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CalWORKs Handbook: 40-105.4 Immunization Requirements

Effective Date:     July 1, 2005

Published Date:    November 22, 2011

Published By:       E114

Summary:

Assembly Bill (AB) 1542, Chapter 270, Statutes of 1997 required that all children in the Assistance Unit (AU), including MFG children, under the age of six have age-appropriate immunizations. This regulation was implemented in Alameda county beginning in July 2005.

All applicants/recipients must be notified of the necessity to provide verification that each child under the age of six has the required immunizations.

If the parent or caretaker relative fails to provide verification or fails to begin a course of appropriate immunizations, unless claiming an exemption, a penalty will be imposed for failure to comply. The penalty is to eliminate the parent’s needs in the grant computation.

General:

I. AGE-APPROPRIATE IMMUNIZATIONS

A. Age-appropriate immunizations are those suggested in the Recommended Childhood Immunization Schedule by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians.

1. Immunizations currently recommended for children under the age of six.


     TYPE OF SHOT

  DOSE

RECOMMENDED AT :

Polio  (or OPV, TOPV, IPV, Sabin, Salk)

1st

2nd

3rd

4th

2 months

4 months

6-18 months

Before starting school (4-6 yrs)

DTaP (DPT)

(diphtheria, tetanus and pertussis)

1st

2nd

3rd

4th

5th

2 months

4 months

6 months

15-18 months

Before starting school (4-6 yrs)

MMR

(measles, mumps, and rubella)

1st

2nd

12-15 months

Before starting school (4-6 yrs)

Varicella Virus Vaccine ( or VAR, VZV)

(chickenpox)   *

1st

12-18 months

Hepatitis B

1st

2nd

3rd

At birth - 3 months

1-5 months

6-18 months

Hib (Hemophilus influenzae type b)

(meningitis, pneumonia)

1st

2nd

3rd

3rd or 4th

2 months

4 months

6 months (may not be required)

12-15 months (if any dose is given after 12 mos. no further doses needed)

* The Varicella Virus Vaccine is only required for children who have not had chickenpox.

 

2.  Recommended immunization schedule for children NOT immunized in the first year of life.

a. If the child has received some, but not all, of the recommended immunizations by his or her first birthday, the recommended schedule will depend on which immunizations the child is missing and the child's age. A health care provider should be consulted to determine the appropriate immunizations. Hib Schedules vary by age when series started.

     VISIT      WHEN    VACCINES WHICH MIGHT BE GIVEN

First Visit

 

Hepatitis B

DTaP (or DTP)

Hib

Polio (or OPV, TOPV, IPV, Sabin, Salk

MMR

Varicella (or VAR, VZV)  *

Second Visit

1 - 2 months after 1st visit

Hepatitis B

DTaP (or DTP)

Hib

Polio (or OPV, TOPV, IPV, Sabin, Salk

Third Visit

1 - 2 months after 2nd visit

DTaP (or DTP)

Polio (or OPV, TOPV, IPV, Sabin, Salk

Fourth Visit

6 months after 3rd visit

Hepatitis B

DTaP (or DTP)

b. Delays between doses do not require repeating doses or re-starting series. After these immunizations have been completed, refer to first chart for immunizations to be completed.

 

Procedure:


II. INFORMING REQUIREMENTS

A. At the time of application and at reinvestigation, all applicants/recipients must receive a notice informing them of their obligation to obtain age-appropriate immunizations for all children in the AU under the age of six.

1. State Form CW 101, “CalWORKs Immunization Rules” is included in CalWORKs Application and RRR packets, and informs applicants and recipients of the following:

a. Their obligation to secure immunization for all children in the Assistance Unit (AU) under the age of six and the penalty for failure to comply;

b. The list of age-appropriate immunizations;

c. Their right to file an affidavit claiming that immunizations are contrary to their personal/religious beliefs or for medical reasons; and,

d. How immunizations may be obtained through a fee-for-service provider that accepts Medi-Cal, a Medi-Cal managed care plan, a county public health clinic or any other available source.

 

III. EXEMPTIONS

A. The immunization requirement does not apply if the parent(s)/caretaker relative submits:

1. A sworn statement signed under penalty of perjury by the recipient stating that the immunization requirement is contrary to his/her personal/religious beliefs.

a. Recipients are not required to explain their reasons for their personal or religious beliefs and workers cannot require information beyond the sworn statement.

2. A written statement from a physician or health professional working under the supervision of the physician, stating that the child should not be immunized, which includes the prohibitive medical condition and the duration.

 

IV. VERIFICATION

 

A. Verification of immunization is required at initial application, when adding a child under the age of six to the AU, and at RRR.

