Kansas
Department of Social and Rehabilitation Services
Janet Schalansky, Secretary
Integrated Service Delivery - Candy Shively,
Deputy Secretary (785) 296-3271
Economic and Employment Support - Bobbi
Mariani, Director (785) 296-3349
MEMORANDUM
To: |
EES Chiefs and Staff
HealthWave Clearinghouse Staff
|
Date: |
April 21, 2004 |
From: |
Bobbi Mariani
Scott Brunner |
RE: |
Implementation of Foster
Care Medical Card Extension
Program |
The purpose of this memo is to provide
implementation instructions
for a new Medicaid coverage
group, which
will provide continued
medical assistance to youth,
ages 18-20,
who are leaving
the foster care system.
Because staff in the agency’s
division of Children and
Family Services
will have responsibility
for eligibility determinations
and maintenance under
this program, this memo
will
focus on coordination
of coverage and
benefits.
Formal policy material is contained in
the CFS Manual section 8531 - C.
-
Background Information
The new medical coverage
group, the Foster Care Medical Card Extension
Program,
is available to former foster care
youth who ‘age out’ of the
foster care system. The Foster Care Independence
Act provides the authority for state
Medicaid programs to elect coverage
under
this optional Medicaid eligibility group.
Coverage under this group is targeted
at young adults who leave the foster
care system. Many youth leave foster
care when they reach age 18, but some
stay in foster care beyond their 18th
birthday. Youth in the custody of SRS
or JJA are potentially eligible for coverage.
However, youth in an ineligible living
arrangement on their 18th birthday (such
as a penal institution or youth detention
facility) are NOT eligible for this extended
medical coverage.
The following are the basic requirements
for coverage under this group:
-
General
and non-financial Medicaid
criteria - such as citizenship/alienage,
residency
and cooperation
-
Date of Birth on or after 07-01-85
-
Received a foster care maintenance payment on their 18th birthday
-
No income or asset test
-
Completed application and annual reviews
Coverage may begin as early
as July 1, 2003. Coverage under this
category may
not extend beyond the
month of the individual’s
21st birthday.
-
Eligibility
Determination
CFS staff have responsibility
for determining eligibility for the new
coverage group
as well as providing
ongoing case maintenance. As potentially
eligible youth prepare
to exit foster
care, the social worker will provide
an application for continued
medical coverage.
A new, single program application has
been developed for this
purpose (CFS
8595). The signed application can be
submitted following the individual’s
18th birthday
and will not be considered a valid application
if submitted prior
to this date.
NOTE: The application may be submitted
to any SRS office for processing, as
per Universal Access guidelines. Other
CFS programs continue to be excluded
from Universal Access.
- KAECSES/MMIS
Eligibility is established on KAECSES
through the FC program. Two new medical
subtypes have been created to use with
the FC program for those eligible for
coverage. The presence of these coding
combinations will denote eligibility
under this category.
Program/Subytpe Combinations:
FC AO - Aged Out - Former CFS custody
FC AJ - Aged Out - Former JJA custody
Additional details regarding KAECSES coding
are available in the CFS Manual.
For Medicaid purposes, persons eligible
under this group are not considered for
managed care but are subject to copay.
PRAP Alerts: In addition to the new medical
subtypes, two new Person Alerts (PRAP)
have been established to identify former
foster care youth as potential eligibles
or non-potential eligibles. At the time
a youth is released from custody and
is age 18 or older, CFS will enter the
appropriate PRAP alert:
AO - Eligible for
FC Aged Out Medicaid - will be used when a youth meets the
necessary foster care status requirements.
In other words, a FC maintenance payment
was received and the individual was in
an appropriate living arrangement on
their 18th birthday.
NA - Not Eligible
for FC Aged Out Medicaid - will
be used when a youth may otherwise
appear
to be eligible, but is not because
of an ineligible
living arrangement on the 18th birthday.
These codes will be extremely important
to eligibility staff, as addressed in
item IV B below.
-
Coordination of Coverage
Although CFS will have primary responsibility
for eligibility determinations, EES and
HealthWave Clearinghouse eligibility
staff must be aware of the potential
of coverage under the new group and be
prepared to coordinate coverage with
CFS staff. CFS has established a regional
contact in each management area to assume
coordination responsibilities. All correspondence
concerning these individuals will be
directed to the CFS regional contact.
A list of regional contacts is included
with this material.
- Persons may be eligible
for more than one coverage
group. For example,
an 18-year-old
may be eligible under both FC AO/AJ
as well as MP. When this occurs,
the following
rules apply:
- FC AO/AJ takes
priority over other forms of coverage
except for SI-related
medical and MS or CI
coverage for persons on
HCBS or in institutional
living arrangements.
Youth accessing HCBS
or long term institutional
care must be moved to
a MS or CI medical program,
as appropriate.
- If other members of the
individual’s family
also apply for medical
coverage and the FC AO/AJ
individual is a member
of the assistance plan,
the FC AO/AJ recipient
shall be included on the
family’s case as
a DI.
- An
application is received
by the HW Clearinghouse
or by EES for a youth
potentially
covered under the
FC AO/AJ group. When
Medicaid coverage
is requested on a
general application,
eligibility must
be determined
under all Medicaid
groups the state
covers. Therefore,
a general Medicaid
application
(e.g., the ES-3100
or the HealthWave
application) for
a former foster care
youth shall not
be denied until coverage
under this program
is considered. It
is the responsibility
of both CFS and EES/Clearinghouse
staff to work together
to ensure the applicant
youth is considered
under the full range
of coverage groups
offered. To ensure
applicants receive
a full determination,
the following process
shall be utilized
for new applications:
- When an individual
potentially
eligible
under this group
leaves
foster
care, the CFS
worker
will
enter the AO
PRAP code.
