Family and Children's Medicaid MA-3230 ELIGIBILITY OF INDIVIDUALS UNDER Age 21

Vi. POLICY RULES - TITLE IV-E INDIVIDUAL UNDER AGE 18, IAS

A. Living in North Carolina

Medicaid eligibility is authorized under I-AS (Title IV-E Adoption and Foster Care assistance) for a child living in North Carolina who has a Title IV-E adoption assistance agreement or who receives Title IV-E foster care payments.

B. Title IV-E Adoption Assistance

Medicaid is authorized without a separate determination of eligibility for Title IV-E Adoption Assistance children under I-AS if the child is:

1. Title IV-E with North Carolina, or

2. Title IV-E from another state and under age 18, which is the Title IV-E age limit in NC.

C. Procedures For North Carolina Title IV-E Adoption Assistance Child Living In North Carolina

1. Verify Title IV-E status of the child with the agency adoption/foster care social worker.

2. Medicaid Application

a. A separate determination of eligibility for ongoing Medicaid is not required. Verification of current Title IV-E status is verification of eligibility for Medicaid.

b. Citizenship/Identity verification must be obtained by the social worker.

c. A copy of the completed DSS-5013, North Carolina Adoption Assistance Agreement, and DSS 5012, Adoption Assistance Eligibility Checklist, are required for Title IV-E Adoption Assistance children. A copy of the completed DSS-5012 and DSS-5013 are obtained from the social worker.

D. Title IV-E Foster Care Assistance

Medicaid is authorized without a separate determination of eligibility for Title IV-E Foster Care children under IAS if the child is:

1. Title IV-E with North Carolina, or

2. Title IV-E from another state and under age 18, which is the Title IV-E age limit in NC, and

3. For whom Title IV-E maintenance payments are being made.

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(VI.D)

Children are in a reimbursable status when they are in a licensed foster care facility. Reimbursable refers to the county’s ability to claim reimbursement for the cost of care and this is available only if the child is in a licensed facility. There is an exception to this:

A child who has been in an IV-E reimbursable placement, for whom IV-E Foster Care maintenance payments were being paid, but who is temporarily (not exceeding 12 months) placed in a non IV-E reimbursable placement, may continue to be automatically eligible as IAS during this temporary absence.

As a general rule, a child who is in a non- IV-E reimbursable placement, or a child for whom IV-E foster care maintenance payments have not been paid, but for whom the county is claiming administration reimbursement is not automatically eligible for Medicaid as a IV-E foster child. Eligibility must be determined under HSF or another aid program/category. This is also true if the child’s absence is expected to last more than 12 months.

For non-IV-E children the reimbursable or non-reimbursable nature of their placement is not an issue in determining eligibility. A non IV-E child who is in county custody must have an application for Medicaid made on his behalf and have his eligibility determined under HSF regardless of where he is placed. If ineligible for HSF, eligibility will be determined under MIC or MPW.

E. Procedures For North Carolina Title IV-E Foster Care Assistance Child Living In North Carolina

1. Verify Title IV-E status of the child with the agency adoption/foster care social worker.

2. Medicaid Application

a. A separate determination of eligibility for ongoing Medicaid is not required. Verification of current Title IV-E status is verification of eligibility for Medicaid.

b. Citizenship/Identity verification must be obtained by the social worker.

c. A signed DSS-5120, Eligibility Documentation/Verification for Foster Care, is required for Title IV-E Foster care children. All sections are completed by the social worker except for part V, which is completed and signed by the IMCW, Income Maintenance Case Worker.

F. Medicaid Authorization

1. At the time the Title IV-E status is verified and ongoing Medicaid is authorized, the IMC must evaluate the retroactive period to determine whether there is medical need and eligibility requirements are met. Refer to MA-3305, M-AF, M-IC, H-SF Budgeting, for procedures.

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(VI.F.)

