Form Cw 101 - Calworks Immunization Rules Instructions printable pdf download

State of California - Health and Human Services Agency

California Department of Social Services

CALWORKS IMMUNIZATION RULES

IMMUNIZATION RULES

FAILURE TO COOPERATE

If you do not submit proof of immunization for all

If you are getting cash aid under the California Work

children under the age of 6 in the assistance unit,

Opportunity and Responsibility to Kids (CalWORKs)

your cash aid will be lowered by an amount equal

Program, you must give the county proof that the

to the share of the cash aid for the parent(s) or

child(ren) in your family under the age of 6 has

caretaker relative(s). Once proof is submitted, the

received age-appropriate immunizations (shots).

share of cash aid will be restored for the parent(s)/

See Column 2 for a list of medically recommended

caretaker relative(s) the first of the following month.

immunizations and see the attached page for the

recommended immunization schedules.

MEDICALLY RECOMMENDED IMMUNIZATIONS

The Advisory Committee on Immunization Practices,

PROOF

American Academy of Pediatrics, and American

If you are an applicant for CalWORKs, you must provide

Academy of Family Physicians currently recommend

proof of immunization within 30 days of approval of

the following immunizations for children under age 6:

Medi-Cal or within 45 days from date of application for

• Polio

CalWORKs if you are already getting Medi-Cal.

• Diphtheria, tetanus, and pertussis (DTaP or DTP)

If you are a current recipient of CalWORKs, you must

• Measles, mumps, and rubella (MMR)

submit proof within 45 days after the county notifies

• Varicella Virus Vaccine* (for Chicken Pox)

you that proof of immunization is required. For each

• Hepatitis B

child under the age of 6 added to the assistance unit,

• Hemophilus influenza type b (for meningitis)

you must submit proof of immunization within 30 days

WHERE TO GET IMMUNIZATIONS

of the child’s approval for Medi-Cal.

• A provider that accepts Medi-Cal

If you have a problem getting immunizations for your

• Your assigned physician in your Medi-Cal

child(ren), contact your worker immediately.

managed care plan

• A county public health clinic

EXEMPTIONS

• Any other source within your county offering free

A child(ren) is exempt from these immunization

or low cost immunizations

regulations if the parent or caretaker relative has

• A “Child Health and Disability Prevention (CHDP)”

good cause listed below:

provider

Permanent

HOW TO GET MORE FACTS ABOUT

• The caretaker does not believe in immunizing

IMMUNIZATIONS

the children;

You can call:

• The caretaker has a medical statement saying

• The National Immunization Information Hotline

that the child should not be immunized;

sponsored by the Center for Disease Control (CDC)

Temporary

and the American Social Health Association. Call

• The caretaker could not get the child to a

Monday through Friday between 5 AM and 8 PM:

doctor because of transportation problems;

• The caretaker could not get a timely doctor’s

- English 1-800-232-2522

appointment;

- Spanish 1-800-232-0233

• The immunization the child needed was not

• Your local health department’s Immunization

available;

Service Program or the CHDP Program

• The parent or child was sick and could not go

(depending on the county) is:

to the doctor;

• Language barriers; and

* The vaccination for chicken pox may not be

• The records do not correctly show all the

available from all physicians.

immunizations the children received and the

caretaker relative is trying to correct the records.

If you have any questions, call your worker.

CW 101 (7/17) Required – Substitutes Permitted

Form Cw 101 - Calworks Immunization Rules Instructions

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