2815 Foster Care and Medical Assistance

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Foster Care and Medical Assistance

Effective Date:

November 2020

Chapter:

2800

Policy Number:

2815

Previous Policy Number(s):

MT 45

Updated or Reviewed in MT:

MT-62

Requirements

Foster Care Medical Assistance provides coverage to children in placement for whom DFCS has temporary or permanent custody.

Basic Considerations

The funding determination for foster care is processed in the SHINES CWIS system by Rev Max Specialists (RMS) and Medicaid eligibility is processed in the Gateway system by Rev Max Medicaid Specialists (RMMS).

The Medicaid Application for Foster Care is submitted to Revenue Maximization Medicaid staff via SHINES to establish a child’s Medicaid eligibility. As soon as possible, but no later than 48 hours of child’s removal, a Social Services Case Manager (SSCM) enters child and family data in SHINES. This section captures information required for Medicaid eligibility, Child Support and the medical services provided for the child prior to removal. Child support information: FCC stage, Income and Expenditure page; Three (3) Month Prior MAO request: FCC stage, Application and Background page.

Within five (5) working days, the SSCM or designated staff initiates the IV-E funding determination process by entering the required information into SHINES. Once the required pages are completed, the IV-E Application is saved and submitted electronically to RevMax.

IV-E Eligibility Criteria

A child must meet the following AFDC Relatedness and court order criteria to be IV-E eligible:

  • The child must meet the following AFDC relatedness criteria in the eligibility month (Reference 2825 AFDC Relatedness):

    • Living with and removal from a specified relative

    • Deprivation

    • Financial need: income and resources

    • U.S. citizen/legal alien status

    • Age

If all AFDC Relatedness criteria is met, then the child must have entered care as a result of a court order with a judicial determination to the effect that it is contrary to the welfare of the child to remain in the home, or that placement is in the best interest of the child, or by a signed Voluntary Placement Agreement. The judicial determination of contrary to the welfare or best interest must be made in the first court order signed by a judge that sanctions the removal of the child. If the judicial determination is not made in the first order, the child is not eligible for the duration of that placement episode in foster care.

There must also be a judicial determination within 60 days of the removal date to the effect that reasonable efforts were made to prevent removal of the child or that reasonable efforts were not required to prevent removal of the child with agency specific details of those efforts. A child is not IV-E eligible until the reasonable efforts language is obtained. If the judicial determination is not made within 60 days of the child’s date of removal from the home, the child is not IV-E eligible for that entire placement episode. For those children who enter DFCS care and responsibility via a Voluntary Placement Agreement, a judicial determination that reasonable efforts to prevent removal is not required for meeting IV-E eligibility. See 2820 Legal Status.

A child who meets all eligibility criteria is IV-E eligible. Title IV-E eligibility is determined each time a child first comes into the care and responsibility of DFCS via a court order or VPA. Eligibility does not automatically grant federal benefits for maintenance costs. Once established, a child’s IV-E eligibility continues as long as the child remains in the same placement episode.

A child loses IV-E eligibility at age 18; the child is in care under a Voluntary Placement Agreement (VPA) and a custody order with a judicial determination to the effect that continued placement is in the best interest of the child statement was not obtained within 180 days of the signed VPA; or the child is on trial home visit or run away status beyond six months, unless a court orders a longer trial home visit.
Any youth who has been IV-E eligible, but reaches the age of 18 and signs an agreement to remain in Extended Youth Supportive Services (EYSS), is classified as Foster Care ages 18 to 21 if all eligibility criteria are met. Reference Policy 1012.6, Child Welfare Manual for Extended Youth Support Services and Section 2890, Foster Care Medicaid age 18 to 21.

IV-E Eligibility Effective Date

The eligibility month is the month the Voluntary Placement Agreement was signed by all parties or the month the petition that led to the removal of the child was filed. The effective date of IV-E eligibility is the first day of the month in which all of the eligibility criteria are met. A child remains IV-E eligible during that placement episode. IV-E reimbursability may vary based on case circumstances.

Procedures

Title IV-E Application

A SSCM completes the required items of information in a child’s SHINES Person Detail page to display in the IV-E Application:

  • Identifying information on the child SHINES Intake stage, Person Detail Page. Use child’s formal name and date of birth as it appears on the child’s birth certificate.

  • Gender, Race: SHINES Intake stage, Person Detail Page.

  • Social Security Number: SHINES Intake stage, Person Detail Page. If not available, proceed with the application and submit.

  • US Citizenship Status: SHINES FCC stage, Citizenship and Identity Page Answer item “yes” or “no” due to item’s impact on Medicaid eligibility.

  • Removal Date: SHINES Investigation, FCF, Custody Page

  • Pregnancy status: SHINES FCC stage, Income and Expenditures Documentation Checklist.

  • Person ID: SHINES generated and added to Intake stage.

