Express Enrollment for Children in the National School Lunch Program

Overview

National School Lunch Program (NSLP) allows children who are approved for free school lunches to apply for MC using the information on the NSLP application.

A modified NSLP application along with a supplemental form can be used to determine eligibility for MC. Our agency must accept and process NSLP applications from schools who wish to participate.

The Santa Clara County Social Services Agency has an agreement with the Campbell and East Side Union High School Districts to process the modified NSLP applications for MC eligibility and complete Express Enrollment for qualified children.

At this time, no other school districts in Santa Clara County are participating in this program. Since MC enrollment through the NSLP application is time-limited, EWs at the Medi-Cal Benefits Assistance (MBA) office process these applications.

Express Enrollment Definition

Express Enrollment is temporary, expedited full-scope healthcare coverage for children up to 19 years old, who qualify to receive free meals through the NSLP. Express Enrollment continues until a determination of eligibility for regular MC is made.

NSLP Application Process

The NSLP provides either free or reduced price meals based on household size and family income. Income is self-declared and no income verification is required. Alum Rock School District Child Nutrition Services (CNS) will inform the family of the child's eligibility for the NSLP or denial within 10 calendar days of receipt of the application.

The Alum Rock School District (ARSD) Child Nutrition Services (CNS) mails an NSLP application to all families a few weeks before the start of the school year. Families must complete, sign and return the NSLP application for an eligibility determination. In order for children to be considered for Express Enrollment, a parent/caretaker relative must consent to the sharing of personal and financial information contained in the modified NSLP application by signing the optional MC benefits section of the application.

Families with household income at or below 130% FPL qualify for free school lunches.
Families with household income at or below 185% FPL qualify for reduced-priced lunches.

Modified NSLP Application Form

The NSLP application has been modified to include information needed for a determination of MC eligibility:

The child's birth date
The child's income
The relationship of all household members to the child for MFBU determination
The income and family size of CF and Food Distribution Program on Indian Reservation (FDPIR) clients
A signature line for the parent/caretaker relative to provide signed consent to sharing of information on the NSLP form for a MC determination
A signature under penalty of perjury statement

Income Verification for Express Enrollment

The modified NSLP application serves as income verification for determining MC eligibility of a child enrolled through the Express Enrollment process. Income is self-declared and no income verification is required. However, IEVS information must be used to verify income when a Social Security Number is available.

Verification of income is required only when the EW determines there is a discrepancy in the reported income, including when:
A change is reported during or after the MC determination,
IEVS discrepancies need clarification,
Retroactive MC coverage is requested,
Income was not reported on the NSLP application, or
Other family members are requesting MC.

Parents are not required to provide Social Security Numbers unless they are requesting MC for themselves.

Express Enrollment Process

The school has sole authority to certify a child for Express Enrollment using the information provided on the modified NSLP application. Once the certification is made, the school notifies the parent/caretaker relative that the child is certified for temporary MC and forwards the application to Social Services Agency for a MC determination.

Activation on MEDS

WITHIN 5 DAYS of receipt of the NSLP application, Social Services Agency must:

Complete CalSAWS and MEDS file clearance procedures,
Complete an AP 18 transaction to report the application information and school determination date to MEDS, and
Activate aid code 7T on MEDS.

Date of Application/Enrollment

The Express Enrollment date is the date the school determined eligibility.
The application date is the date the application is received at Social Services Agency.

Ineligible Children

Children in the following categories are not eligible for Express Enrollment:

Children who are already receiving MC benefits through an active CW or MC case, or through SSI.
Children whose NSLP applications lack sufficient information for the school to make a determination for Express Enrollment.
Children with family income exceeding the income limit.

Note: These applications are to be processed for other MC programs.

