.Purpose

Policy

Background

Release Date:

06/17/21

Definitions

Requirements

Verification Docs

·       

At Intake/application;

·       

When adding children under the age of six to the AU; and

·       

At Redetermination (RD).

CAIR2

CAIR2 is a secure web-based, confidential, statewide computerized database that stores immunization (vaccine) records for California residents.  CAIR2 is managed by the California DPH.

Records stored in CAIR2 are confidential medical information.  Inappropriate use or disclosure of information may result in civil and criminal penalties and termination of DPSS’ rights to use CAIR2.

Read-Only Access

CalWORKs Eligibility staff will have read-only access to view and/or confirm immunization status.  The immunization records may also be printed and shared with applicants/participants.

Requirement

Limit/Condition

Informing Requirements

At Intake/application and RD, all applicants/participants must receive the CW 101, CalWORKs Immunization Rules, informing them that they must obtain age-appropriate immunizations for all children in the AU under the age of six.  

The form must be included in all CalWORKs Intake and RD packets assembled in district offices.

The form is included by a vendor in the RD packets that are centrally assembled and mailed.   

The CW 101 informs applicants/participants about:

1.    Their obligation to obtain immunizations for all children in the AU under the age of six and the penalty for failure to comply;

2.    A list of recommended age-appropriate immunizations;

3.    Exemptions to the immunization requirement.  These are permanent and include:

a.    The needy caretaker does not believe in immunizing the children; and

b.    The needy caretaker has a medical statement saying the child should not be immunized.

4.    Good Cause reasons a participant can be excused from providing the immunization verification for their children.  These are temporary and include:

a.    Lack of reasonable access to immunization services;

b.    Lack of available appointments;

c.    Language barriers between the doctor and the applicant/participant;

d.    Physical distance;

e.    Illness of a child or parent/needy caretaker relative;

f.     Bona fide transportation problems; 

g.    The records do not correctly show all the immunizations the children received, and the needy caretaker relative is trying to correct the records; and

h.    DV.

5.    How immunizations may be obtained through a(n):

a.    Provider that accepts Medi-Cal;

b.    Medi-Cal managed care plan;

c.    County public health clinic;

d.    Appropriate source that offers free or low-cost immunizations; or

e.    “Child Health and Disability Prevention” provider.

CAIR2

When an applicant/participant is unable to obtain immunization records on their own within the allotted time period, Eligibility staff will be able to assist by accessing CAIR2 to obtain the records.  When records are unavailable, the applicant/participant will be required to provide the verification. 

Note:  Some immunization records may not be available in CAIR2 because the participant did not authorize their medical provider (physician) to include them in CAIR2.

Timeframes to provide proof of immunizations

Intake/New Applications

Applicants must submit verification of immunization within:

1.    Thirty calendar days of approval for Medi-Cal, if applying for CalWORKs and Medi-Cal benefits; or

2.    Forty-five calendar days of approval for CalWORKs, if applying for CalWORKs and already receiving Medi-Cal benefits.

Note:  CalWORKs applications can be approved pending verification of immunization records. 

Approved

CalWORKs approved families must submit verification of immunization within 45 calendar days of the authorization of the annual RD.

Mid-Period Reports

When adding a child(ren) under the age of six to the AU mid-period, the immunization verification must be provided within 30 calendar days of establishing eligibility for Medi-Cal for the child; or, if applying for CalWORKs and already receiving Medi-Cal benefits within 45 calendar days.

Permanent Good Cause/Exemptions

A child may be exempt from the immunization requirement for medical and personal/religious belief reasons.  The applicant/participant (parent/needy caretaker) can do either of the following to request the exemption:

1.    Make a verbal exemption request.  Making a verbal request is the same as completing the CW 2209.  Any penalty imposed should be suspended and a Journal entry should be made documenting the action; or

2.    Complete the CW 2209 to request an exemption.

The CW 2209 must be provided:

1.    At Intake/application;

2.    At RD; 

3.    Anytime a request for verification is sent; 

4.    When a Notice of Action (NOA) is sent causing grant changes because immunization verification was not provided or verification could not be obtained from CAIR2; or

5.    When requested by the participant.

Medical Exemption Reasons

The types of medical exemption reasons include, but are not limited to, situations in which there is:

1.    A newborn who has not reached the age for vaccinations;

2.    A child with allergies; or

3.    Immunizations are not considered safe due to the physical condition of the child.

For a medical exemption:

1.    A verbal request can be made, or the CW 2209 can be completed.

2.    A Medical Exemption Statement or a written statement from a physician or authorized personnel must also be provided.

