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Informing Requirements
The following forms and/or information must be provided to clients:
- EWs must provide clients with the MC 219 and document that it was given/sent to the client. (The client is not required to sign and/or return it.)
- The “Responsibilities of Public Guardians/Conservators or Applicant/Beneficiary Representatives” (DHCS 7068) must be completed and signed by the client's representative, if applicable.
- Scan the original copy in IDM, and
- Give a copy to the applicant/client.
- For Non-MAGI: The “MC General Property Limitations for All MC Applicants” (MC 007) must be reviewed with applicants, and applicants must be informed of:
- Property limits.
- How property is exempted, counted, and valued.
- Their right to reduce non-exempt excess property within the month of application.
- Options of how excess property may be reduced and how adequate consideration may be obtained to establish eligibility for the month MC is requested.
- If the client declares other health, dental, or vision insurance, the correct other health coverage (OHC) code must be posted on MEDS. For mail-in applications, the EW must check the HIAR screen in MEDS and/or contact the client by phone to obtain the necessary information.
- If the client declares a pending lawsuit due to accident or injury, the EW must ask the client to complete the “Potential Third Party Liability Notification” (DHCS 6168) form. Refer to Third Party Liability.
- Your Rights Under California Welfare Programs” (PUB 13) must be given to the applicant or to the AR.
- Women, Infants and Children” (WIC) information must be given to pregnant women and to families with children (included in CW Intake packets).
- “Child Health and Disability Prevention” (CHDP) (PUB 183) brochures are included in CW packets. The brochure describes support services (scheduling and assistance with finding transportation) provided by CHDP as well as how and where services are provided. The correct information must be entered in CalSAWS to make sure a referral reaches the CHDP unit. This form is shelf stock.
Note: The Prenatal Care Guidance Program is available to pregnant women through CHDP. This program focuses on informing, motivating and assisting pregnant women with early and appropriate care. EWs should inform pregnant applicants and clients about this program and refer them to CHDP for guidance. The correct information for a referral must be entered in CalSAWS.
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