2. Enter a DSS-8124 screen and DSS-8125 screen in EIS, authorizing Medicaid under the IAS aid program/category for Title IV-E child once verification of Title IV-E status is received. For reporting purposes, complete the case level special use field on the DSS-8125. The Special Use Codes FC or AS and IF cannot be entered at the same time on the DSS-8125. Enter the FC or AS and State code one day and the IF and beginning date of Medicaid authorization on another day.

3. Refer to MA-3425, Certification and Authorization, for the certification/authorization periods for a Medicaid Title IV-E child.

G. Another State’s IV-E Children Living In North Carolina

1. Children living in North Carolina for whom a IV-E adoption assistance agreement is in effect with another state or who are receiving IV-E foster care payments from another state are eligible for Medicaid coverage by North Carolina. The effective date of eligibility is the latest of:

a. The effective date of IV-E adoption assistance agreement/IV-E foster care payment, or

b. The month following termination of Medicaid by the other state.

2. Medicaid Applications and Authorization:

a. For documentation purposes, use a base document (DMA-5063) with the demographic information for the child completed, such as name, address, and contact information. Income and resource information is not needed. A signature is not required.

b. For reporting purposes, complete the case level special use field on the DSS-8125 as follows:

(1) Enter the “AS” code for the adoption assistance child or the “FC” for the foster care child and the standard postal abbreviation for the state responsible for the child’s placement, i.e., AS NY or FC SC.

(2) For a foster care child only, enter the “IF” code (in foster care), and the beginning date of Medicaid authorization on a separate DSS-8125. The Special Use Codes FC or AS and IF cannot be entered at the same time on the DSS-8125. Enter the FC or AS and State code one day and the IF and beginning date of Medicaid authorization on another day.

c. Verification of Title IV-E Status

(1) Title IV-E Adoption Assistance Child

Acceptable verification is a copy of the current Adoption Assistance Agreement which has been signed by the adoptive parent(s) and the agency administering the Title IV-E Adoption Assistance program, usually a county department of social services.

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(VI.G.2.c.(1))

This agreement states the child’s eligibility for Title IV-E Adoption Assistance in the adoption assistance state. The agreement is in effect once signed until the adoption is terminated under one of the terms of the adoption agreement.

(a) The adoptive parent(s) should have a copy of the current agreement that will verify Title IV-E status.

1) If the parent(s) cannot provide a copy of the agreement it will be the parent(s)’ responsibility to provide the name and address of the Title IV-E Adoption Assistance Agency in the state responsible for administering the Title IV-E program.

a) The IMC should ask to see the adoption assistance check or Medicaid identification card, or

b) The parent(s) may be able to provide the name of the placement social worker.

2) It is the IMC’s responsibility to request a copy of the agreement from the other state once the adoptive parent(s) provide the agency’s name and address. Refer to V.E for the appropriate ICAMA form to use.

(b) In lieu of a copy of the IV-E Adoption Assistance agreement, a written statement on agency letterhead from the IV-E assistance state verifying that a child is currently eligible for IV-E Adoption Assistance in their state is acceptable verification of IV-E status to receive Medicaid from North Carolina.

(2) IV-E Foster Care Children

A written statement on agency letterhead from the IV-E assistance state that a child is currently eligible for IV-E Foster Care Assistance in their state is acceptable verification of IV-E status to receive Medicaid from North Carolina. The statement must include the time period for which IV-E foster care eligibility has been determined by the other state.

In order to receive Medicaid from North Carolina, current proof of IV-E foster care eligibility must be re-verified with the IV-E assistance state every six months. Verify current IV-E status with the local DSS foster care worker. Refer to V.E. for the appropriate ICAMA form to use.

REISSUED 11/01/09 - CHANGE NO. 12-09

(VI.G.2.c.(2))

If verification cannot be obtained from the local foster care worker, it will be the parent’s responsibility to provide the name and address of the IV-E Foster Care Agency (see the foster care check or Medicaid ID card) in the other state that is responsible for administering the IV-E program. It will be the worker’s responsibility to request verification of the child’s current IV-E foster care status.