This
will allow others
to
know that
potential
FC AO/AJ eligibility
exists.
- When an
application
is received
by an entity
other than
CFS, the
registration
clerk
will look
for the
presence
of the
alert and
take the
following
action:
If the AO alert is present, the age of
the applicant will be noted.
- If
the individual is under the
age of 21, the application
must be referred to CFS. A
copy of the application shall
be given/faxed to the regional
coordinator, who will process
eligibility based
on this application,
a
new FC AO/AJ
application
is not necessary. The regional coordinator will communicate the results of the
determination to the
entity receiving the
application.
The
EES or HealthWave
Clearinghouse eligibility worker must then continue
to process
benefits
or coverage
under
other programs
or groups.
- If
the
applicant
is
age
21
or
older,
process
the
application
considering
other
coverage
groups.
If
the NA
alert is
present, or if no alert has been
entered for a former foster
care recipient, assume
the requirements for the
FC AO/AJ program
are not met and process
the application considering
other coverage groups.
- A
FC AO/AJ application
is received
by CFS
for an individual
already receiving
Medicaid
under another category. With the exception
of coverage under the
SI
medical
program or MS/CI
for long term care
situations, coverage
in the FC AO/AJ
group
takes priority over all
other groups.
Therefore,
when a FC AO/AJ
application
is received
for a person with coverage
under
another group,
action to terminate
coverage
under the existing
program shall
be taken
as soon as possible.
Coverage
will then
be established under the
FC AO/AJ group.
CFS will
contact the eligibility
worker indicated
on the CAP1 screen
to initiate
the change in medical
program.
- A FC AO/AJ recipient has
reached age 21 or otherwise
terminating
coverage
in the FC AO/AJ group. The CFS
staff person will receive a KAECSES
alert just
prior to the individual reaching
age 21. CFS will then take action
to terminate
coverage. The notice sent will
inform the individual they can apply
for continuing
coverage through EES or the HealthWave
Clearinghouse. However, an individual
terminating from FC AO/AJ for a
reason other than age (e.g., residency,
cooperation,
failure to complete the review
process) will not likely be eligible
for coverage
under another group.
- Continuous Eligibility
for Pregnant Women. A pregnant
woman, covered under
the FC AO/AJ program, is protected
under the continuous eligibility
provisions
through the end of the postpartum
period. Therefore, if a pregnant
woman reaches
the age of 21, action must
be taken to ensure her coverage
continues. Her newborn
infant is also continuously
eligible for coverage through
his first birthday.
This policy is also true for
pregnant teens in the general
foster care population
or recipients of adoption
support.
To ensure that both groups are protected,
a new KAECSES alert will be generated
to alert CFS staff to a potential pregnancy.
The alert will originate from the MMIS
and will be set when a pregnancy-related
service has been received in the past
60 days. If FC coverage is scheduled
to terminate, CFS staff will work with
EES or HealthWave Clearinghouse staff
to verify the pregnancy. Information
on file with the fiscal agent can be
used to verify a pregnancy.
Any ongoing coverage for a pregnant woman
or teen no longer eligible for a foster
care-related medical program or adoption
support medical program shall be provided
through the MP program. The program is
to be processed by local EES staff initially
and then sent to the HealthWave Clearinghouse
for case maintenance.
- Implementation Process
CFS staff have identified individuals
who have left foster care since 07-01-03
and otherwise appear to meet program
requirements. A special announcement
will be sent to these individuals telling
them about the opportunity for ongoing
medical coverage under the new group.
An application will also be included
with the mailing. Persons choosing to
apply may return the application to any
SRS office for processing. Although persons
may apply at any time, an opportunity
for prior coverage will be offered for
a limited period of time according the
following:
- For applications received prior
to 05-01-04, coverage shall be backdated
to the individual’s
release from foster
care, but no earlier
than
07-01-03.
- For
application received on or
after 05-01-04, coverage
will be established
beginning the month of
application, unless prior
medical is requested.
Youth currently receiving coverage under
other programs shall be transferred to
coverage under the extension program
as they are identified and approved.
Coordination between the current case
manager and the CFS worker is necessary
to ensure remains in place through the
change.
Although the responsibility for program
administration of the new extension program
rests with CFS, efforts by EES and HealthWave
Clearinghouse staff are necessary to
ensure success of the new program. Many
of the major coordination issues have
been addressed in this memo. However,
it is quite likely that scenarios which
fall outside of these examples will also
occur. Coordination of regional staff
will be necessary when these situations
arise, and central office staff may also
need to be contacted.
For program questions, please contact the
program manager, Deanne Dinkel in CFS.
Questions regarding coordination with
the family medical programs may be sent
to Kristi Scheve in Health Care Policy;
coordination issues regarding the elderly
and disabled programs (including long
term care and HCBS) may be sent to Jeanine
Schieferecke in EES. Questions and issues
regarding automated systems are sent
to SRSTSC (HelpDesk).
Thank you for your support and cooperation
in making this new program a success.
BM:SBJS:jmm
Attachment: SRS Area Office Contact Names
for Medical Card Extension Program
|