*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
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Effective: October 1, 2009 |
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03.25.25 - Medical Assistance (MA) for Children Receiving Adoption Assistance |
Archived: June 1, 2016 (Previous Versions) |
Children who receive Title IV-E or state-funded adoption assistance are automatically eligible for Medical Assistance (MA) in Minnesota.
Federal and state laws determine adoption assistance eligibility criteria and funding. DHS collects federal reimbursement under Title IV-E of the Social Security Act for adopted children who meet IV-E criteria. A child with special needs who does not meet IV-E criteria may qualify for state-funded adoption assistance, a program that mirrors IV-E, but is paid for with state funds and has slightly different eligibility criteria.
Minnesota Adoption Assistance
The DHS Adoption Assistance Unit administers and determines eligibility for Minnesota’s adoption assistance. The purpose of adoption assistance is to facilitate the adoptive placement of children whose special needs would otherwise prevent their adoption without subsidy assistance.
In Minnesota, prior to issuance of the final adoption decree, DHS and the adoptive parent(s), guardian, or conservator enter into a written agreement stating the terms of the subsidized adoption under the adoption assistance program. The resulting Adoption Assistance Agreement includes MA eligibility and may include provisions for subsidy payment for the adopted child.
When the adoption is finalized and Adoption Assistance Agreement signed, DHS sends a letter and the Adoption Assistance Agreement to the child’s county of residence as notification of adoption assistance approval. Upon receipt of this information, the county or tribal agency is responsible for approving MA eligibility for the adopted child.
Interstate Compact on Adoption and Medical Assistance (ICAMA)
Minnesota participates in the Interstate Compact on Adoption and Medical Assistance (ICAMA). When children with adoption assistance agreements that include health care coverage move to Minnesota, they are automatically eligible for MA. Adoption Assistance (Title IV-E or state-funded) for children adopted in other states who move to Minnesota is administered by the state that determined the child’s subsidized adoption eligibility. Typically, this is the state where the child’s adoption was finalized or will be finalized.
As notification that a child who is eligible for MA under ICAMA has moved to Minnesota, the state where the child was adopted sends a Notice of Medicaid Eligibility/Case Activation (ICAMA Form 6.01), an Adoption Assistance Agreement, and the child’s final adoption decree (if the adoption has been finalized) to the DHS Adoption Assistance Unit. DHS forwards the information to the child’s county of residence for MA approval.
Refer to TE02.05.28 and Interstate Compact on Adoption and Medical Assistance (ICAMA) for more information.
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)
Children who receive IV-E or state-funded adoption assistance are automatically eligible for MA without a separate application or eligibility determination until age 18, or age 21 with an extension.
Children adopted in Minnesota with a signed and approved Adoption Assistance Agreement are automatically eligible for MA until age 18, or age 21 with an extension.
Note: Due to laws regarding confidentiality and security requirements, access to all adoption assistance cases is restricted on MAXIS.
l Minnesota Adoption Assistance:
n MA eligibility under the Adoption Assistance basis begins the first day of the month adoption assistance is approved.
n Children determined eligible for Adoption Assistance in Minnesota may already have MA eligibility as foster care children at the time the agreement is signed. To prevent a lapse in coverage, coordinate Adoption Assistance and foster care eligibility spans in MMIS.
l ICAMA:
n MA eligibility under the Adoption Assistance basis begins the date coverage is requested on the ICAMA Form 6.01.
Note: See POLI/TEMP TE02.05.28 (Adoption Assistance Cases) for information on how to set up and approve these cases on MAXIS.
Children who receive IV-E and state-funded adoption assistance are exempt from renewal requirements.
Verify initial eligibility for IV-E and state-funded adoption assistance. MA eligibility under the adoption assistance basis ends when the child turns 18.
l Minnesota Adoption Assistance:
n Initial eligibility: Letter from DHS Adoption Assistance confirming Adoption Assistance eligibility and a copy of the Adoption Assistance Agreement.
n Extension: DHS Adoption Assistance sends an Adoption Assistance Agreement Amendment to the county agency prior to the child’s 18th birthday if an Adoption Assistance extension is granted. The amendment lists a new end date for adoption assistance.
m The child remains MA eligible under the adoption assistance basis until age 21, or the end date on the Adoption Assistance Agreement Amendment, whichever occurs first if DHS provides verification that an extension is granted.
m Close MA with 10-day notice effective the month after the child’s 18th birthday if no Adoption Assistance Agreement Amendment is received to verify that an extension has been granted. Redetermine eligibility under another basis.
l ICAMA:
n Initial Eligibility: The ICAMA Form 6.01 and Adoption Assistance Agreement verify initial MA eligibility for ICAMA children. DHS Adoption Assistance sends these forms to the child’s county of residence when the child moves to Minnesota.
n Extension: DHS sends a Report of Change in Child/Family Status (ICAMA Form 6.03) to the county to verify that an extension has been granted.
