ATC Horizontal Integration Webinar

On Nov 14, 2016the Alliance to Transform CalFresh (ATC) hosted a webinar on Horizontal Integration, also known as “dual enrollment.” Horizontal Integration reflects the “Connected” goal of ATC’s strategies for statewide CalFresh excellence. The other strategies include “Quick,” “Consistent,” and “Equitable” access to CalFresh.

Social safety net programs such as Calfresh, MediCal and CalWORKS have the potential to work together to in order to prevent experiences of hunger, homelessness and other lack of basic needs that can have long term impacts on children and communities. And yet, there are significant numbers of households that are not accessing all of the benefits for which they may qualify.

The webinar included overviews of: Current estimates on rates of dual enrollment, technological opportunities to increase dual enrollment, and details on how reporting rules impact dually enrolled households. About 67% of our attendees were community advocates and application assisters; the other third were county administrators.

Diana Jensen from the SF-Marin Food Bank and a member of ATC presented on two of the ways dual enrollment is measured.

One way is to look at the portion of CalFresh participants that are also receiving MediCal: basically taking the CalFresh participants receiving any type of MediCal and dividing it by all CalFresh participants.

The estimates from this measure show that 90% – 98% of CalFresh recipients likely eligible for MediCal are receiving it.

The second measure is what portion of MediCal recipients receive CalFresh. This measure is trickier since it requires determining which MediCal recipients could be eligible for CalFresh but are not receiving it.


Diana worked with CDSS to identify which MediCal aid codes might indicate that someone could be eligible; this analysis is still being refined. Through this data they want to understand how many of the portion of likely eligible MediCal recipients still need access to CalFresh. The preliminary estimates show that between 22% – 62% of MediCal recipients likely eligible for CalFresh are receiving it.


Diana is working with the state and counties to get a better sense of who those likely eligible and non-participating people might be. They are planning to look at the characteristics of those not enrolled, layering county data regarding MediCal participant income levels, and refine this data for in-reach work. There’s also a goal to look at the most promising models of in-reach from counties across the state.

Adam Dondro from DHCS presented on the portal to CalFresh from CalHEERS (California Healthcare Eligibility, Enrollment, and Retention System) which includes Covered California, the online website for health insurance coverage.

This portal, or “bridge,” targets Covered California applicants for medical coverage that may be eligible for CalFresh based on their income information (200% FPL or below), and allow them to apply for CalFresh directly from CalHEERS/Covered California.

Applicants can choose to continue from their completed Covered California application to apply for CalFresh or CalWORKS. When that happens, a new browser comes up and asks a person to enter their case number so it can be linked to their case, and they can then click through to the CalFresh or CalWORKS application. If a person doesn’t enter the correct Covered California number, they can still go through the process but it will require the county to follow up with them to get the correct information.

No data is yet available about how frequently this option is being used. However, estimates based on preliminary data suggest that several thousand people with income under 200% FPL have used this portal since it was launched at the end of July. Only several hundred people with incomes above 200% FPL were moved forward, which means the system seems to be working the way it should in terms of filtering in people who are likely to qualify for CalFresh or CalWORKs.

The system isn’t ideal; it still requires clicking through a number of pages to get to the application for CalFresh. The State would like to collect more data on how this tool is being used and where people are falling off the process in order to make a data informed decision to improve it. According to Adam, “DHCS is constantly looking for ways to better align the applications, but at this time there are no plans to add the questions for other programs into CalHEERS.”

He also added that, “The functionality of the existing system does not have any reported issues at this time.” However, if concerns arise related to the portal both application assisters and county administrators are encouraged to share issues they may encounter with Adam at his email.

Additionally, there are forms on the CalHEERS side of the process and the SAWS* online apps where issues can be submitted. (*“SAWS” is the Statewide Automated Welfare Systems – which are consortia such as CalWIN, C-IV and LRS; the SAWS portals are C-IV Yourself, My BenefitsCalWin, etc.)

After people complete the application process, no matter if they apply online, in person, over the phone or by mail, they will need to be aware of reporting rules for their granted case.

Shirley Sanematsu from Western Center on Law and Poverty presented information about MediCal reporting timelines. Shirley shared the redetermination timeline for MediCal, and the changes that must be reported during that time. Similar to CalFresh, certain changes must be reported by people to MediCal within 10 days.

For people that have both CalFresh and MediCal, some counties have implemented their option to align the redetermination date with CalFresh. This means that, for example: A household that has a recertification date for CalFresh in July, and a recertification for MediCal in September, could recertify for both programs in July and extend their next recertification to June of the following year. More information is available in the ACWDL 14-22.
health care eligibility guide on their website. Advocates can down load from their website and use for understanding benefits and the program rules.

Our final presenter, Jessica Bartholow from WCLP, shared more details about the mandatory reporting requirements, which have recently been streamlined in CalFresh and can impact dually enrolled cases..

The first issue to note is that there may be two different Income Reporting Threshold (IRT) amounts for a household enrolled in CalFresh and CalWORKs. The CalFresh calculator can help identify the IRT for CalFresh households, as well as its usual purpose to indicate likely eligibility for a family.

The second issue to note is that when action is taken on a reported issues, such as IRT, changes in the household size or eligibility, it is considered “known by the county” or “cross over reporting” and can thus be applied to other programs like MediCal, CalFresh, CalWORKs.
It’s important to let people know that if there are certain changes in their household they should plan to report them within ten days in order to avoid overpayments or missed benefits.

A number of myths and concerns associated with overpayments often impact peoples’ understanding of reporting requirements and program guidelines. Sometimes people consider leaving the program due fear or frustration related to overpayment issues, however by staying on the program they can repay what is owed from their benefits. If they are no longer eligible or leave the program they must repay an overpayment with cash, tax credit returns, etc.

Finally, Jessica reviewed that not all the guidance is clear about the IRT and overpayment processes, so if advocates see places where the rules seem to be applied in an unfair way, they should report it to WCLP in case there are opportunities to improve the guidance. For example, mixed status household IRTs are harder for clients to comply with since their incomes are prorated. WCLP has sent that information to DSS, who is working to address issues like this.

Contact information for the presenters is listed below:

Diana Jensen
Senior Policy and Advocacy Analyst
SF-Marin Food Bank
415-282-1907 x313

Adam Dondro
Assistant Director
California Department of Social Services

Shirley Sanematsu
Senior Attorney
Western Center on Law and Poverty

Jessica Bartholow
Policy Advocate
Western Center on Law and Poverty