Quality Control Cooperation Requirements

Quality Control Review

The QC review is a state-mandated system for determining the extent of and reasons for errors in the determination of eligibility and payments.

Annual Review Period

For QC purposes the annual review period is October 1 through September 30.

Rules

A CalWORKs applicant/recipient is responsible to cooperate with Quality Control (QC) should their eligibility case be selected for review.

The EW must inform the client of this requirement during:

Each initial application interview.
Each annual redetermination interview.

When an individual in the AU or a non-needy caretaker relative refuses to cooperate in a QC review the entire AU is ineligible and the case discontinued.

Failure to Cooperate — Good Cause

Good cause for failure to cooperate includes, but is not limited to:

Illness or incapacity.
Court-required appearances or temporary incarceration.
Family crisis or other change in circumstances.
Other substantial and compelling reasons.

Note: Good cause is determined by the QC reviewer.

Refuse to Cooperate — Without Good Cause

The refusal to cooperate without good cause is determined when the individual:

States directly to the QC reviewer that he/she is refusing to cooperate, or
Fails to respond in a timely manner to QC's request for cooperation, or
Fails to attend any scheduled interviews (as determined by the QC reviewer), or
Fails to meet the requirements of providing necessary information or signing the required release of information forms as required by the QC reviewer.

Discontinuance

When a determination is made that an applicant or recipient failed to cooperate with QC without good cause, an adequate and timely notice of action must be sent discontinuing the entire AU.

Ineligibility begins the first of the month after the month in which the noncooperation with QC occurs.

ExampleExample

A recipient refuses to cooperate with QC on February 26. The QC reviewer notifies the EW on February 27, but a timely and adequate Notice of Action cannot be given for March 1. The EW shall provide a notice to take appropriate action on March 31. The CalWORKs amount received for March 1, is declared an overpayment.

If the recipient cooperates with QC before the effective date of the discontinuance, the EW must rescind the discontinuance action.

Client Reapplies

When an individual has refused to cooperate with QC, a request for a restoration or reapplication may be made, but the AU is not determined eligible until:

The AU subsequently cooperates and meets all eligibility conditions, or
The AU reapplies for aid at least 95 calendar days after the end of the annual review period in which the refusal to cooperate occurred and meets all eligibility conditions. (After January 3rd of the following year.)

Note: Immediate need payments are not available to a family which is ineligible for CalWORKs because of noncooperation with Quality Control. Until the appropriate family member cooperates with QC, the family remains ineligible for any CalWORKs benefits, including Immediate Need, Special Needs, etc.

ExampleExample

A recipient refuses to cooperate with QC on January 7, 2006. The EW is notified by the QC reviewer and the case is discontinued January 31, 2006.

The client reapplies on June 23, 2006, but is still ineligible as she refuses to cooperate. She will remain ineligible as long as she refuses to cooperate.

She may reapply on January 4, 2007 and have her eligibility determined without agreeing to provide QC with the items needed (this is 95 days after the end of the Annual Review Period).