Note: The ICAMA Form 6.03 is used to notify DHS, the county, or the state that administers the child’s Adoption Assistance of changes in the adopted child’s MA case status, identifying information, address, or adoption status.
n Refer to the ICAMA Form 6.03, section F for information about the new end date of Adoption Assistance for the child. The child remains MA eligible under the adoption assistance basis until age 21, or the end date listed on the ICAMA Form 6.03, whichever occurs first, if DHS provides verification that an extension is granted.
n Close MA under the adoption assistance basis effective the month after the child’s 18th birthday with 10-day notice if DHS does not provide an ICAMA Form 6.03 verifying an extension has been granted.
Social Security Number (standard guidelines)
l Minnesota Adoption Assistance:
n IV-E: A SSN is not required. Request a SSN or obtain a completed Application for Social Security Number (SS-5), but do not terminate eligibility if the SSN is not provided.
n State-funded: A SSN is required. Request the child’s SSN or obtain a completed Application for Social Security Number (SS-5) from the adoptive parent(s). Require receipt of the SSN within six months of approval. Close MA if a SSN or SS-5 is not provided within six months.
l ICAMA:
n A SSN is not required for IV-E or state-funded ICAMA children. Request a SSN or obtain a completed Application for Social Security Number (SS-5), but do not terminate eligibility if the SSN is not provided.
Children who receive IV-E or state-funded adoption assistance are exempt from providing documentation of citizenship and immigration status because they have already provided documentation as a condition of eligibility for adoption assistance.
Residency (standard guidelines)
Children who receive IV-E or state-funded adoption assistance under an agreement from another state that includes health care coverage become Minnesota’s financial responsibility when they move to Minnesota.
Children who move from Minnesota to another state become the responsibility of the new state if that state has reciprocity under ICAMA. The child remains Minnesota’s responsibility if the new state does not have full reciprocity under ICAMA. Minnesota MA will supplement the child’s health care benefits if the new state’s MA program does not include all Minnesota MA benefits.
See State Residence - Adoption Assistance.
Insurance and Benefit Recovery (standard guidelines)
Children who receive IV-E or state-funded adoption assistance must enroll in their adoptive parents’ health insurance plan if it is cost effective.
Do not deny eligibility for the child if the adoptive parents fail to cooperate with providing information about cost effective insurance.
DHS pays Medicare Part B premiums through the buy-in for MA-eligible IV-E adoption assistance children only.
Children who receive IV-E or state-funded adoption assistance are considered a household size of one. Create a separate health care case for each adopted child and enter the child as member 01 in MAXIS. List the adoptive parents on the case. Do not list other household members.
Refer to TE02.05.28 - Adoption Assistance Cases, for procedural instructions.
Not applicable - there is no income or asset test, so no evaluation method is needed.
Asset Guidelines (standard guidelines)
There is no asset test for children under 21.
There is no income test.
There is no income test.
There is no income test.
Covered Services (Prepaid MHCP Manual)
Follow MA guidelines for Children Under 21.
Children who receive IV-E or state-funded adoption assistance are excluded from managed care enrollment.
Note: Children who receive IV-E or state-funded adoption assistance may enroll voluntarily in managed care.
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 Call Center at DHS (651) 431-2700 or (800) 366-5411, Option 5, for information on provider enrollment.
Not applicable.
Follow standard MA guidelines. Redetermine eligibility for MA under another basis if adoption assistance ends or the child turns age 18 and no extension is granted, or age 21, with an extension.
See Change in Basis of Eligibility for more information.
Children who receive IV-E or state-funded adoption assistance and are certified disabled are automatically eligible for MA under the Adoption Assistance basis. This includes children who receive waiver services. Do not approve MA under the disabled basis of eligibility for these children.