.Purpose

Policy

Background

Release Date:

2/2/2023

Definitions

Requirements

Verification Docs

Term

Description

PSN

A supplemental monthly payment issued to all pregnant persons who have applied for or are receiving CalWORKs with eligible children from the date of their PSN request.

1.     Effective May 1, 2022, the PSN payment is $100.

2.     Prior to May 1, 2022, the PSN payment was $47.

Good-Faith Effort

When the applicant/participant:

1.     Has attempted to comply with the requirement, but is having difficulty obtaining the requested document from a third party; and

2.     Is unable to provide the medical verification due to circumstances beyond their control.  

For instance, their doctor has not been able to schedule an appointment during the 30-day period. 

Requirement

Limit/Condition

Eligibility Requirements

To be eligible to a PSN payment, the applicant/participant must:

a.    Have a verified pregnancy; and

b.    Be eligible to receive CalWORKs and be included in the AU, if an applicant; or

c.    Be active in the CalWORKs AU, if a participant.

Note:  Excluded Members are not eligible to a PSN payment because they are not part of the AU. Refer to 82-832 Excluded Member policy for details.

Refer to 82-836 Pregnant Person policy for details.

Payment Limit

The PSN payment is $100 per month per eligible participant in the AU as of May 1, 2022. The $100 PSN payment is in addition to the Maximum Aid Payment for the AU.

Prior to May 1, 2022, the PSN payment was $47 per month.

PSN Requests

A participant can report a pregnancy and request a PSN:

a.    Mid period (in writing, via telephone, or in person);

b.    On the SAR 7, Eligibility Status Report; or

c.    At Renewal (RE).

PSN Payment Time Frames

When to start a PSN payment depends on:

a.    Whether the pregnant person is an applicant for or participant of CalWORKs;

b.    Whether a pregnant person is a teen or an adult;

c.    If others are aided in the AU; and

d.    The anticipated Date of Birth (DOB) of the child, also known as estimated delivery date.

New Applicant

A pregnant applicant (adult or minor) is eligible to receive PSN payments from the date of application, if they have applied for CalWORKs as:

a.    Part of an AU with at least one other eligible child; or

b.    The needy caretaker relative of a child that receives SSI/State Supplementary Payment (SSP), or Foster Care benefits (Kin-GAP, AB 110, Emergency Caregiver, Approved Relative Caregiver); or

c.    A PPO with no other eligible children. Refer to Eligibility Requirements Section for details.

Approved case

A pregnant participant in an AU, regardless of age, is eligible to receive PSN payments from the first of the month of the request once required verification has been received.

The PSN will continue:

a.    Through the end of the Semi-Annual Reporting (SAR) Payment Period in which the child is expected to be born; or

b.    Through the end of the month prior to the newborn being added to the AU. Refer to the Examples Section for details.

PSN Stop Date – Child Added to AU

PSN payment will stop:

a.    At the end of the SAR Payment Period in which the child is expected to be born once the required verification is provided; or

b.    At the end of the month prior to the month in which the newborn is added to AU, if the birth of the child is voluntarily reported mid-period.

Refer to the Examples Section for details.

Adding Newborns

The following rules apply when adding a newborn to the AU:

After the application, CW 8A – Statement of Facts for Children Under 16 or SAWS 2 PLUS – Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs, is completed and all other eligibility criteria are met, the newborn must be added to the CalWORKs AU effective the first of the:

a.    Month after the birth was reported, only if the addition results in an increase in benefits;

b.    Next SAR Payment Period following the SAR 7/RE on which the birth is required to be reported, if the addition results in a decrease or no change in benefits; or

c.    Month after the newborn has been released from the hospital, if the addition results in an increase in benefits in an Annual Reporting/Child Only (AR/CO) case.

Upon notification of the newborn’s name, DOB, and gender, the County must take action to approve Medi-Cal and issue a Medi-Cal card for the newborn effective the child’s DOB when the parent(s) has already been determined CalWORKs eligible and the newborn is a mandatorily included person.

Deemed Eligibility

Infants born to mothers who are eligible for and receiving Medi-Cal at the time of birth may be enrolled in Medi-Cal without an application. This is referred to as Deemed Eligible (DE). Medi-Cal eligibility for the DE infant must be established no later than ten calendar days after the birth is reported and is effective as of the first of the month of birth.

The birth of the newborn may be reported to the County via:

a.    MC 330 – Newborn Referral form;

b.    Telephone call;

c.    Letter;

d.    MEDS alert; or

e.    Any other contact with the County.

Only the following information regarding the infant must be provided to add the DE infant to Medi-Cal:

a.    Name;

b.    DOB; and

c.    Gender.

Refer to 40-103.44 Medi-Cal for CalWORKs Ineligible Members policy for details.