(a.) When an IV-E child loses IV-E status in the other state, the Medicaid caseworker must complete an ex parte review. Determine if the child is eligible for EFCP. If so authorize eligibility.

(b.) When an IV-E child who was placed in N.C. by another state (or one who moved here with his adoptive parents) moves out of North Carolina, terminate Medicaid. Inform the parent(s) that it is their responsibility to immediately inform the county if they plan to leave N.C. See MA-3430, Notice and Hearings, to determine the appropriate notice.

(c.) Inform the IV-E assistance state of the effective date Medicaid is being provided by North Carolina once the application is approved. Refer to V.E. for the appropriate ICAMA form to use.

H. North Carolina IV-E Children Living In Other States

A child receiving Title IV-E funds from NC but who lives in foster care or adoptive placement in another state is not eligible for Medicaid coverage from NC. He is eligible for Medicaid in the other state.

1. Children approved for IV-E adoption assistance/foster care payments from N.C.

a. Inform adoptive parents/caretaker of child that he must apply for Medicaid coverage in the county of the state in which the child is a resident.

b. Refer to V.E. for the appropriate ICAMA form to use.

2. IV-E eligible child moves out-of-state

a. Do not establish an IV-E case in EIS. Terminate Medicaid if a Medicaid case exists.

b. Inform the adoptive parents or foster care provider that he must apply for Medicaid benefits for the child in the state in which he is currently living. As long as the child remains eligible for IV-E adoption assistance or foster care assistance from North Carolina, the child is eligible to receive Medicaid from his state of residence without a separate determination of Medicaid eligibility.

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(VI.H.2.)

c. Provide the family with a current IV-E verification statement on agency letterhead that they can provide to their residence state as proof of the child’s IV-E status in North Carolina when they apply for Medicaid benefits. Use the verification letter and provide the other state with proof of the child’s continuing IV-E eligibility at each

IV-E redetermination. Refer to V.E. for the appropriate ICAMA form to use.

3. Child lives in another state and ceases to be IV-E eligible in North Carolina:

a. Provide written verification to the residence state that the child is no longer IV-E eligible in North Carolina so they can terminate IV-E Medicaid benefits to the child.

b. The child may be eligible for Medicaid benefits from North Carolina as a non IV-E eligible child (HSF or MAF). Evaluate potential Medicaid eligibility. If the child is Medicaid eligible in North Carolina, inquire with the resident state to determine if that state has opted to provide Medicaid coverage to non IV-E eligible foster children. If the resident state has not included this option in their state Medicaid plan, North Carolina must continue to provide Medicaid if eligibility requirements are met.

I. SSI Child

If the child is SSI and IV-E eligible, the child is covered under the M-AD Medicaid program. If SSI terminates and the child is IV-E eligible, you must terminate the M-AD case and complete a new 8124 under I-AS. A transfer from I-AS to M-AD or from M-AD to I-AS is not an allowable transfer (EIS-3450 II).

J. Redeterminations

1. Title IV-E Adoption Assistance

The Title IV-E Adoption Assistance program does not require redeterminations of a child’s eligibility. Once a child has been determined eligible and is receiving Title IV-E Adoption Assistance, the child remains Medicaid eligible. A State may terminate the Title IV-E Adoption Assistance only under circumstances specified at section 473(a)(4) of the Social Security Act. The PQA report (PQA-108) is a monthly report that shows children who are IV-E Adoption Assistance eligible. Document the record that continued IV-E eligibility was verified per PQA report at the 12 month Medicaid certification period.

2. Title IV-E Foster Care Assistance

a. For a Title IV-E Foster Care child, a redetermination is completed every 12 months; and

b. anytime there is a change that could impact eligibility.

c. A DSS-5120A, Foster Care and/or Medicaid Redetermination, is required.

REVISED 07/01/10 – CHANGE NO. 08-10