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Effective: April 1, 2009 |
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03.25.20ar4 - Medical Assistance (MA) for Children in Foster Care (Archive) |
Archived: December 1, 2010 |
Children in foster care who are eligible under Title IV-E of the Social Security Act are automatically eligible for Medical Assistance (MA). Children in foster care who are not IV-E eligible must meet an MA basis of eligibility and all MA eligibility requirements associated with the MA basis. All children meet a child under 21 basis, but they may also meet another basis, such as a pregnant woman or disabled basis.
Overview of Foster Care
Children enter foster care in a variety of ways, including:
l Voluntary placement through an agreement between the parent and the county or tribal social services,
l Court order into placement through the juvenile court either as a child protection or delinquency matter, or
l Court order into placement through a tribal court for a child protection matter.
County or tribal social service funds pay the costs of care for children in foster care. Sometimes other funding sources reimburse the costs. Title IV-E is a federal reimbursement program (under Title IV-E of the Social Security Act) with eligibility based, in part, on the rules of the former Aid to Families with Dependent Children (AFDC) program. IV-E funds are used to reimburse the county or tribe that pays for the foster care placement costs if the child meets IV-E eligibility criteria and the placement is eligible for IV-E funding.
IV-E will not reimburse the county or tribe that pays for the foster care placement costs of children who do not meet the IV-E eligibility criteria or whose placement does not qualify for IV-E reimbursement.
Government Social Service Agency Responsibility
Minnesota’s child welfare system is state-supervised and county or tribe-administered. County and tribal social services agencies are responsible for placement and supervision of both IV-E and non-IV-E foster care children. The social worker is responsible for determining the need and appropriateness of placement and obtaining the authority for placement (court order or voluntary placement agreement). The county or tribe responsible for the child in placement is responsible for determining the funding sources for that foster care placement.
MA Eligibility
Children are automatically eligible for MA if they are eligible for IV-E. Approve MA when IV-E staff communicate their determination that a child is IV-E eligible.
Children must meet an MA basis of eligibility (child under 21, pregnant woman, or disabled) and all MA eligibility requirements associated with that basis if they are not eligible for IV-E.
Note: Due to laws about confidentiality and security requirements, access to all foster care cases is restricted on MAXIS.
Minnesota Permanency Demonstration Project
The Minnesota Permanency Demonstration (MnPD) project waives certain Title IV-E foster care rules for eligible children. Children from five Minnesota counties (Carlton, Cass, Dakota, Hennepin and Ramsey) are participating in the MnPD project. MnPD project participants receive automatic MA. See bulletin #07-21-08 for information about automatic MA for MnPD project participants. Additional information about the project can be found on the DHS Web site.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
l IV-E: MA is automatic without a separate application or eligibility determination for a child who is IV-E eligible.
Note: Counties and tribes 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 to eliminate multiple forms.
l Non-IV-E: MA is not automatic if there is no IV-E eligibility. An application must be filed on behalf of the child and the child must meet MA criteria. The foster care placement must be in a facility or licensed foster home in which residents are MA-eligible. See Chapter 14 for living arrangement policy.
Note: Generally, the county or tribe 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:
n Approve MA effective the first day of the month of placement if the child is eligible for MA without a spenddown .
n Approve MA effective the date the spenddown is met.
n Deny MA for the placement month if the child has a six-month spenddown and cannot meet it. Begin a new certification period beginning with the month after placement using only the child’s income.
To determine the non-IV-E eligibility begin date:
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.
Renewals (standard guidelines)
l IV-E: Automatic MA eligibility. An MA renewal is not required.
l Non-IV-E: Follow MA guidelines for the basis of eligibility that applies to the child.
l IV-E: Automatic MA eligibility.
l Non-IV-E: Follow MA guidelines for the basis of eligibility that applies to the child.
l IV-E: Automatic MA eligibility. A Social Security Number (SSN) is not required. Request a SSN, but do not terminate eligibility if the SSN is not provided.
l Non-IV-E: Follow MA guidelines for the basis of eligibility that applies to the child.
U.S. citizens who are in foster care are exempt from U.S. citizenship and identity documentation requirements.
For noncitizens:
l IV-E: Automatic MA eligibility. Proof of immigration status is not required.
l Non-IV-E: Follow MA guidelines for the basis of eligibility that applies to the child.
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 on the Placement of Children are considered residents of the placing state, and are not eligible for MA in Minnesota.
See State Residence - Foster Care.
l IV-E: Foster care children enrolled in Medicare have Part B premiums paid through the buy-in.
l Non-IV-E: Follow MA guidelines for the basis of eligibility that applies to the child.
For information about other health insurance or third party liability for any child in foster care, contact the social worker first. If necessary, the social worker will contact the biological and/or foster parents.
Note: Medical support referrals and parental fees may apply to children in foster care. For more information, see Minor Child Lives Away From Both Parents.
Household Composition (standard guidelines)
l IV-E: Automatic MA eligibility.
l Non-IV-E: Deem parental income and 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 for the month of placement. Use only the child’s income and a household size of one beginning with the first full month that the child is in foster care.
l IV-E: Automatic MA eligibility. There is no income or asset test, so no eligibility method is needed.
l Non-IV-E: Use the eligibility method for the basis of eligibility that applies to the child.
Asset Guidelines (standard guidelines)
l IV-E: Automatic MA eligibility. There is no asset test.
l Non-IV-E: There is no MA asset limit for children.
l IV-E: Automatic MA eligibility. There is no income test.
l Non-IV-E: Follow MA income and deeming guidelines for the basis of eligibility that applies to the child.
l IV-E: Automatic MA eligibility. There is no income test.
l Non-IV-E: Follow MA guidelines for the basis of eligibility that applies to the child.
Spenddowns (standard guidelines)
l IV-E: Automatic MA eligibility.
l Non-IV-E: Foster children who are not IV-E eligible and who have income in excess of the MA limit for their basis of eligibility may be required to meet a spenddown to qualify.
Example:
Tyler is a foster child who is not IV-E eligible. 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 (Prepaid MHCP Manual)
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 (800) 366-5411 for information on provider enrollment.
Children in foster care are enrolled in managed care unless they meet a managed care exclusion.
Not applicable.
l IV-E: If IV-E eligibility ends, determine if the child is eligible for MA under another basis. See Application Required and Application Not Required to determine if a new application is required.
l Non-IV-E: Follow MA guidelines for the basis of eligibility that applies to the child.
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.
Note: Sometimes a worker will learn of a change in the child’s placement circumstances through SSIS. Other times the social worker will contact the county worker directly.
If a TEFRA child is placed in foster care, TEFRA must close. To have a TEFRA basis of eligibility, the child must be living with at least one biological or adoptive parent.
l IV-E: If the IV-E eligible child is placed in foster care while receiving MA under TEFRA, begin automatic MA eligibility the first day of the month of placement. Switch the child back to TEFRA the month after the child returns to the parents’ home.
l Non-IV-E: Redetermine eligibility if a non-IV-E eligible child is placed in foster care while receiving MA under TEFRA. Close MA if the child is not eligible for MA under another basis. If the child is eligible for MA under another basis and later returns to the parents’ home, change the child’s eligibility back to TEFRA the month after the child returns to the parents’ home.