointment Letter.
• Five days after the RRR is placed in “Initiated” status, the system will trigger the
Client Correspondence subsystem to generate the RRR Appointment Letter or
RRR Mail-In Letter along with the consolidated forms and verifications list in
batch, but the print mode will be set to “Online.”
Note:
This is to ensure that the EW reviews correspondence in the CalWIN’s Print
Queue and has the opportunity to add comments and/or Special instructions in
the “manual variable” fields prior to printing the correspondence that’s to be
mailed to client. The appointment letter must be mailed at least seven (7) days
in advance of the office or home visit appointment.
14.5.1
Rescheduling the Appointment
If the recipient wishes to reschedule the appointment, the appointment should be
rescheduled prior to MEDS cutoff in the month the RRR is due.
If the new appointment is scheduled after GA NOA cutoff and the recipient fails to
keep the appointment, the case may not be discontinued unless a waiver is
obtained. The seven (7) day timely notice requirement must be met.
The new appointment must be noted on the Maintain Case Comments window.
14.5.2
Failure to Keep Appointment
If the recipient fails to keep the RRR appointment:
• The system will automatically place the Benefits in “Discontinued Status.” This
will discontinue the case and generate the appropriate seven (7) day notice.
Note:
The recipient must not be discontinued for failure to keep an appointment for
an RRR scheduled in advance of the RRR due date month.
• After MEDS cutoff:
• Obtain a waiver, or
Revised: 10/29/14
Update # 2014-09
General Assistance Handbook
page 14-5
Reinvestigations
• Discontinue at the end of the following month.
Note:
Medi-Cal eligibility for the future month cannot be stopped after MEDS cutoff.
Therefore, Medi-Cal cannot be discontinued until the end of the future month.
An overpayment must be calculated and a good cause determination must be
made.
If it is determined that the client...
Then...
Had Good Cause for not completing the
RRR in a timely manner,
The Overpayment is Non-Willful.
Did Not have Good Cause for not
completing the RRR in a timely manner,
The Overpayment is Willful.
Overpayment is Willful,
A budget must be completed and
carefully documented to show the
amount of the Overpayment.
14.6 Reinvestigation Procedures
The following procedures must be completed at each RRR.
In addition, the EW must send the recipient the following documents:
• "Application for CalFresh Benefits" (CF 285), if an RRR is required for CalFresh
or a new application for CalFresh is requested.
• Required forms for normal shelter cost verification. [Refer to “Required Forms,”
page 28-3, for specifics.]
Note:
Collections scans the Release Memo and/or the Demand Letter into their
department’s section of Intergraded Document Management (IDM) System;
therefore, when applicable, it is necessary to verify with Collections that the
Release Memo and/or Demand letter was sent after the case was last closed.
Update # 2014-09
Revised: 10/29/14
General Assistance Handbook
page 14-6
Reinvestigations
14.6.1
Review of Case Documents
Prior to the RRR, the Eligibility Worker MUST review IDM for all documents which
were obtained and completed during the preceding year, including:
• The last “Statement of Facts for Medi-Cal” (MC 210),
• “Statement of Facts for General Assistance” (GA 100),
• “ Application for CalFresh Benefits” (CF285), and
• CalWIN “Statement of Facts” (CSF 60), and
• All “Quarterly Eligibility/Status Reports” (QR 7s).
The Eligibility Worker is to compare current documents with past history, checking
for consistency and correct information.
Note:
If case documents are not scanned into IDM, the physical case folder must be
reviewed, when applicable.
14.6.2
Rights & Responsibilities Explanation to the Client(s)
The EW must explain the General Assistance Program rights and responsibilities to
the client and complete the following:
• Provides the client with a copy of the “General Assistance Program - Rights and
Responsibilities” (GA 14).
• Advises the client that all changes in circumstances and income must be
reported within ten days of occurrence and reported on the “Quarterly
Eligibility/Status Report “(QR 7).
• Explains the “Quarterly Eligibility/Status Report” (QR 7) and the “Instructions &
Penalties Quarterly Eligibility/Status Report” (QR & addendum), and the form QR
7A “How to Fill Out Your QR 7".