The statement must include:

a.    Child’s name;

b.    Medical condition;

c.    Duration of the illness;

d.    If applicable, the vaccine they are temporarily/permanently exempt from taking; and

e.    The date, name, phone number, and signature of the physician or authorized personnel.

Note:  When a verbal request is provided, the CW 2209 is not required.

Temporary Good Cause

Additional 30 Calendar Days to Submit Immunization Verification

A parent/needy caretaker relative can claim Good Cause to obtain additional time to provide verification of up-to-date immunizations.  An additional 30 calendar days to submit verification is granted when the following circumstances exist:

1.    Lack of reasonable access to immunization services;

2.    Lack of available appointments;

3.    Language barriers between the doctor and the applicant/participant;

4.    Physical distance;

5.    Illness of a child or parent/needy caretaker relative;

6.    Bona fide transportation problems;

7.    The records do not correctly show all the immunizations the children received, and the needy caretaker relative is trying to correct the records; or

8.    DV - Effective July 1, 2018, applicants/participants who are victims of past or present DV can claim Good Cause for providing immunizations for the child(ren). When the applicant’s/participant’s abuse occurred in the past, the issue causing the non-cooperation or inability to comply must be related to the current DV situation

Note:  This determination of Good Cause is separate from DV waivers that are offered for GAIN participants.

The applicant/participant can do either of the following to request Good Cause:

1.    Make a verbal request; or

2.    Complete the CW 2209.

Good faith effort to meet immunization requirements

An applicant/participant who has made a good faith effort to meet the immunization requirements can be granted aid.  A good faith effort includes the following:

1.    When immunizations have been initiated for a child(ren) in the AU, but the series cannot be completed because of a spacing requirement between vaccine doses (verification must be provided);

2.    When a vaccine is not available, the participant must:

a.    Indicate why the vaccine is not available; and

b.    Obtain a written statement from a physician or authorized personnel; and

3.    When the AU declares homelessness.

The applicant/participant can do either of the following to establish a good faith effort:

1.    Make a verbal request; or

2.    Complete the CW 2209.

When a good faith effort is claimed in any of the

above situations, verification of the child’s immunization status must be obtained at the next RD.   

Immunization Penalty

If an applicant/participant fails to submit timely verification of up-to-date immunizations and does not qualify for a medical/religious exemption or have Good Cause, the parent/needy caretaker relative remains in the AU, but their needs are not allowed.

Two-Parent Family

If both parents are in the AU and either parent fails to comply with immunization requirements, the needs of both parents are not allowed. 

Stepparent in the Home

If the second parent is a stepparent and they are in the AU with the parent, only the parent is penalized.  However, if the parent is absent and the stepparent is the needy caretaker relative, then the penalty is applied to the stepparent.

Senior/Minor Parent

When the AU contains both a senior parent and a minor parent with the minor parent’s child, the senior parent(s) is responsible for submitting the verification of immunization and is responsible for:

1.    The minor parent; and

2.    The minor parent’s child.

The senior parent(s) is penalized if the verification is not submitted.

Time Limits

If an AU has been penalized, the months on aid will count towards the 48-Month Time Limit for the aided parent/needy caretaker relative.  While the grant has been reduced by the parent(s)’/needy caretaker relative(s)’ share, the parent(s)/needy caretaker relative(s) is still considered aided. 

Inter-County Transfer (ICT)

An ICT family that has submitted adequate verification of age-appropriate immunizations in the first county is not required to resubmit duplicate verification in the second county. 

GAIN

A parent/needy caretaker relative who is penalized must cooperate with GAIN requirements, if the penalty is from GAIN or immunizations or both. 

Lifting an immunization penalty/restoration of aid

Immunization Verification is Obtained

Once verification of immunization is submitted, the grant is increased to reflect the needs of the parent(s)/needy caretaker relative(s) effective the first of the month following the month in which verification is received.

