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

VIi. POLICY RULES - FOSTER CHILD UNDER AGE 18, H-SF

A. To be eligible in the H-SF aid program/category an individual must:

1. Be under 18 years of age. Coverage may be received up to age 21 if a signed voluntary agreement, Contractual Agreement for Residential Care (CARS), was completed with the County DSS. If a signed CARS is in place, the child continues to receive State foster care funds.

2. Be a citizen of the United States, with identity and citizenship documented, or an alien who meets alienage requirements. Refer to MA-3332, US Citizenship Requirements and/or MA-3330, Alien Requirements.

3. Be a resident of North Carolina as defined in MA-3335, State Residence.

4. Not have resources for reserve in excess of the applicable allowance for the budget unit. Refer to MA-3320, Resources.

5. Meets income criteria:

a. For private living budgeting, refer to MA-3305, M-AF, M-IC, H-SF Budgeting.

b. For long-term care budgeting, refer to MA-3325, Long-Term Care Budgeting.

6. Not be receiving Medicaid from another aid/program category, county, or state.

7. Not be an inmate of a public institution, except individuals receiving psychiatric care in the state’s mental hospitals

8. Provide verification of all health insurance coverage for himself and assign to the State all rights to third party payments from such insurance coverage. Refer to MA-3510, Third Party Recovery (TPR).

9. Furnish his Social Security number, or apply for a number if he does not already have one, and furnish all Social Security numbers which he has used or under which he has received benefits. Refer to MA-3355, Enumeration Procedures.

Refer to MA-3355, Enumeration Procedures, for enumeration instructions of a child in adoptive placement.

10. Apply for all benefits to which he may be entitled (For example: Unemployment Insurance Benefits, Disability, Social Security, etc.). Refer to MA-3300, Income.

REISSUED 07/01/10 – CHANGE NO. 08-10

(VII.A.)

11. Be ineligible for Title IV-E foster care assistance, and also meet one of the following:

a. The county department of social services (DSS) has legal custody as a result of a court order and is placed in any setting, licensed or unlicensed, including foster care facility/home, other private home, or a long-term care facility, or

b. The county DSS has placement responsibility.

(1) The county DSS has placement responsibility when:

(a) The parent(s), other relative, or legal guardian has delegated caretaking responsibility to the county DSS by written agreement for the child(ren) living separate and apart from them, or

(b) The child(ren) age 18 or older has expressed, through a written agreement with the county DSS (CARS), a need for care and has agreed to a foster care arrangement, or

(c) A court order is issued which directs the county DSS to care for and supervise the child(ren) outside of his own home even if legal custody is not transferred to the county DSS.

(2) When the county DSS has placement responsibility instead of custody, placement may be in any of these settings:

(a) Foster care facility supervised by a county DSS and licensed by the Department of Health and Human Services (DHHS).

(b) A private child-caring institution licensed/approved by DHHS and in compliance with Title VI of the Civil Rights Act,

(c) A private group home licensed/approved by DHHS and which is in compliance with Title VI of the Civil Rights Act, or

(d) A medical institution as defined in MA 3325, Long Term Care Budgeting, I.A.

REISSUED 11/01/09– CHANGE N0. 12-09

(VII.)

B. County Placement Responsibility/Custody - H-SF

1. A signed and dated DSS-5120 for Medicaid under the H-SF aid program/category is required.

a. The application should be made so that coverage can begin the month the county assumes custody/placement. The date of application is the date the DSS-5120 is signed by the county director or his designee.

NOTE: Back-dating a Medicaid application in order to cover prior months is prohibited. See 3. below on retroactive coverage.

b. The IMC must process the Medicaid application for HSF. It must be signed by the director’s designee but cannot be signed by the same caseworker who is determining eligibility for Medicaid.

c. The director’s designee must provide the IMC with all information pertinent to the child’s eligibility for Medicaid or must assist in obtaining necessary information.

d. Only the assets and income of the child are considered in determining financial eligibility under HSF.

2. There may or may not be a State Foster Home Fund payment for this child. Refer to the Family Services Manual, Chapter IV, Foster Care Services, Section 1202, for information on eligibility for State Foster Home Fund payments.

3. The county DSS must make application for coverage under the appropriate aid program/category for any retroactive months, applying parental financial responsibility if the child was in the home of his parent(s) or temporarily absent. See MA-3220, Retroactive Coverage.

a. Retroactive coverage is limited to the 1, 2, or 3 months immediately proceeding the month of application.

b. There must be medical need in the retroactive period.

4. Unless there is good cause, a child under H-SF must be referred to Child Support Enforcement. Refer to MA-3365, Child Support, for instructions.

REISSUED 11/01/09 – CHANGE NO. 12-09

(VII.)

C. Procedures

1. Document:

a. The child’s legal status with regard to custody/placement.

b. All contacts made to verify custody or placement responsibility:

(1) Obtain a copy of the court order granting custody/placement responsibility or a copy of the written agreement from the parent(s) delegating placement responsibility to the county DSS, and

(2) File in the income maintenance case record.

2. Eligibility Determination

a. Determine financial responsibility and verification requirements according to MA-3305, M-AF, M-IC, and H-SF Budgeting.

b. Cease parental financial responsibility beginning with the month the county DSS takes custody or assumes placement responsibility. Refer to MA-3305, M-AF, M-IC, and H-SF Budgeting.

c. Determine whether the child has income, including child support, and/or assets of his own. Income received by the child or assets he owns are countable in determining his eligibility.

d. Determine financial eligibility. Refer to MA-3300, Income; MA-3305, M-AF, M-IC, and H-SF Budgeting; and MA-3320, Resources, for procedures.

(1) Evaluate for H-SF.

He is eligible under the H-SF aid program/category if:

(a) His assets are within the Categorically Needy (CN) limit, and

(b) He has no income, or

(c) His income is equal to or less than the CN income limit for one.

(2) Evaluate as M-IC/NCHC if income and/or assets exceed the CN level.

(3) Evaluate for H-SF MN with a deductible if income exceeds the M-IC/NCHC income limit and assets are within the MN allowance.

REISSUED 11/01/09– CHANGE N0. 12-09

(VII. C.)

3. Return Home

a. Sometimes a child can be placed in his parent(s)’ home but remains the responsibility of the county DSS and is supervised by the county agency. He continues to be H-SF.

b. The child remains in the custody of the DSS until his parent(s) is once again granted legal custody by the court.

c. When it is determined that the stay is no longer temporary, that is, legal custody is given back to the parent(s), evaluate eligibility under another aid program/category, applying parental financial responsibility.

D. Redeterminations

1. For a Foster Care child, a redetermination is completed every 12 months; and

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

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

E. SSI Child

If the child is receiving SSI, a transfer is allowed from M-AD to H-SF or from H-SF to M-AD.

If SSI terminates, the case is still shown as M-AD and the child is eligible for H-SF, you must terminate the M-AD case and complete a new 8124 to authorize for H-SF.