Revised: 10/29/14
Update # 2014-09
General Assistance Handbook
14.6.3
page 14-7
Reinvestigations
Housing Assistance Information and Verification
Is client required to pay for shelter?
If...
Then...
Yes
•
“Housing Assistance Verification” (GA 31) or "Client’s Housing
Assistance Statement" (GA 11) is required for GA.
• CalFresh only cases -complete the “Shelter Cost Statement”
(CSF 47). Verification of current living situation is required.
No
If the client is in a specialized program (i.e., Mental Rehabilitation,
State-Licensed Residential care, SLE/THU recovery homes, and etc.) the
“Housing Verification-Specialized Programs” (GA 2A) is required to be
completed at RRR. [Refer to “Overview,” page 28-1, for specifics.]
Does the housing verification agree with the new Statement of Facts in amount of
rent and street address?
If...
Then...
No
• Documentation and new verifications are required.
• Housing cannot be allowed until new verification is received for GA, for
Food Stamps refer to the three Housing Verification Forms *# 2 below.
Does the residence information on the current QR 7 agree with the new Statement
of Facts?
If...
Then...
No
• Documentation and new verifications are required.
• Housing cannot be allowed until new verification is received for GA, for
Food Stamps refer to the three Housing Verification Forms *# 2 below.
Three Housing Verification Forms:
1. “Housing Assistance Verification” (GA 31) is to be used for GA client
required to pay for shelter, obtain vendor/landlord information and is required
for client to choose one of the three Personal Need Options, Section III of the
form. [Refer to Update 2008-2 and GA Handbook Chapter 27, Section 27.1.2
“Personal Needs Option,” page 27-5 and “Housing Verification - Specialized
Programs” (GA 2A). Forms GA 2A is to:
• Verify address and type of facility the tenant is living in.
• Request a current State license.
Update # 2014-09
Revised: 10/29/14
General Assistance Handbook
page 14-8
Reinvestigations
• Be complete each time the client changes RCH facilities and at each RRR
and send a copy to be scanned into IDM.
• Submit with forms CSF 13 or SCD 1029.
2. *“Shelter Cost Statement” (CSF 47) is use for Food Stamps only cases.
• Shelter cost does not have to be verified again unless questionable.
• If rent increases. Shelter is not disallowed if the CSF 47 for verification of
rental increase is not provided by the client, rent remains the same.
3. "Client’s Housing Assistance Statement" (GA 11) is use if client’s landlord
refuses to cooperate, client must complete the Vendor Payment Information, read
the Acknowledgment, and chose one of the three Personal Needs Options on the
form.
14.6.4
New Property
Has new property been acquired?
If...
Then...
Yes
Documentation and verification of how the new property
was acquired is mandatory.
Has any property been transferred or sold?
If...
Then...
Yes
• Documentation and verification of the details of the
transfer/sale are mandatory.
• Calculation of a period of ineligibility may also be
required.
Is the recipient property eligible?
14.6.5
If...
Then...
No
The client must be discontinued with a timely NOA.
Employment Status and History
The following questions must be asked:
Revised: 10/29/14
Update # 2014-09
General Assistance Handbook
page 14-9
Reinvestigations
Is a new application for UIB/DIB/SSI necessary?
If...
Then a...
Yes
• New Application must be documented and verified
in order to complete the RRR.
• “Authorization for Reimbursement of Interim
Assistance Initial Claim or Posteligiblity Case”
(SSP 14), and a
• “Referral to SSA” (SCD 169), may also be required
(check last SSI denial).
No
Document the reason on the Maintain Case
Comments window.
Is a new work registration required?
If...
Then...
Yes
Access the Employment Services subsystem and
complete steps the steps to "Refer" and "Assign
Activity".
No
Document the reason on the Maintain Case Comments
window.
Is a new verification of incapacity required?
14.6.6
If...
Then.
Yes
New “General Assistance Program - Request for
Medical Information” (SCD 1400) must be completed.
No
Document the reason on the Maintain Case
Comments window.
MEDS/CDB
A MEDS/CDB screen must be printed at each RRR for each recipient, in order to
determine:
• Status of SSI.