No Longer a Preschool Child

When a family does not provide proof of immunizations, a penalty is applied.  If the child turns six or is no longer a preschool child, the penalty no longer applies and should be removed:

1.    At the end of the month prior to the month the child turns six years of age; and

2.    Benefits must be restored the first day of the month the child turns six years of age. 

In this instance, the child has reached the age of compulsory school and is no longer subject to the CalWORKs immunization requirements.  The system is programmed to lift the penalty automatically.

Verification is needed and one child turns six and the other child has not reached age six

If there is still a child in the AU:

1.    Who has not yet reached the age of six;  

2.    Whose verification of immunization is still needed; and

3.    The child/needy caretaker relative does not meet an exemption or Good Cause criteria, the penalty should not be lifted until the youngest child for whom the penalty is imposed:

a.    Reaches the age of six; or

b.    Meets one of the exemption/Good Cause criteria.

If…

Review the…

The child(ren) is under the age of six

Recommended Childhood Immunization Schedule for Children Under the Age of Six (Schedule I).

The child(ren) is not immunized in the first year of life

Recommended Immunization Schedule for Children Not Immunized in the First Year of Life (Schedule II).

Recommended Childhood Immunization Schedule for

Children Under the Age of Six (Schedule I)

Type of Vaccine

Dose

Recommended At

Polio (or OPV, TOPV, IPF, Sabin, Salk)

1^st

2^nd

3^rd

4^th

2 months

4 months

6-16 months

Before starting school (4-6 years)

DTaP (DPT)

(diphtheria, tetanus and pertussis)

1^st

2^nd

3^rd

4^th

5^th

2 months

4 months

6 months

15-18 months

Before starting school (4-6 years)

MMR

(measles, mumps, and rubella)

1^st

2^nd

12-15 months

Before starting school (4-6 years)

Varicella Virus Vaccine*

(or VAR, VZY (chicken pox)

1^st

12-18 months

Hepatitis B

1^st

2^nd

3^rd

At birth – 3 months

1-5 months

6-18 months

Hemophilus influenza type b (or Hib)

1^st

2^nd

3^rd

3^rd or 4^th

2 months

4 months

6 months (may not be required)

12-15 months (if any dose is given after 12 months. No further dose needed).

Kinrix

[diphtheria, tetanus, pertussis (DTaP), and polio (IPV)]

The Kinrix vaccine is a combination vaccine which includes Polio and DTaP in one single vaccination.  The vaccine is given to children between the ages of four and six years old who need their booster doses DTaP and IPV before they begin kindergarten.  The vaccine meets the immunization requirement for children receiving CalWORKs and will be accepted if listed on the immunization records. 

*The varicella virus vaccine is only required for susceptible children, i.e., those who have not had the chickenpox.

Recommended Immunization Schedule for Children

Not Immunized in the First Year of Life (Schedule II)

Visit

When

Vaccines Which Might Be Given

First visit

Hepatitis B

DTaP (or DTP)

Hib

Polio (or OPV, TOPV, IPV, Sabin, Salk)

MMR

Varicella (or VAR, VZV)

(chickenpox)

Second visit

1 – 2 months after 1^st visit

Hepatitis B

DTaP (or DTP)

Hib

Polio (or OPV, TOPV, IPV, Sabin, Salk)

Third visit

1 - 2 months after 2^nd visit

DTaP (or DTP)

Polio (or OPV, TOPV, IPV, Sabin, Salk)

Fourth visit

6 months after 3^rd visit

Hepatitis B

DTaP (or DTP)

Category

Acceptable Documents

Proof of up-to-date immunizations

Verification of immunizations is recorded in the yellow vaccination/immunization record/booklet.  If the booklet is not provided, the following methods are acceptable:

1.    Printout from a health plan;

2.    Statement from a physician/clinic;

3.    Immunization booklets from other counties, states, and countries; or

4.    Immunization records may be obtained from CAIR2 when the applicant/participant is unable to provide the immunization records.

Note:  When the immunization status cannot be determined, the parent/needy caretaker relative must provide a statement from a doctor or clinic.