1. Maximum Family Grant (MFG) children are members of the AU, and therefore subject to the immunization rules

2. SSI children are NOT members of the AU, and therefore NOT subject to the immunization rules.

B. Acceptable verification

1. The California Immunization Record  (Yellow Card) is the primary document used to verify immunizations.

2. Acceptable documentation of verification of immunization may also be provided by the following:

a. A medical provider (i.e. physician, authorized member of physician’s staff, public

    health department, etc.); or

b. A public agency which requires age-appropriate immunizations (i.e. local school

    district, the head start program, a licensed day care center, etc.)

c. Verification of immunizations must be submitted until the child completes all age-appropriate immunizations or the child reaches the age of six.

d. Applicants/recipients shall provide verification of immunization for all children in the AU under the age of six in the

    following time frames:

IF THE FAMILY IS...

AND ...

THEN THE VERIFICATION MUST BE SUBMITTED WITHIN...

Applying for CalWORKs

Is receiving Medi-Cal

45 days from the date of application

Applying for CalWORKs

Is also applying for Medi-Cal

30 days for the date Medi-Cal is approved

Applying for CalWORKs for an additional child under age 6

Child is receiving Medi-Cal

45 days from the date of application

Applying for CalWORKs for an additional child under age 6

Is also requesting Medi-Cal for child

30 days for the date Medi-Cal is approved

Receiving CalWORKs

 

45 days form the date of written notification requesting immunization verification.


1. Maximum Family Grant (MFG) children are members of the AU, and therefore subject to the

    immunization rules.

2. SSI children are NOT members of the AU, and therefore NOT subject to the immunization rules.

E. Good cause for not submitting verification

1. The worker shall determine if good cause exists for not submitting verification due to lack of reasonable access to immunization services.

2. If it is determined that good cause exists, the applicant/recipient will have an additional 30 days to submit immunization verification.

3. Circumstances which may constitute good cause, due to lack of reasonable access to immunization services, may include but are not limited to the following:

  • language barriers
  • physical distance
  • illness of a parent(s)/caretaker relative
  • bona fide transportation problems
  • applicant/recipeint is unable to take the child to a doctor during work hours
  • vaccine shortage
  • lack of available appointments

4. Applicants/recipients who have made a good faith effort to initiate age-appropriate immunizations for their child(ren) in the AU, but the child(ren) cannot complete the series because of a spacing requirement between vaccine doses, may be considered at that point to have received "all age-appropriate immunizations".

F. For each child under the age of six, the ET must document receipt and verification of immunization, determination of good cause or any exemption in CalWIN on the Collect Individual Immunization Detail screen.

1. Each dose received must be documented as received as follows:


• In the Immunization Received [Y/N] field, enter “Y”
• In the Verification Status field, enter appropriate answer from drop-down menu.
• In the Verification Source field, enter appropriate answer from drop-down menu.
• If the child has been granted good cause or exemption for immunization, choose the appropriate reason from the drop-down menu in the Reason for Not Receiving Immunization Shot field.

 

G. For intercounty transfer (ICT) cases, an applicant/recipient, who has submitted verification of age-appropriate immunizations in the first county and that county has determined it to be adequate, shall not be required to resubmit duplicate verification in the second county.

1. When processing an ICT, if the client cannot readily provide the immunization verification, the eligibility worker must contact the other county to request a copy of the immunization verification before applying a penalty.

V. FAILURE TO COOPERATE

A. If an applicant/recipient fails to submit timely verification of immunization of any child(ren) in the AU under the age of six, and DOES NOT qualify for an exemption or have good cause, the grant must be reduced by the amount allowed for the needs of the parent(s)/caretaker relative in the AU.

B. The CalWIN system will automatically impose an Immunization Penalty on the parent(s) or caretaker relative of any child under age six who does not have documentation of the age-appropriate immunizations (or good cause/exemption) entered in CalWIN.

1. Example: An AU composed of a mother and her three children fails to submit verification of immunization and is not found to have good cause. The mother has total earned income of $525 per month and no disability-based unearned income. The AU is nonexempt. Grant Computation: AU size remains four, but due to the penalty, MAP for three is used.

 

$ 525

Gross Earned Income

- 225

$225 Income Disregard

$ 300

Remaining Earned Income

- 150

50% Earned Income Disregard

$ 150

Net Nonexempt Income

 

$ 679

 

MAP for three (excluding the parent)

- 150

Total Net Nonexempt Income

$ 529

Aid Payment

C. Restoration Of Aid For A Penalized Parent

1. Once verification of immunization is submitted, the grant is increased to reflect the needs of the parent(s)/caretaker relative effective the first of the month following the month in which verification is received.

References:

EAS Section 40-105.4
All County Letters 97-70 and 98-35




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