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Effective: December 1, 2006 |
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03.25.20ar1 - Medical Assistance (MA) for Children in Foster Care (Archive) |
Archived: May 1, 2007 |
Children who have been placed in foster care may be eligible for Medical Assistance (MA) in one of two ways:
l Title IV-E foster care: This is a cash program (under Title IV-E of the ) with eligibility based on the rules of the former program. IV-E funds pay for the placement if the child meets IV-E eligibility criteria and the placement is eligible for IV-E funding. Children are automatically eligible for MA if Title IV-E funds are paying for their cost of care.
l Separate MA eligibility determination (non-IV-E): Some foster children do not receive IV-E funds for the cost of care because they do not meet the IV-E eligibility rules or their placement does not qualify for IV-E reimbursement. Usually county social service funds pay for the cost of care for these children.
Eligibility factors are listed below with any information that is unique for this group. Links to standard program guidelines are included as well.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
l IV-E: If the child is IV-E eligible, MA is automatic without a separate application or eligibility determination.
Note: County agencies use the HCAPP with the Title IV-E Foster Care Supplement to the Health Care Programs Application (DHS-3478) to determine eligibility for Title IV-E for children in placement.
l Non-IV-E: If there is no IV-E eligibility, MA is not automatic. The child must meet MA criteria. The placement must be in a facility or licensed foster home in which residents are MA-eligible.
Note: Generally the county social services agency files an application on the child's behalf if the child is not already active on MA.
Eligibility Begin Date (standard guidelines)
l IV-E: Automatic eligibility begins effective the first day of the month in which IV-E reimbursement begins.
l Non-IV-E: If the child is eligible without a spenddown, approve MA effective the first day of the month of placement. To determine whether the child has a spenddown:
n Deem parental income for the month of placement. Use a household size that includes the parents, child in placement, and other household members who would be counted in the child’s household size.
n Use only the child’s income and a household size of one beginning with the first full month of placement.
n Determine if the income for the six-month budget period beginning with the month of placement is under the six-month income standard.
Example:
Ashley is placed in a licensed foster home from her biological parents' home on August 12. She does not meet IV-E criteria. The social worker files an MA application for Ashley and requests MA effective August 1. Ashley’s parents are employed and their income exceeds the monthly standard for a household of three.
Action:
For the budget period of August-January:
m For August, count parental income for August and use a household size of three.
m For September through January, because Ashley has no income, count zero income and use a household size of one for September through January.
Ashley is eligible for MA without a spenddown effective August 1 because, although her parents’ income exceeds the applicable standard for the placement month, total income for the six-month budget period is less than the standard.
If the child has a six-month spenddown and cannot meet it, deny MA for the placement month and begin a new budget period beginning with the month after placement using only the child’s income.
Renewals (standard guidelines)
l IV-E: Follow IV-E guidelines.
l Non-IV-E: Follow MA guidelines for Children Under 21.
l IV-E: Follow IV-E guidelines.
l Non-IV-E: Follow MA guidelines for Children Under 21.
l IV-E: Follow MA guidelines for Children Under 21.
l Non-IV-E: Follow MA guidelines for Children Under 21.
l IV-E: Follow IV-E guidelines.
l Non-IV-E: Follow MA guidelines for Children Under 21.
Residency (standard guidelines)
l IV-E: These children are residents of the state in which they currently reside, even if placed by another state.
n Children placed in another state become that state's financial responsibility.
n Children placed in Minnesota from other states become Minnesota’s financial responsibility. This applies to all IV-E foster children regardless of whether the state, county, or another party has legal custody of the child and regardless of whether the child is placed by another state. See State Residence - Foster Care.
l Non-IV-E: When these children are placed in another state, they may remain the responsibility of the placing state. If they move to another state without formal placement, they must reapply for MA in the new state.
n Children placed in other states by Minnesota remain Minnesota's responsibility.
n Children placed in Minnesota under the Interstate Compact are considered residents of the placing state, and are not eligible for MA in Minnesota.
See State Residence - Foster Care.
l IV-E: DHS pays Medicare Part B premiums through the buy-in for MA-eligible IV-E foster care children. Follow MA guidelines for Children Under 21 for other health insurance.
l Non-IV-E: Follow MA guidelines for Children Under 21.
Household Composition (standard guidelines)
l IV-E: Follow IV-E guidelines.
l Non-IV-E: See eligibility begin date above for guidelines on deeming parental income to non-IV-E foster children.
l IV-E: Not applicable - there is no income or asset test, so no evaluation method is needed.
l Non-IV-E: Use Method A for income.
Asset Guidelines (standard guidelines)
l IV-E: There is no separate asset test for MA for these children.
l Non-IV-E: There is no MA asset limit for children under 21.
l IV-E: There is no income test.
l Non-IV-E: Follow MA guidelines for Children Under 21.
l IV-E: There is no income test.
l Non-IV-E: Follow MA guidelines for Children Under 21.
Spenddowns (standard guidelines)
l IV-E: There is no income test.
l Non-IV-E: Foster children who do not get IV-E funds and who have income in excess of the MA limits may be required to meet a spenddown to qualify.
Example:
Tyler is a foster child who does not qualify for IV-E funding. His social worker files an MA application on his behalf. The county receives an RSDI check on his behalf because one of his parents is disabled. The RSDI amount exceeds the applicable income standard of 150% FPG.
Action:
Tyler must meet a spenddown to qualify for MA.
Note: Tyler may also qualify for MinnesotaCare. Work with the social worker and MinnesotaCare staff to determine which program is more beneficial.
Follow MA guidelines for Children Under 21.
Service Delivery (standard guidelines)
If Minnesota retains financial responsibility for a child living in another state, the child’s medical providers must enroll as providers in Minnesota to receive Minnesota MA payment. Providers may call the Provider Help Desk at DHS (651-431-2700 or 1-800-366-5411) for information on provider enrollment.
Not applicable.
If a child in foster care returns to the parental home, begin deeming the parental income for the first full month in which the child lives at home.
l This includes trial home visits when the county retains custody for both IV- E and non- IV-E children. Federal law allows IV-E children to retain IV-E status with no payments for up to six months during trial home visits. For additional information on how to process these cases, see POLI/TEMP TE14.15 (IV-E Foster Care - Trial Home Visit).
l Automatic MA is not available unless IV-E payments are made on the child’s behalf. If the child returns to placement and IV-E payments resume, the child is again eligible for automatic MA without a new application.
Note: Do not require a new application to determine the child’s eligibility in the parental home. Leave the child’s MA open while the determination is pending.
Not applicable.