Appeals and State Hearing

A caregiver may request a Hearing if they disagree with any action taken by the county.  Instructions on how to request a hearing can be found on page 2 of the Notice of Action (NOA) form. At the hearing the legal, regulatory, or policy basis for the intended action is explained and presented by the Appeals and State Hearing (ASH) Worker.

The ASH Worker is responsible for the investigation and presentation of the facts to the Administrative Law Judge.

The Appeals EW (AEW) is responsible for research and compiling information necessary for a specific appeal.  The AEW may be required to go into the field to gather evidence, documents and affidavits in the attempt to get the appeal overturned.  The AEW is also responsible to take all necessary actions as a result of the State Hearing decision.

An Adverse Action is Appealed and Granted

Eligibility Worker (EW) Responsibilities

1. Determine eligibility based on the evidence known at the time of the decision for one of the following actions: denial of relative (Youakim) foster care, termination, or adverse payment.
2. Complete the adverse NOA 290 form
3. Send it to the caregiver within ten (10) calendar days prior to the effective date of the adverse action.
   • The caregiver will complete the reverse side of the NOA 290 form and/or telephone the State Hearing Board stating the disagreement with the action. This will initiate an appeal of the eligibility determination decision.

Appeals Eligibility Supervisor (AES) Responsibilities

1. Receive the DCFS 2138 form from the ASH worker and the eligibility segment, if available.
2. Annotates he compliance due date on the unit controls.
3. Assign to an AEW.

Appeals Eligibility Worker (AEW) Responsibilities

1. If the original eligibility segment was not received, and is necessary, the AEW should contact the current case-carrying EW or the Library for the segment.
   1. If the original eligibility segment is not available, see steps when physical case is unavailable.
2. Complete the appropriate action as instructed on the DCFS 2138 form. This includes all actions, such as:
   1. Initial eligibility evaluation, add child or redetermination of eligibility. 
   2. Within 48 hours, take action for aid paid pending, if appropriate.
3. Return the DCFS 2138 form by the compliance due date
   • Which is 30 days from the date received.
4. Route it to the ASH worker and Appeals ES.

AES Responsibilities

1. Annotate the unit controls of the completed action.

AEW Responsibilities

1. Send the eligibility segment to the “on loan” location or if appropriate to the foster care library.

The Physical Case is Unavailable

AEW Responsibilities

1. Review the State Hearing decision/disposition compliance action and the DCFS 2138 form.
2. If case is not obtained through Case Storage Vendor, reconstruct the eligibility case within the compliance action due date.
   • Include all known information, documents and evidence obtainable.
3. Access the services case and computer systems to obtain necessary printouts and documents:
   1. Court Report(s)
   2. Minute Order(s)
   3. DCFS 280, TA action request
   4. WCMIS/Single Index. Case/persons summary and persons eligibility
   5. CWS/CMS; Case, Client, Court, and Placement Notebooks
   6. MEDS; Whole case individual inquiry, ACE registration and IEVS
   7. LEADER
   8. AWINS
   9. APPS: Financial Authorization Document (FAD)
   10. CWS/CMS, CWS Lite
   11. ASFA Approval-SOC 815 form
   12. SOC 158 form
4. After the printouts, evidence and documents are obtained, prepare the eligibility case in Model Case Format
5. Follow the existing procedure to process the appropriate action.

There is a Withdrawal of an Appeal

AES Responsibilities

1. Receive the DCFS 281form and/or the DCFS 411 form from the ASH worker.
2. Assign to AEW.

AEW Responsibilities

1. Receive the DCFS 281 or the DCFS 411 form.
2. Complete the action indicated on the DCFS 281 form and/or the DCFS 411 form.
3. Send a Notice of Action and/or referral to DPSS as appropriate.
4. Send a copy of the Notice of Action to the ASH worker with regulation noted.
5. Notify the Redetermination Worker and CSW of the Aid Paid Pending status and State Hearing pending.

Decision of the Administrative Law Judge (ALJ) is to Pay Foster Care (FC) Payments

AEW Responsibilities

1. If the decision is to pay a relative foster care (Youakim):
   1. Access the CWS/CMS application.
   2. Search, retrieve, and open the existing client/case.
   3. Update the secondary assignment.
   4. Check the MEDS and LEADER program to see if the claimant received CalWORKs or SSI.
   5. Data enter the appropriate information in the FC 2, Medi-Cal and SAWS 1 notebooks.
   6. Data enter the appropriate information in the AFDC-FC page of the client notebook. 
      • Explain the reason for eligibility in the comments text box.
   7. Data enter the aid code ‘42’ on the ID NUM page of the Client Notebook.
   8. Search the CWS/CMS database to determine if the relative is found as a substitute care provider.
      1. Create a new placement home and Substitute Care Provider notebook if the relative is not found.
         1. Open a new Placement Notebook.
         2. Select the relative home. 
         3. Data enter the ID, rationale, ongoing requests and incidental pages.
         4. Request ‘pending approval’. 
         5. Save to the database. 
   9. Contact the SCSW to approve the placement, ongoing requests and incidental payment.
   10. Refer to the CWS/CMS Budget Action procedure guide.
   11. Record all eligibility activity in Case Notes.
   12. Complete the NOA form with the computation of funds due.
2. Complete and send a Transfer Request via e-mail to the Transfer Desk.
3. Upon response from Transfer Desk, forward physical case to Redetermination Worker.

Forms

CWS/CMS

Case Information Notebook                                                                                                                      Client Notebook
Placement Notebook
FC2 Notebook
SAWS1 Notebook
Medi-Cal Notebook
Case Notes

DCFS 280, TA Action Requests
DCFS 281, Notice to Initiate/Terminate Aid Paid Pending the Appeal Hearing
DCFS 411, Request for Case Correction
DCFS 2138, Report of Compliance with Adopted Fair Hearing Decision
NOA 290, Notice of Action
SOC 815, Approval of Family Caregiver Home