General Case Rejection Criteria

Application

  1. A current/valid application is not on file. 
  2. Required signatures are missing on the application forms.
  3. Identity is not verified. (CW & CF only)
  4. The wrong Beginning Date of Aid was used for the application.
  5. A program was requested by the client or the client’s authorized representative (AR) and the EW did not follow up on the request (i.e. The client indicates he/she has a disability, but a SP-DDSD packet was not sent).
  6. A Withdrawal of Application/Information Application Refusal (SCD 166) form was not signed by the applicant or mailed and documented by the EW when the applicant chose not to apply for all or some of the programs.

    1. Note: Applications submitted via CalHEERS and BenefitsCAL do not require an SCD 166. However, documentation in CalSAWS Journal Detail page clearly explaining what additional programs were explained and offered by the EW and documentation of the applicant’s response is required, regardless of the method of application.

  7. The client's language preference as noted on the application is NOT appropriately entered and documented in CalSAWS.

    1. Reminder: The Notice of Language Services (GEN 1365) must accompany information sent to the client whenever the information being sent is not in the client's preferred language. 

  8. Verification is missing or conflicts with case actions and/or system entries.
  9. IEVS was not requested or processed.
  10. Aid paid as an ICT and ICT forms are not on file and the EW’s attempt to obtain them is not documented.
  11. RE dates and/or cycles are not aligned properly and case comments do not provide a clear explanation of why the RE dates/cycles for all programs have not been aligned.
  12. There is no documentation that Rights and Responsibilities (R & R’s) were provided or explained.
  13. Appropriate referrals were not made.
  14. The Family Diversion Contract (SCD 1307) is not in the case record, if applicable.
  15. A restoration of benefits was completed but there is no current Statement of Facts or Statement of Facts for Determining Continuing Eligibility for the Cash Assistance Program for Immigrants (CAPI) (SOC 804) in the case record.
  16. No Determination of Federal AFDC-FC Eligibility (FC 3)/AFDC-FG/U Worksheet (FC 3A) was taken to determine Federal eligibility for Foster Care and document was not signed. (FC Only)
  17. No Petition, Court Order or Voluntary Placement Agreement on Foster Care eligibility is in the case file and/or is incomplete. (FC Only)
  18. When placement is Foster Family Home (FFH) no temporary or fully approved/certification is on file. (FC Only)
  19. Missing or incomplete Foster Child’s Data Record and AFDC-FC Certification (SOC 158A). (FC Only)

Eligibility

  1. Eligibility was not determined correctly.
  2. The wrong aid code is allocated.
  3. All changes reported or requests were not acted on in a timely manner (based on program regulations).
  4. Manual budget is not on file or it is incomplete when the system is unable to determine the budget.
  5. The client has asked for a SOC certification by the EW for medical bills and the SOC procedures were not done.

Re-Evaluation (RE)

Note: For the purposes of this chapter, re-evaluation (RE) is used instead of program-specific terminology (redetermination/recertification/reinvestigation).

  1. The RE is overdue/incomplete, or forms are on file but not processed.
  2. A case is transferred the month prior to the month in which the RE is due, and the RE has not been completed.
  3. The RE was updated but current application is not in the case record for that RE.
  4. RE dates and/or cycles are not aligned properly and case comments do not provide a clear explanation of why they are not aligned.
  5. There is no documentation that a RE was completed. (exception: Auto-BRE MC REs)
  6. IEVS is not requested or processed.
  7. There is no documentation that Rights and Responsibilities (R & R’s) were provided or explained.
  8. The RE due date was not reset when a change of circumstances was reported. (MC only)
  9. E-verified proof of income is not on file for a manually processed MC RE.

