Edwards v Kizer (also known as Edwards v Myers)

Issue

Effective April 30, 1982 a preliminary injunction required the continuation of zero SOC MC benefits to persons discontinued from Aid to Families with Dependent Children (AFDC - CW) until eligibility or ineligibility for MC only is completed and an adequate and timely notice is issued.

Decision

The new provisions of the Judgment which were not previously part of the preliminary injunction are:

The modification of MEDS to allow the automatic issuance of aid code 38 based on the CW discontinuance code, and
The use of a mandated, shorter “Statement of Facts”, when there is insufficient information on file to determine ongoing eligibility.

Aid code 38 continues to be a “transitional” aid code for certain persons discontinued from cash assistance. County error will be cited if Edwards extends beyond two months; however, aid code 38 must be continued if MC eligibility has not been determined timely.

Persons Affected

Persons being discontinued from cash assistance under the following aid codes must be reviewed for ongoing MC eligibility as required by Edwards:

CW (aid codes 30, 33, 35, 3E, 3G, 3H, 3L, 3M, 3P, 3R, 3U)
CW-Foster Care (FC) (aid codes 40, 42, 4C, 4G)
Refugee Cash Assistance (RCA) or Entrant Cash Assistance (ECA) (aid codes 01,08)
Transitional Medi-Cal (TMC) (aid codes 39, 59) and Four Month Continuing (aid code 54), if ongoing MC eligibility has not been approved/denied by the end of the TMC eligibility period.

RCA/ECA and Edwards

Effective April 2, 1998, individuals terminated from RCA or ECA (aid codes 01 and 08) are eligible for Edwards benefits until the MC redetermination for ongoing MC eligibility is completed.

MEDS Conversion

The State automatically issues aid code 38 benefits for the future month to individuals at MEDS Renewal when they have been active on MEDS in the current calendar month in one of the following aid codes:

01, 08, 30, 33, 35, 38, 39, 3E, 3G, 3H, 3L, 3M, 3P, 3R, 3U, 40, 42, 4C, 4G, 54, or 59

AND

A negative action was taken for a reason other than the following:

Death
CW and MC discontinued at the client’s request
Failure to cooperate with MC requirements
Children on CW who are transferred into another county administered program (i.e., FC)
Determined ineligible for MC
Resident of a non-medical public institution
Loss of California residency.

When an entire case is being discontinued for a reason other than those listed above:

MEDS will automatically convert the case to aid code 38 at MEDS Renewal, and
CalSAWS will automatically convert the case to aid code 38 on the 5th working day of the month following the cash discontinuance. A NOA is automatically generated in this process.

Note: EWs must manually convert any case (and send an NOA) when Edwards is required and/or already established on MEDS if the case was not automatically converted in CalSAWS.

Reminder: Edwards cases may not be transferred out of the district office until MC eligibility has been determined.

General Requirements

Aid code 38 MC benefits are to be issued only until:

A redetermination of ongoing eligibility can be made following the ex parte process, and
A timely and adequate NOA is sent.

Note: An SCD 2350 is required only when the SAWS 2 PLUS on file is over 12 months old.

Discontinuing Individuals from CalWORKs/RCA/ECA

Individuals will automatically be converted to aid code 38 on CalSAWS and MEDS the month following cash-linked program discontinuance UNLESS:

The discontinuance is for one of the “non-Edwards” reasons, AND
The action is taken before MEDS cutoff.

Discontinuing CalWORKs/RCA/ECA Case and Information on File

If...	Then...
CW/RCA/ECA was discontinued due to increased hours/earnings,	Evaluate eligibility for TMC, or Refugee Medical Assistance (RMA).
CW only (not RCA/ECA) was discontinued due to increased child/spousal support,	Evaluate eligibility for Four Month Continuing, aid code 54.
CW/RCA/ECA was discontinued for another reason and there IS enough information on file to establish ongoing MC,	Establish eligibility for MAGI MC and set the RD due date 12 months from the date the SAWS 2 PLUS on file was signed. A 10-day NOA is needed if there will be a negative action. Note: Include an MC 219 in the next annual MC RD.
Additional time/information is needed to determine ongoing MC eligibility,	Establish aid code 38. Exception: Clients claiming disability must be set up using the appropriate aid codes.
	Follow the ex parte process. If information is not provided within the 30-day time frame or eligibility no longer exists, discontinue aid code 38.

MFBU Considerations

Edwards (aid code 38) clients must be included in the case of other family members who are applying for MC; for example, the absent parent who has returned home. Aid code 38 clients are included as ineligible persons when determining the SOC for other family members. Edwards persons can use their medical expenses which are not covered by MC to reduce the SOC for other family members.