March 26, 2020

In response to the COVID-19 pandemic, CSAC has been working across all policy areas to support flexibility throughout county operations and programs. Over the last few weeks, CSAC has worked closely with several county affiliates, stakeholders, and state departments to ensure necessary adjustments are made to vital county services.

As counties face immediate challenges to the delivery of health and human services programs such as, Medi-Cal, CalWORKs, CalFresh, Foster Care, and In-home Supportive Services, CSAC has been in continual communication with members of the Administration, to advocate for clear guidance and sustainable solutions. The Newsom Administration has made several significant changes through executive orders and department guidance that will directly assist the most vulnerable individuals and families in our communities.   

HEALTH

Request for Section 1115 Medicaid Waiver Extension

CSAC and county affiliates have submitted a coalition letter to the Department of Health Care Services (DHCS) and key members of the Administration and Legislature, requesting their partnership and action towards extending the Section 1115 Medicaid Waiver set to expire this year.

In the last several months, CSAC and county affiliates have worked closely with DHCS staff in preparation to transition many of the key components, such as, Whole Person Care and Public Hospital Redesign and Incentives in Medi-Cal (PRIME), from previous Section 1115 Medicaid waivers to the Medi-Cal 2020 waiver. As state and local governments divert their immediate attention and resources to responding to the COVID-19 pandemic, stakeholders no longer have the capacity to provide thoughtful engagement in the Medi-Cal 2020 waiver discussion. While counties provide frontline response, we have asked DHCS to pursue a request for a one-year extension from the Centers for Medicare and Medicaid (CMS). Additionally, our county coalition submitted a letter to our California Congressional Delegates, urging their support in this request for an extension.

CMS Approved Changes to Medi-Cal for COVID-19 Response

The Department of Health Care Services (DHCS) received approval from the Centers for Medicare & Medicaid Services (CMS) on key items that will assist California’s health care delivery system for Medi-Cal recipients.

Last week, DHCS requested a series of rule waivers under a Section 1135 Social Security Act waiver. The requested items would provide California more flexibility in ensuring the timely high-quality access to care for those in most need. While CMS continues to review the waiver requests in its entirety, they have notified the state of the following approvals: 

• More flexibility in allowing out-of-state doctors and other medical providers to treat California patients, both in person and through telehealth.
• Changes to allow for efficient use of hospital capacity and shift patients to appropriate care settings, maximizing the state’s ability to treat those in need.
• Modifications to prior authorization rules on treatment and the establishment of medical necessity, enabling the health care system to more quickly respond to the rapidly evolving situation.

Guidelines for the approved items will be available soon. As DHCS receives more information on their additional federal requests, CSAC will be providing an update.

DHCS Resources

Section 1135 Waiver Requests: March 16,  March 19

CMS Approval Letter: March 23, 2020, letter

HUMAN SERVICES

Child Welfare Guidance

CDSS issued All County Letter (ACL) No. 20-25 on March 21, providing counties with guidance to ensure child, family, and staff safety during key components of the child welfare system. The ACL priorities safety in several ways including, clarifying the live scan requirements for emergency placements can be postponed until “stay at home” order is lifted, providing guidance for case workers to assess the need for a face-to-face visit or meeting, and resources for assisting displaced college foster youth.

In-Home Supportive Services Reassessments

All County Letter No. 20-26 gives counties the flexibility to suspend face-to-face reassessment appointments through June 30, 2020. The reassessment appointments can be completed by telephone, but should not lead to any adverse action prior to June 30, 2020. The ACL explicitly states that initial IHSS assessments shall be completed face-to-face, while minimizing the time spent in a potential recipient’s home.

CDSS Homeless Programs

All County Welfare Directors Letter (ACWDL)issued on March 19, provides guidance on allowable flexibility in the CalWORKs Homeless Assistance (HA) and Housing Support programs, Housing and Disability Program (HDAP), Home Safe, and Bringing Families Home. This ACWDL aims to provide counties the ability to use current programs to assist families in need as a result of the COVID-19 crisis, while minimizing safety risks in regards to face-to-face contact.

LAO Report on COVID-19 and Nutrition Assistance

In addition to the guidance in information issued by the Administration and state departments, the Legislative Analyst’s Office released a new report providing an overview of challenges many individuals may have accessing nutrition assistance during this COVID-19 crisis, how recent federal and state actions can assist with access, and the significant uncertainty that remains for nutrition programs. Read the report here: LAO Nutrition Programs in COVID-19 Recovery Actions.