Required Supplemental Forms/Notices

When a modified NSLP application is received by SSA, the following informing notices and request for information must be sent to the family:

“Notice and Supplemental Form for Express Enrollment Applicants” (MC 368) - The MC 368 includes a check box indicating the child's Express Enrollment status and is also a request for additional information necessary to complete the MC eligibility determination.
“Important Information for MC Applicants” (MC 368 Attachment) - The MC 368 A includes the applicant's Rights, Responsibilities and Declarations, the MC Confidentiality Notice, and the MC Privacy Notice.
MC 003
Health Care Options Flyer
CHDP Brochure
WIC 2
Other forms as applicable

Information NOT Required

MC 13
MC 219
CW 2.1 (Q) and CW 2.1 Notice and Agreement
- Note: Medical Support forms are given to the parent(s) for completion; however, if only the child(ren) are active, no action is taken if they are not completed and returned. Cooperation with medical support enforcement is required if the parent(s) want MC.
Proof of California Residency
Verification of Income
Verification of Allowable Income Deductions
- Note: Income deductions are not allowed unless verification is provided; therefore, income deductions may be requested to bring the family income within the FPL limit (if applicable).

Fair Hearing Rights

There are no fair hearing rights or NOA requirements during the Express Enrollment period. However, once an eligibility determination is made for regular MC, the appropriate NOA must be sent to either approve or deny the application, and fair hearing rights apply.

MC Eligibility Determination

The MC eligibility determination requirements (including timeframes for providing forms and verifications) have not changed. EWs must first evaluate the child for eligibility under the applicable FPL program.

Express Enrollment (7T) continues until a MC eligibility determination is completed by the EW. Since MC applications must be processed within 45 days, it is expected that Express Enrollment will not exceed two months.

Since the Express Enrollment period is temporary and is NOT considered a MC determination, children in aid code 7T must have an eligibility determination for zero SOC MC before CEC applies.

Other Family Members Requesting MC

When other family members request MC they are NOT required to complete the SSApp. However, the necessary information must be requested for the other family members. Once sufficient information is provided to determine eligibility under all MC programs, all necessary verifications and requirements must be met.

Request for Retroactive Benefits

The requirement to complete a “Supplement to Statement of Facts Request for Retroactive MC Eligibility” (MC 210 A) has not changed. Income verification is required for all requested retroactive months (if appropriate). Eligibility for retroactive months is based on the date the NSLP application is date-stamped as received by a Social Services Agency district office.

Required Actions - NSLP Application Procedures

EWs must take the following steps upon assignment of an NSLP application:

Complete one MC 368 for each child listed on the NSLP for whom MC is requested.
Mail the request for information forms (MC 368, MC 368A) and applicable informing notices (MC 003, Managed Care Flyer, CHDP Brochure, WIC 2) to the parent/caretaker relative.

When the MC 368 is returned, EWs must:

Determine immigration status of each child to determine scope of coverage.
Determine eligibility for MC, using the information on the NSLP application.
Complete the appropriate CalSAWS windows.
Mail the appropriate NOAs. If the child does not qualify for full-scope, zero SOC MC, send a referral flyer to the Alum Rock School District Health Care Outreach Program Coordinator.
Review MEDS to make sure the appropriate aid codes are active.
1. If approved, MC is active and aid code 7T is terminated.
2. If denied, MC is not active and aid code 7T is terminated.
Follow up with the family if Retro MC is requested or if the MC 368 indicates that other family members wish to apply for MC.
Collect the required supplemental forms and verifications and determine eligibility based on current rules and processes.
Document actions in the Search Case Comments window and make sure all documents are scanned into IDM appropriately.
1. Note: Follow-up action may be required if the MC 368 is returned incomplete.

When the MC 368 is NOT returned, EWs must:

Conduct follow-up activity (i.e. phone or written contact to the family). Allow a minimum of 10 additional days for the family to submit the required information.
1. Note: If the family indicates that they are working to meet the requirements as requested by the EW, additional time must be allowed.
Send NOA and a referral flyer to the Alum Rock School District Health Care Outreach Coordinator.
Document actions in the Search Case Comments window and make sure all documents are scanned into IDM appropriately before submitting case to the EW Supervisor for transfer to closed files.