Courtesy Applications

The “County of Responsibility” is the county responsible for evaluating and redetermining the MC benefits. In the event that a county which is not the county of residence receives an application, the receiving county must date-stamp the application and forward it to the correct county as soon as administratively possible. The receiving county must use the date stamp from the sending county as the date of application.

These charts are intended to function as guidelines when determining the county of responsibility. There will be situations other than those identified in these charts. When resolving county of responsibility issues, staff should be flexible and keep in mind the best interest of the applicant/recipient and/or his/her representative. Staff must consider criteria such as:

Age of the applicant/recipient and his/her representative,
Physical and mental condition of the applicant/recipient,
Travel distance for the applicant/recipient and his/her representative, and
Possible delay in the processing of the application and eligibility determination that will create undue hardship for the applicant/recipient and/or his/her representative.

Courtesy Application

Situation

County of Responsibility

An application from different sources (i.e. CalHEERS External Referral, mail-in etc.) made in a county other than the county of responsibility.

The county in which an applicant or his/her representative applies for MC benefits is the county responsible for making the initial eligibility determination, even if it is not the applicant’s county of residence.

If all information needed to determine eligibility is available, the county must issue benefits then initiate eICT to the client’s county of responsibility.

Otherwise, the county must forward the application and all information collected within 15 days from the date of application to the county of responsibility for follow up and completion of the initial eligibility determination.

Example 1 Example 1 An individual lives in Santa Cruz and becomes ill in Santa Clara County. The individual is immediately admitted to VMC. The outstationed EW at the hospital receives a MC referral from the hospital staff. The client completes the necessary application form(s), and provides sufficient information for the EW to determine initial eligibility. The EW would approve MC, then initiate an eICT to Santa Cruz County, the client’s county of responsibility.
Example 2 Example 2 An applicant’s representative applies in Santa Clara County on behalf of an individual who resides in Alameda County. The individual is hospitalized and unable to complete and participate in the application /eligibility determination process in Alameda County. Santa Clara County must accept the MC application from the representative. If the representative has knowledge of the applicant’s income/resources and can provide Santa Clara County with information to process the MC application, Santa Clara County must determine initial eligibility and grant MC benefits to the individual. Santa Clara County would then transfer the continuing eligibility case responsibility to Alameda County.

Person Maintains a Home

Situation	County of Responsibility
Person maintains a home and resides permanently.	The county where person lives.
Person maintains a home but works out of town seasonally.	The person is considered temporarily absent from home. The county where person maintains his/her home is the county of responsibility.
Person maintains a home but is vacationing in another county.	The person is considered temporarily absent from home. The county where the person maintains his/her home is the county of responsibility.

Homeless Individuals

Situation

County of Responsibility

Person is homeless with no permanent living arrangements.

County of physical presence at time of application is the county of responsibility. If the homeless person moves to another county or requests the case be transferred to another county, an eICT must be initiated.

Homeless person intends to reside in one county but maintains a mailing address or

P. O. Box in another county for mail pick up and delivery.

County where the homeless person intends to reside is the county of responsibility. An eICT is not required.

Individual with a Guardian

Situation	County of Responsibility
Client has a private guardian.	Private guardian has no effect on county of responsibility. Determine as if there were no private guardian.
Client has a public guardian.	Public guardian is a county agency. County in which public guardian is located is the county of responsibility.

Individuals Under 21 Years of Age Not living at Home

Situation	County of Responsibility
Person is between 18-21 years of age and NOT claimed as a tax dependent and NOT under parental control.	County in which the person resides. This person is NOT considered living in the parent’s household.
Person is between 18-21 years of age and living away from home and IS claimed by his/her parent as a dependent for state or federal income tax purposes.	County in which the claiming parent resides if the parent lives in the state. If the parent resides in another state, the county of responsibility is the county in which the child resides. However, the parent must complete the application / redetermination form(s), provide the county with information / verification, and cooperate with county staff in the child’s eligibility determination process. The EW must grant benefits to the child if eligibility conditions are met.
Person is under 21 years of age and is living away from home and doesn’t have any information on tax dependency status.

Example 1 Example 1 A 19-year old applied for MC in San Joa qui n County. During the interview, the applicant informs the eligibility worker that his/her parents reside in Santa Clara County and claims him/her as a tax dependent. San Joaquin County must deny the application unless the applicant is applying for the Minor Consent program. San Joaquin County must inform the applicant that if he/she wants full-scope benefits, his/her parents must file an application in Santa Clara County.

Example 2 Example 2 The applicant is an 18 year old attending school in California. The applicant’s parents reside in the state of Oregon but he/she is the parents’ tax dependent. The parents must apply for the child because the child is claimed as a tax dependent of his/her parents. The county of responsibility is where the child resides because his/her parents reside out of state. [Refer to “MN/MI and Non-MAGI MC MFBU,” page 19-1] [Refer to “MAGI MC Tax Household,” page 14-1]

Deceased Individual

Situation	County of Responsibility
The deceased individual incurred hospital bills,	The county where the person was residing at the time of death.

NOTE: If the deceased person’s family or representative applies in any county within the state, the county in which the applicant’s representative applies must accept and process the application under the courtesy application procedures.

Out of Home Placement

Situation	County of Responsibility
Foster children and children eligible for the Adoption Assistance Program (AAP).	County in which the placing agency is located.
Person is placed in county or private facility in another county by a county agency.	County that made placement, unless counties and individual agree otherwise.
Person is placed in county or private facility in another county by a private party.	County in which the facility is located unless the person’s family resides in another county. NOTE: This does not apply to persons who are in separate MFBUs from their families, e.g., LTC persons.
Person is placed in state hospital by county mental health agency or Regional Center for the Developmentally Disabled.	County in which state hospital is located. NOTE: This situation supersedes all other situations except situations where MFBU/Tax Household includes other family members.
Persons placed in county or private facility in another county after release from a state hospital.	County in which the facility is located. NOTE: This situation supersedes all other situations except situations where MFBU/Tax Household includes other family members.

Pending DDSD Determination

Situation

County of Responsibility

Case has MFBU/Tax Household member(s) already active on MC and one of them has a pending DDSB determination,

The county where the family currently resides is the county of responsibility.

The Sending County must initiate an eICT to the new county of residence. Include copies of the DDSB referral in the ICT packet.
The Receiving County must notify DDSB of the client’s new address.

Case consists of only the applicant (there is no active case),

The original (Sending) county that initiated the DDSB referral must keep the case until a decision is received:

If the client is disabled, approve MC and then initiate eICT.
If the client is not disabled and there is no eligible for other MC programs, deny the MC application. No eICT is required.

Withdrawals/Requests for Discontinuance

A client may withdraw an application for or request discontinuance from MC by any of the following:

Verbal request specifically stating MC. (EWs must still mail the MC 215 or SCD 166.)
Completion of the MC 215 (scan into IDM and give a copy to the applicant) or SCD 166 (automatically populates in the CalSAWS print queue when the withdrawal is added to CalSAWS, this form does not need to be returned for the EW to complete the withdrawal action).
Submitting a signed written request specifically stating MC. The signed request should be scanned into IDM.

Note: The client must indicate that he/she clearly understands the process by signing the withdrawal form. A withdrawal/request for discontinuance should be a free and willing decision based on an understanding of all available information.

Courtesy Applications