Social Security Number (SSN)

  1. A client has been on aid over 30 days with an unvalidated SSN and the “Social Security Administration Referral Notice” (MC 194) was not sent.
  2. Documentation on file indicates that the client refuses to secure SSN(s) and person(s) without number(s) are on aid.
  3. Photocopy of the SSN card or other acceptable verification of the SSN is not on file when required.
  4. A new person was added without a SSN or proof of application for a SSN according to specific program regulations.
  5. SSN is unvalidated on MEDS and/or not e-verified in CalHEERS, Federal Hub or IEVS and no follow-up action was taken.
  6. Photocopy of the SSN card or other acceptable proof (including IEVS validation) is not on file after 60 days and GA was not discontinued. (GA only)

Citizenship/Immigration

  1. Non-citizen status was not verified via SAVE and/or secondary verification was not initiated when required.
  2. Sponsorship information is inconsistent, not explored or verified, or there is no Sponsor’s Statement of Facts - Income and Resources (SAR 22) on file.
  3. A SAVE response report is not imaged, when required.
  4. Affidavit of Support (I-864) is not imaged, when required.
  5. Proof is not on file that non-citizen(s) met a Qualifying Exemption or have filed an appeal with Social Security. (CF only)
  6. A person is incorrectly coded as Federal/CFAP. (CF only)
  7. The Satisfactory Immigration Status (SIS) period has expired and no verification has been received. Full-scope benefits have not been reduced to restricted. (MC only)
  8. An incorrect level of benefits (full vs. restricted) was issued. (MC only)
  9. Citizenship verification is not in the case within 90 days of request and no follow-up action was taken or no request was made. (MC only)
  10. The CAPI Indigence Exception Statement (SOC 809) and CAPI Indigence Exception Determination (SOC 813) are not on file for indigent non-citizens or it is not documented that the SOC 813 was sent to both USCIS and CDSS. (CAPI only)
  11. Sponsorship information is inconsistent, not explored or verified, or there is no Sponsorship Questionnaire (GA 54) on file. (GA only)

Residency

California residency has not been verified.

Property/Resources

  1. Property is not verified, per program regulation.
  2. Property is over the program limit and appropriate action was not taken.
  3. Property reserve is incorrectly determined and eligibility is affected, or the determination is unclear and eligibility is questionable per program regulations.
  4. Ownership/availability/utilization or allocation of property was not correctly determined.
  5. Excess property has been disposed of and there is no verification or clear documentation on file.
  6. The client is in long-term care and property was transferred within the last 30 months without adequate consideration and the correct period of ineligibility was not computed. (MC only)

Periodic Reporting

  1. The periodic report (PR) is on file but was not processed.
  2. The PR is incomplete and a discontinuance NOA was not sent and there are no related case comments.
  3. The Sponsor’s Semi-Annual Income and Resource Report (SAR 72) and Senior Parent Semi-Annual Income Report (SAR 73) are required but are not on file, or are incomplete and the discontinuance NOA was not sent.
  4. The PR is missing required signatures.
  5. The PR was accepted as complete and required verification is not on file.
  6. The PR was not received by NOA cut-off and discontinuance action was not taken.
  7. The case was restored without the required PR.
  8. The “Transitional Medi-Cal (TMC) Quarterly Status Report” (MC 176 TMC) was not sent to the client in a timely manner. (MC only)

Budgeting

Income and Deductions

  1. Income (i.e. earned/unearned/exempt/in-kind) is not verified as required.
  2. Income or anticipated income is not correctly budgeted.
  3. Expenses exceed income and there is no follow up or documentation.
  4. The client was not referred to apply for unconditionally available income as required.
  5. Information indicates other possible income, but was not explored and documented by the EW.
  6. IEVS was not requested or processed when needed.
  7. Income changes/termination was not verified and/or documented.
  8. Expenses and deductions were not appropriately budgeted and/or verified.
  9. Income and deductions are allocated incorrectly.
  10. Income/deductions amount on the budget differ from that reported and there is no documentation to clarify the reason (e.g. averaged income, prorated income, etc.)
  11. Verification of a UIB application approval/denial is not on file after 30 days of the request. (CW and GA only)
  12. Request to be Selected as Payee (SSA 11-BK) was not started for a child receiving SSA or SSI. (FC only)

