Craig v Bontá FAQs

If there is no time left in the 12 month CEC period, can we mail an application form and discontinue the child if it is not received? Answer: No. All Craig v Bontá individuals are NOT required to complete an application or redetermination form. The ongoing MC eligibility must be determined using the Ex Parte process (ex parte review, phone contact, and MC 355). If it is determined that the child qualifies for zero SOC MC, then a new 12-month CEC period applies.

 If the client fails to provide information/verification during the Ex Parte process and the client is eligible for Medicare Part A, do we set up QMB only? Answer: If the Ex Parte process is completed and the client failed to provide necessary information/verification, the EW must check MEDS to verify the client is back on SSI. If so, an SSI/QMB only case should not be set up since QMB for SSI members will be managed directly by DHCS. 

 If the client was discontinued from SSI due to cessation of disability, do we keep the case in pending status in CalSAWS and leave the aid code 6E active on MEDS until a disability decision is received from DDSD?                                    Answer: When the reason for SSI discontinuance is due to cessation of disability, a DDSD referral is required when the individual claims a new disabling condition not already considered by Social Security Administration. The EW may need to contact SSA. The client will be placed in the MC aid code 6N for 3 months to allow time for an appeal to Social Security. If the client loses the appeal or does not file an appeal within 3 months, then the MEDS programming logic will change the 6N aid code to a 6E aid code. After the 3 months, since a Craig v Bontá individual is a MC recipient, the client can be granted Pending Disability aid code (6J/5J) until a disability decision is received from DDSD. For clients 19 - 64 years old, a MAGI MC eligibility determination should be completed.

What is the purpose of sending a limited DDSD referral for former SSI individuals discontinued for reasons other than cessation of disability? Answer: A limited DDSD referral must be sent to request the disability reexamination date if the client was receiving SSI based on disability and was discontinued for reasons other than cessation of disability (i.e. income, property, etc.).