Ancillary Expenses Requests

A written request is required for all ancillary expenses. The request must indicate the necessary item or service, the reason for the request, and the cost of the item or service. The SCD 1584, a letter from the service provider, or a letter from the employer can be used as the request. A request for ancillary expenses may be made by any one of the following:

• Client
• Agency Staff
• Service Provider.

Note: The SCD 1584 can be used to document the estimate and the request. Forward a copy to the IDM station.

Request Review

CWES Workers are to use the following guidelines when reviewing all requests for ancillary payments, except for clothing requests, and Diaper Assistance. Refer to Clothing Request Review for more information.

Guidelines:

1. Review the request and determine if the expense poses a barrier to the client’s path to self-sufficiency. The request must indicate the necessary item(s) or service(s), the reason for the request, and the cost of the item(s) or service(s).

If the client is in a post-assessment activity, review the WTW Plan and, if necessary, consult with the Assessment Counselor.

2. When the client’s WTW Plan calls for drug, alcohol or mental health services/activities, the ancillary expense must be pre-approved by the CalWORKs Social Worker. The Social Worker is responsible for securing documentation to verify the necessary item(s) or service(s), the reason for the request, and the cost of the item(s) or service(s). The social worker completes the “Ancillary Expenses Estimate, Request, and Verification” (SCD 1584) and attaches supporting documentation.
3. If the cost of the item fluctuates, two estimates are required.
4. When the request is for dental services, the client is required to submit verification from the service provider stating the cost for the specific service is “DENIED” by Medi-Cal. The service provider must submit a TAR for pre-authorization to the DHS. It normally takes from four to six weeks for a review by DHS. The TAR requests are handled through the local DHS Medi-Cal Field Office: 100 Paseo de San Antonio, San Jose, CA 95113.
5. ALL authorizations for payments require either an itemized estimate for purchase or actual receipts for reimbursement. The SCD 1584 may be used, however, other documentation is also acceptable. The client is responsible for submitting appropriate documentation to verify the need for the item(s) or service(s), the reason for the request, and the cost of the item(s) or service(s).
6. The cost may be verified by one of the following:
   1. CWES Worker
   2. Agency staff
   3. Sales representative
   4. Service provider.
7. If the cost of the item(s) or service(s) is over $750, supervisor’s approval is required.
8. A case review of prior expenditures must be made to ensure that no more than one authorization is paid for the same item or service. In extenuating circumstances, exceptions may be considered with supervisor approval.
9. A “WTW/Cal-Learn Ancillary Services Approval/Denial” (NA 823) must be issued within TEN working days from the date ALL required documentation is received.

Clothing Request Review

CWES Workers use the following guidelines when reviewing clothing requests.

Guidelines:

1. The employment must be expected to last more than thirty calendar days for either part-time or full-time work.

Exception: Uniforms needed for training.

2. Accessories, purses, or lingerie are not considered.
3. ALL authorizations for payments require either an itemized estimate for purchase or actual receipts for reimbursement. The SCD 1584 may be used, however, other documentation is also acceptable.

The client is responsible for submitting appropriate documentation to verify the need for the item(s), the reason for the request, and the cost of the item(s). The need for the item and the reason for the request may be verified by the employment counselor or the employer.

4. The costs for clothing may be verified by one of the following:
   1. CWES Worker
   2. Agency staff
   3. Sales representative.
5. If the cost of the item(s) is over $200, Supervisor’s approval is required.
6. A “WTW/Cal-Learn Ancillary Services Approval/Denial” (NA 823) must be issued within TEN working days from the date ALL required documentation is received.

Dress for Success San Jose

Refer clients to Dress for Success San Jose before authorizing clothing expenses, whenever possible.

Request for Reimbursement

Request for reimbursement for ancillary expenses can be made after the request review is completed and the original receipt of the incurred cost is received.