2812 Department of Juvenile Justice Medicaid Application Processing | Medicaid

DJJ Commitment under age 19 Medicaid must be immediately determined for youth in a DJJ commitment.

When a child is adjudicated delinquent and placed in an out-of-home facility pursuant to a delinquency court order, the county DJJ office will request medical assistance for the child through the DJJ Revenue Maximization Unit. This request must be within two (2) working days of the child’s entering placement. The county DJJ office will make the request by completing Form 223, Medicaid and IV-E Application for Foster Care and Adoption Assistance, and Form 224, Removal Home Income and Asset Checklist, as a Word document and sending as an attachment to the DJJ Revenue Maximization Unit. The child’s social history face sheet, screening placement form, petition and a copy of the court order should accompany the application.

The DJJ Revenue Maximization Unit will log the application upon receipt. Medicaid Eligibility Specialist (MES) will then review the application and determine eligibility for DJJ Commitment under age 19 Medicaid

The child must be removed from all active or pending cases prior to being placed in DJJ Commitment under age 19 Medicaid. The DJJ Revenue Maximization Unit will register a new Medicaid case, coding the living arrangement as PLA, Placement in RYDC, CRP, Community Residential Placement or JCA, Joint custody while awaiting placement in RYDC. This will generate the interface update to GAMMIS. Once the living arrangement code is on the member file, the current CMO enrollment segment will close effective the following month.

Reference 2853 Foster Care CMO Procedures of the Medicaid Policy Manual.

If the child is SSI eligible when entering care, the DJJ Revenue Maximization MES will open a Medicaid case on Gateway, coding the child’s living arrangement PLA, CRP or JCA. This will generate the interface update to GAMMIS. This will not adversely affect SSI.

The DJJ MES will request any additional documentation needed for the IV-E determination. Documentation will be faxed to the appropriate DJJ MES.

The local DJJ office will receive notification of the decision by a Gateway generated letter.

A face-to-face interview is not required. A telephone call to the JPPS will suffice to clarify information on Form 223 and Form 224. Additionally, a telephone call may be used to clarify supporting documents when necessary.

No application should be denied due to the JPPS' failure to cooperate with the eligibility determination process. The DJJ MES is expected to pursue all avenues to obtain required information.

Follow the verification guidelines found in the appropriate sections of this manual. If no other option is available, the JPPS' statement as to removal home circumstances is acceptable.

The statement must be in writing, signed and dated by the JPPS.

Clearinghouse must be checked for information on all members of the removal home family and the child in care.

Complete the mandatory forms below when processing an application for a child in care:

Any application for Medical Assistance can be used as the application for a child in care. Forms 223 and 224 are preferred, as all the information requested on these forms is needed to make an appropriate IV-E determination.

The DJJ Revenue Maximization Unit determines eligibility for DJJ Commitment under age 19 using the Standard of Promptness (SOP) for that COA (Refer to 2065 Family Medicaid Application Processing). Calculate the SOP beginning with the date of application.

If the SOP date falls on a weekend or holiday, complete the application by the last workday prior to the weekend or holiday.

The Standard of Promptness for Medicaid is 45 days.

For title IV-E determinations when the only verification missing to complete the IV-E case is the court order, the application may be held up to the 60th day. If, after 60 days the court order language is outstanding, the DJJ MES should finalize the case as IV-B, with the

understanding that the case will be reviewed for IV-E eligibility once the court order is received. If at any point the DJJ MES determines that the child does not meet the AFDC Relatedness criteria, it is not necessary to wait for the court order language. The application should be approved as title IV-B.

Approve Medicaid and continue eligibility as long as the child continues to meet the requirements of the COA under which they are approved. A CMD must be completed prior to denial or termination of any Medicaid COA.