Medi-Cal Status Report - State Of California - Health And Human Services Agency

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California’s Protection & Advocacy System
Toll-Free (800) 776-5746
CBAS Hearing Penalties
July 2013, Pub. #5528.01
Background
In 2012 the Adult Day Health Care program (ADHC) became the
Community Based Adult Services (CBAS) program. Some Medi-Cal
ADHC participants (now called “CBAS participants”) were found
ineligible for CBAS and challenged this by filing for fair hearings with the
Department of Social Services (CDSS). (CDSS is the agency in charge
of fair hearings for Medi-Cal recipients.)
CDSS is supposed to issue a hearing decision within 90 days. In some
cases it took much longer than that for CDSS to issue a decision.
Because of these delays, CDSS has to pay a penalty to the Medi-Cal
recipient who had the hearing. This penalty is called a “Ball v. Swoap”
penalty after the name of the lawsuit that established it.
Many CBAS participants are now getting these Ball v. Swoap penalty
checks in the mail from the state of California. Many of these checks are
for large amounts of money, with no explanation of what the check is for.
However, the checks do have the words “CBAS” and “Hearing” printed
on them. That is how you know it is the late hearing decision penalty.
People are asking about what happens to their benefits when they get
these checks. People are asking what they should do when they get
one of these checks. This memo answers questions about what will
happen and what people should do.

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