• Status of Medi-Cal.
• Status of Food Stamps.
Update # 2014-09
Revised: 10/29/14
General Assistance Handbook
page 14-10
Reinvestigations
• Receipt of aid in another county.
• Follow up on information received as required.
The MEDS screen print must be scanned into the IDM System under Benefits - F5.
14.6.7
State Programs - Disability Determination Service
Division (SP-DDSD) Referral
If a referral to SP-DDSD is needed, the EW must complete forms and follow
procedures as described in the SP-DDSD section of the Medi-Cal Handbook.
[Refer to Medi-Cal Handbook, “DDSD — Disability Referral Criteria,” page 27-1.] If
not, document the reason.
14.6.8
Food Stamps
The EW must complete all forms and follow procedures as described in the Food
Stamp Handbook.
[Refer to CalFresh Handbook, “Application,” page 3-1, to browse for more
information. and Common-Place Handbook Chapter 27, Section 27.4 “CalFresh,”
page 24-3 for Food Stamps RRR Packet.]
14.7 Completion of All Actions and Forms
The RRR is considered complete when:
• The “Statement of Facts” (CSF 60) has been reviewed, and
• The “Statement of Facts for General Assistance” (GA 100).
NOTE: For combo RRR applications (GA with CF and/or MC), the form
"Application for CalFresh, Cash Aid and/or Medi-Cal/Health Care Programs
(SAWS 2 Plus) can be completed, instead of the GA 100.
• The appropriate verifications have been received, copied, documented and
returned to the recipient, and
Revised: 10/29/14
Update # 2014-09
General Assistance Handbook
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Reinvestigations
• The Maintain Case Comments window is updated with required information.
• All appropriate referrals are made.
• All alerts associated with the case are cleared.
• All reports associated with the case are processed.
• EDBC is run, the case is authorized/discontinued, as appropriate.
• All client correspondence is sent and/or inappropriate correspondence is
DELETED (EW is to review CalWIN’s Client Correspondence the Print Queue
window.)
Refer to the Common-Place Handbook Chapter 24 for the required RRR forms:
• “CalFresh RRR Packet,” page 24-21.
• “Medi-Cal RD Packet,” page 24-24, and
•
14.7.1
“General Assistance (GA) RRR Packet,” page 24-27.
Examples of Documentation of RRR
Case notes must be documented so that any individual reviewing the case clearly
understands what is occurring in the case. Below are some examples:
Employable
On 11/24/10 - Completed an RRR interview with the client. Client’s rights and
responsibilities were explained regarding GA, CF and MC, and the recipient stated
that he understood them and appeared to understand.
On 11/24/10 - Reviewed and compared all current documentation and forms i.e.,
property, income, living arrangements and verifications with the previous
documents on file in IDM. There appear to be no changes since the last RRR.
Update # 2014-09
Revised: 10/29/14
General Assistance Handbook
page 14-12
Reinvestigations
Unemployable
On 11/22/10 - Client in office for RRR, and stated that she is now under the care of
a doctor. A new “General Assistance Program - Request for Medical Information”
(SCD 1400) form was given to client with the explanation that she has ten days in
which to return the completed form. Client’s rights and responsibilities were
explained for GA, FS and MC, and the client stated that she understood them.
On 11/26/10 - Client brought in completed “General Assistance Program - Request
for Medical Information” (SCD 1400) form. RRR completed. All forms completed
and verifications have been scanned into IDM. New exemption expiration date
entered into the Collect Employability Detail window by clicking the Display
Employability Summary window in the Data Collections Subsystem.
14.7.2
"The GA Budget"
The budget on the Display Grants windows in the Wrap Up subsystem must be
reviewed for correctness and the budget updated if necessary. The EW must
document on the Maintain Case Comments window that the budget was reviewed
and that there was No Change, or that the budget was revised, if appropriate.
14.7.3
Child Health and Disability Prevention (CHDP)
A CHDP brochure must be given to each applicant/beneficiary under 21 years of
age. The appropriate entries must be made on the Collect CHDP/Social Services
Request Detail window in the Data Collections subsystem.
Revised: 10/29/14
Update # 2014-09