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

X. Policy rules - Expanded Foster Care Program (EFCP)

A. General

The Expanded Foster Care Program (EFCP) for IAS and HSF adolescents ages 18, 19, and 20 will be without regard to the adolescent’s assets or income through the month they turn age 21. Former or current foster care adolescents, ages 18, 19, and 20 are eligible for Medicaid if they were in foster care on their 18^th birthday. This does not include adoption assistance or children who were adopted.

REISSUED 11/01/09– CHANGE NO. 12-09

(X.A.)

Potential EFCP eligible children age 18, 19, and 20 who aged out of foster care at age 18 or those children who are foster care or I-AS (IV-E Foster Care), must be evaluated for all Medicaid programs/categories, excluding Medically Needy, North Carolina Health Choice (NCHC), and Family Planning Waiver. Use the eligibility criteria for that program which may mean counting the child’s income and assets. If eligible, approve in the appropriate program/category. If unable to determine eligibility due to the individual’s failure to provide verification, do not put into EFCP. If verification is provided and individual is ineligible for other Medicaid programs, place into EFCP. Do not count the child’s income and assets for EFCP.

Foster care children receiving under MIC should remain in MIC if they continue to be eligible for MIC. At the point they lose eligibility under MIC, evaluate them for EFCP. For those former foster care children receiving under MAF categorically needy, they can remain MAF categorically needy. If their income or assets causes them to lose MAF categorically needy eligibility, evaluate them for EFCP.

B. Eligibility criteria for adolescents age 18, 19, and 20 in the Expanded Foster Care Program (EFCP) are:

1. Were in foster care on their 18th birthday.

Contact a social worker to verify a child was in foster care on his 18^th birthday.

2. Continues to be a resident of North Carolina.

Adolescents must apply in their county of residence for EFCP. This may not have been the county of residence when they were in foster care.

3. Must not be receiving Medicaid from another county or state.

Recipients in EFCP may have their case transferred from county to county. EIS will allow for HSF and IAS county transfers to be keyed November 5^th, 2007. Prior to November 5^th, 2007, caseworkers must terminate the case in the first county and complete an administrative application in the second county.

4. Must not be an inmate of a public institution.

5. Must furnish their social security number, provide third party information, and apply for all benefits to which they may be entitled. Applying for all benefits to which an applicant may be entitled is one of the federal requirements for Medicaid eligibility. If a person does not comply, they are not eligible and therefore you must deny the application.

IAS and HSF adolescents in the Expanded Foster Care Program who are caretaker relatives are exempt from cooperating with Child Support. There is no child or medical referral requirement for a foster adolescent who now has a child, as long as the individual remains covered in the Expanded Foster Care Program. However, if the individual’s category of coverage is changed to a family group where child support requirements must be met as a condition of eligibility for the caretaker relative, then a referral must be made to Child Support.

REVISED 11/01/09– CHANGE NO. 12-09

(X.B.)

6. IAS and HSF children are excluded from citizenship and identity documentation requirements. They are exempt as the social worker must verify citizenship/identity.

C. Redeterminations

The Medicaid caseworker must complete a redetermination every 12 months to determine continuation for Medicaid services in the Expanded Foster Care Program (EFCP). The redetermination is without regard to assets or income of the child through the month they turn age 21.

D. Retroactive Coverage

Retroactive coverage is not allowable for any month prior to October 1, 2007, if eligible for the Expanded Foster Care Program (EFCP).

E. SSI child

If the child is SSI, the child is covered under the M-AD Medicaid program. If SSI terminates and the child is eligible for the EFCP, you must terminate the M-AD case and complete a new 8124 to authorize under EFCP.

F. Pregnant Woman and Auto Newborn Coverage

For the child to receive auto newborn coverage under the Medicaid program, the pregnant woman must be covered by a Medicaid program that covers the child’s birth. This includes I-AS and H-SF.

If the recipient receiving Medicaid under the EFCP is pregnant or becomes pregnant she can receive pregnancy related care covered by Medicaid under the EFCP through the month of her 21st birthday.

If the recipient delivers her baby while covered by Medicaid under the EFCP, the baby is entitled to auto newborn coverage from his date of birth through the month he turns age one. The newborn is also exempt from providing further verification of citizenship and identity. The mother must be evaluated for coverage under other Medicaid programs should the Medicaid coverage under the EFCP end, including M-PW through the end of the post partum period, if applicable.

REISSUED 11/01/09– CHANGE NO. 12-09

(X.)

G. Case Management Reports

EIS will display the following special message reports for the HSF and IAS Expanded Foster Care Program (EFCP) on the Case Management Report.

1. “Age 18 in MMM” (e.g. “Age 18 in JAN”)

Appears on the Case Management Report two months prior to the birth month, one month prior to the birth month, and in the birth month. This message is displayed only for HSF non-SSI cases, not for HSF SSI cases.

2. “Age 21 in MMM”

Appears on the Case Management Report two months prior to the birth month and one month prior to the birth month.

3. “Age 21 or Over”

Appears on the Case Management Report in the birth month and ongoing until the caseworker terminates the HSF or IAS for that child.