Special Needs

  1. A Special Need is incorrectly entered, paid, verified or end dated.
  2. A Special Care Increment (SCI) was approved but not included in the FC rate or the wrong amount was included in the rate. (FC only)
  3. SCIs were paid and there is no current verification in the case. (FC only)
  4. No follow-up was done when SCI payments expired. (FC only)

Notices Of Action (NOA)/Client Correspondence

  1. Timely or adequate NOA is not on file.
  2. All required NOAs have not been sent out and/or invalid NOAs deleted from the print queue.
  3. NOAs are left in Distributed Documents Search page without some sort of disposition status.

Household (HH)/Assistance Unit (AU) Composition

  1. The HH/AU composition is incorrect.
  2. An incorrect relationship was established in CalSAWS/CalHEERS.
  3. A HH/AU member was not added or removed timely.
  4. Required forms are not on file.

Local Child Support Agency (LCSA) Communication

  1. A referral to the LCSA was not made when required and/or a signed copy of a current Notice and Agreement for Child, Spousal and Medical Support (CW 2.1 NA) and Support Questionnaire (CW 2.1 Q) are not imaged.
  2. The Unrelated Adult Male (UAM) is listed on the birth certificate as the parent, and a referral to establish paternity has not been made.
  3. Correspondence from the LCSA indicates non-cooperation/failure to assign support rights, but the EW did not apply the penalty/sanction to the grant.
  4. Incomplete determination of “Good Cause.”

Work Registration/Exemption/Exclusion/Sanction

  1. Work registration was not completed in CalSAWS.
  2. A work exemption/exclusion/sanction or voluntary quit sanction was incorrectly applied.
  3. A previous sanction was not resolved before benefits were approved.

Case Journaling

Journal entries were not entered for client contact and/or action taken.

Case Narration Tool

Case Narration Tool not used as required for intake interviews, annual renewals and/or EBT card issuances. The use of the CNT is not required for Supplemental Security Income Qualified Medicare Beneficiaries (SSI QMB) redetermination processing, Edwards (38 aid code) redetermination, and Craig v. Bonta cases.

Caseload Reviews

Follow up was not done on Quality Assurance/Quality Control (QA/QC) sanction(s).

Benefit Issuance

  1. An incorrect benefit amount was issued.
  2. An overpayment (O/P) and/or overissuance (O/I) exists but required follow-up action was not completed (identification, forms, referrals, recoupment when possible, NOAs, etc.).
  3. An O/P, O/I, underpayment (U/P) or underissuance (U/I) adjustment was not computed or adjusted correctly or timely.
  4. An incorrect determination of the type of O/P or O/I was made.
  5. EBT errors were not corrected (e.g. unlinked benefits).

Systems

  1. There is a discrepancy between MEDS, CalSAWS and/or CalHEERS.
  2. Duplicate MEDS records have not been chained.
  3. MEDS alerts are not processed.
  4. MEDS screens must be imaged when:
    1. Any verifications (Medicare, UIB, SSI, income, etc.) have been used and obtained via MEDS,
    2. An individual is sanctioned,
    3. The completion of a “Request for Online Transaction” (SCD 1296) is done before and after to review the results,
    4. SSI Denial Applications (completed by clerical staff),
    5. Letter of Authorization (LOA) cases (with MEDS screen(s) displaying the aid code activated for the requested month(s)),
    6. TOA requests or reviews,
    7. SSI/QMB cases,
    8. Low-Income Subsidy cases, and
    9. Specific CalFresh ABAWD screens.
  5. MEDS screens do not need to be imaged when:
    1. The case is granted or denied at intake for regular applications,
    2. The RE is processed by continuing staff.

Important: Intake EWs must review MEDS and/or any other system(s) for eligibility determination prior to transferring a case out of their worker number. Upon receiving a case, continuing EWs should review MEDS and/or other system(s) to ensure that eligibility has been determined correctly.

Related Topics

Case Rejection Criteria Overview