COVID-19

In response to COVID-19 and to assist Californians in meeting their basic needs, multiple Executive Orders temporarily suspended the requirement that medical verification of pregnancy had to be provided before approving benefits for PPO Intake cases; these COVID flexibilities were not applicable for Approved cases.  

During this timeframe, a written sworn statement or verbal attestation was accepted in lieu of the medical verification as a result of the following Executive Orders:

The temporary flexibilities ended when AB 135 and AB 172 were implemented on July 16, 2021, which provided permanent flexibilities when a pregnant person is unable to provide medical verification. 

Category

Acceptable Documents

Pregnancy Verification

Medical verification of pregnancy is a required condition of eligibility for CalWORKs.

Option 1

Acceptable forms of pregnancy verification are:

1.     Written statement from one of the following that includes the estimated delivery date.

a.    Physician;

b.    Physician’s Assistant;

c.    Authorized member of a health facility;

d.    State certified nurse mid-wife;

e.    Nurse Practitioner; or

f.      Designated medical or clinic personnel with access to the patients’ medical records.

2.     Ultrasound or sonogram from a health clinic that contains:

a.    The mother’s name; and

b.    Estimated delivery date.

Verification Exceptions Due to AB 135 and AB 172

Option 2

Pregnant applicants/participants who cannot provide medical verification (Option 1) at the time of application or when a pregnancy is reported (Approved cases) may submit a written sworn statement signed under penalty of perjury. An acceptable written sworn statement must include the following information:

a.    Applicant’s/Participant’s name;

b.    Date of application (for PPO cases); and

c.    Declaration of pregnancy.

Option 3

A verbal attestation and a signed SAWS 2 PLUS are acceptable only when a written sworn statement cannot be provided. Question 6m on the SAWS 2 PLUS must be completed.

Note: Applicants/Participants who reported the pregnancy or provided a written sworn statement or verbal attestation must provide a medical verification of pregnancy within 30 working days following the declaration date or submittal of the sworn statement or verbal attestation for benefits to continue.

Eligibility Worker (EW) failure to request verification

If the EW fails to request a pregnancy verification, then the participant is entitled to PSN payments for the previous months when they reported the pregnancy, no matter when the pregnancy verification is signed or when it was submitted.

Pregnancy continues beyond estimated delivery date

The participant is required to verify pregnancy initially (when the pregnancy is reported) and when the pregnancy continues beyond the estimated delivery date.

PPO applicants applying for Immediate Need (IN) or Homeless Assistance (HA)

PPO applicants who are unable to provide medical verification of pregnancy at the time of application are allowed to provide a written sworn statement or verbal attestation of their medical verification in order to be determined eligible for IN or HA.

Reporting Requirements – Loss of Child

Any time a pregnancy does not result in the birth of a child, CalWORKs participants are required to report, verbally or in writing, within 30 calendar days following the end of their pregnancy. 

When pregnancy ends due to the loss of a child, the case is discontinued at the end of the month following the month in which the loss was reported with timely and adequate notice.  For example, the loss occurred on November 28, the case should be discontinued end of December.

Mental Health Referral

In these instances, staff must provide information about, and a referral to, mental health services, including but not limited to, services provided by the Department of Mental Health (DMH) that include grief and loss resources.

The information about mental health services must be provided to the participant either by:

1.     Providing the DMH 24/7 Help Line number: (800) 854-7771; or

2.     Providing the DMH web address: https://dmh.lacounty.gov/resources/grief-loss/

Overpayment

CalWORKs eligibility stops at the end of the month of the 30-working-day period with timely and adequate notice when medical verification is not provided within the 30-working-day period and there is no good-faith effort. 

In situations where the benefits continue beyond the end of the month of the 30-working-day period, an overpayment will be established for any ineligible month. The PSN payments will resume upon receipt of medical verification of pregnancy effective the month in which the verification was provided. 

Example:  A pregnant participant with an active CalWORKs case has a due date of January 5 to provide pregnancy verification. They fail to provide the pregnancy verification by the due date and the system fails to terminate the PSN payment timely by end of January and issued PSN for February and March. An overpayment will be created to collect the PSN payments for each additional month (February -March).

Loss of Child

If the participant fails to report the loss within 30 calendar days and benefits continued, an overpayment must be established according to current policies for any subsequently aided months.

Example:  A participant with an active CalWORKs case has a pregnancy due date of June 1. The participant lost the child on January 2 and continued receiving the PSN payments. During the RE in April, the participant reports the loss which should have been reported by February 2 (30 calendar days). Eligibility includes the month in which the loss occurred and the month after. As such, in this instance, the case should have been discontinued February 28. As a result, the EW informs the participant that the overpayment will be established to collect the PSN payments for March-April.