Decisions

Definition

For any appeal which is ultimately heard by the Administrative Law Judge, a written decision will be issued and adopted by either the State Department of Social Services or the State Department of Health Services.

The written decision will contain:

A summary of the hearing
The evidence presented by both sides
Applicable regulations
A conclusion and,
An order.

Action

The decision will indicate the action to be taken as follows:

IF...	THEN...
The County's position is upheld in its entirety,	The claim will be denied.
The claimant's position is upheld in whole or in part,	The claim will be granted. The claim may be granted in its entirety or may be granted in part.

Copy of the Decision

A copy of the decision will be forwarded to the current caseworker, to take the required action. When that action has been taken the decision is to be scanned into the IDM system under Benefits- F6:Misc/Court Review/OP/OI or CWES-F2:Application, as appropriate.

Note: The EW or EWS must notify the AO immediately to request an extension if it is not possible to comply within the 30 day period due to extenuating circumstances (e.g. CalWIN functionality, DDSD delay).

General

When the claim is granted in whole or in part, the order at the end of the decision will contain specific instructions as to what the County must do. The County is required to comply with this order within 30 days of its receipt. The County is compelled to comply even if the County plans to request a rehearing.

Appeals Unit

Upon receipt of a decision requiring compliance, the Appeals unit will send to the following to the assigned unit supervisor and cc the Appeals liaison of the office: (if the issue is dealing with collection activity):

A copy of the decision.
A “Fair Hearing Communication” form, SCD 2597.

Note: If the issue involves collection activities, the Collection Unit must be notified of the disposition and the required action.

Assigned Unit Supervisor

The EW Supervisor must take the following action:

IF...	THEN...
The case is closed,	Assign the action on the decision and compliance to the designated unit.
The case is open,	Assign the action on the decision and compliance to the EW.

Exception: When the EW of record is located in a specialized office (e.g., Benefits Service Center [BSC], General Assistance Bureau, etc.), the case must be sent to the office who last administered the program appealed.

NOTE: District Office clerical staff must assign the case to the correct office and mail the Appeals Liaison of that office to inform of the case transfer.

Controls

The EW supervisor or Appeals Liaison is responsible for keeping such controls as may be necessary, to ensure proper compliance within the allotted time period.

Role of the EW

Upon receipt of the decision and SCD 2597, the EW shall take immediate action to comply with the order as follows:

The response on the compliance form should paraphrase as nearly as possible the directions set forth in the State hearing decision.
Any questions regarding the compliance should be addressed to the Appeals Officer who is assigned to the case in question.
Each and every element of the order must be complied with.
If there are aid payments to be made, the compliance form must contain:
- The date on which the payments were made,
- The amount,
- The month for which the payment was intended.

Ineligible Due to a Factor NOT Covered in the Appeal

Compliance means that the County has taken definitive action to issue the aid or services to which the claimant was found eligible. In many cases, the phrase “as otherwise eligible” is used in the decision order. This may result in a determination that the claimant is not eligible for aid because of some eligibility factor not covered in the appeal.

NOTE: In such cases, it is a requirement for compliance that an adequate notice of action be issued to the claimant advising him/her of the County's decision. Further appeal may be possible.

Internal Transfers

Compliance occurs only when the County has issued the required aid payment or issued a notice of action advising the claimant of ineligibility. Internal transfers are not considered by the State to be compliance and are not to be used as a method of compliance unless such transfer will result in the required payment or NOA within the 30-day time period.