A SSCM completes the child’s parent information. The information in this section allows the case manager to identify the child’s mother and father and all principals in the case excluding the child, as identified by the Relationship – Self in SHINES. This information is captured for the IV-E funding determination as removal household data. Parental and removal household information is entered on the Intake stage, Investigation stage, Person Detail Page.

All court orders related to the child’s removal and giving custody to DFCS are uploaded to SHINES External Documentation based on name, date of birth, legal county and SHINES Person Identification Number (PID).

IV-E Eligibility and Processing

Once the required pages are completed and the court orders uploaded, the IV-E Application is submitted to RevMax via SHINES.

“AFDC Relatedness” Criteria

Eligibility for IV-E requires that the child must have a relationship to the Aid to Families with Dependent Children (AFDC) within six months prior to or during the “eligibility month”. In all references to “AFDC Relatedness”, the eligibility of the child is based on the AFDC program and its policies that were in effect in Georgia on July 16, 1996.

For the RMS to determine if the child meets the “AFDC Relatedness” criteria in the removal home, a Social Services Case Manager (SSCM) provides RevMax with social and family information, the circumstances and financial data at the time of the child’s removal.

Establish eligibility for AFDC (based on Georgia’s July 16, 1996 AFDC policy). Verify that the child meets the AFDC criteria for initial IV-E eligibility in the month that the petition for custody was filed or the Voluntary Placement Agreement was signed.

Establish age and citizenship based on a child’s birth certificate or Vital Records screening.

Establish the child’s deprivation using criteria in Section 2825 – AFDC Relatedness and Section 2826 – Unemployed Parent.

Determine the removal home’s financial need based on Section 2825 – AFDC Relatedness and Section 2845, SSI Eligible Child.

RMS must address household management and verify income and resources through collateral contacts including but not limited to Clearinghouse, BENDEX, $TARS, SDX, Gateway for:

  • Household Composition

  • AU income and resources

Establish “living with/removal from” criteria

If the child did not live with a specified relative in the eligibility month, determine if s/he lived with a specified relative in any one of the six months prior to the month in which the petition for custody was filed or the Voluntary Placement Agreement was signed. Determine if the child could have received AFDC in the home in the removal month if the child had been living with the specified relative from whom custody was removed. Reference Section 2825 for Living With/Removal Home Rule prior to March 27, 2000.

If AFDC relatedness cannot be established, notify the SSCM of the funding determination through the SHINES Eligibility Summary Page

If AFDC relatedness can be established, proceed to review and determine if the court order(s) that brought child into care meet the required judicial determination to the effect that it is contrary to the welfare of the child to remain in the home, or that placement is in the best interest of the child, or by a signed Voluntary Placement Agreement. The judicial determination of contrary to the welfare or best interest must be in the first court order sanctioning removal signed by a judge. There must also be a judicial determination within 60 days of the removal date to the effect that reasonable efforts were made to prevent removal of the child or that reasonable efforts were not required to prevent removal of the child with agency specific details of those efforts.

If the child is IV-E Foster Care eligible, approve the IV-E Foster Care Eligibility Summary Page, documenting the determination details in SHINES Contacts and Summaries.

Assign each foster child an individual case number and case record.

Refer the absent parent(s) to DCSS through SHINES interface with DCSS. Refer to 2851 Child Support Referrals.

Retain all documentation and SHINES print screens in the case record for permanent verification. Retention of all court order(s) is mandatory. The SSCM remains responsible for providing court orders to the RMS. If upon the receipt of the court order(s) the RMS finds the order to be questionable, it should be discussed with the Revenue Maximization supervisor and a second level review completed by the Rev Max State Office. Court Orders determined to be IV-E non-compliant are forwarded to the DFCS Legal Counsel for review.

If all points of eligibility cannot be established or the child is financially ineligible, verify and validate the SHINES determination of IV-E ineligible.

Terminate IV-E Foster Care eligibility for a Voluntary Placement Agreement unless a judicial determination is made within 180 days of the date the agreement was signed.

  • Assurance of the required contrary to the welfare wording in the court order or validity of the Voluntary Placement Agreement

  • The name of the agency or individual to whom the court order gives responsibility for placement of a child

  • The date the court order or Voluntary Placement Agreement expires

  • The child is in a licensed/approved placement

  • The name and address of the placement source

A copy of the initial court orders containing the contrary to the welfare, best interest and reasonable efforts made to prevent removal or reasonable efforts were not required are printed from SHINES External Documentation and become a permanent record of temporary or permanent custody of the child and are maintained in the foster care record

Reimbursability

A child must be determined IV-E eligible in order to be determined IV-E reimbursable. Initial IV-E eligibility is based on the circumstances in the home from which the child was removed, via a custody order or Voluntary Placement Agreement. If a child is determined not eligible for IV-E, the child is ineligible for the duration of that placement episode for both IV-E eligibility and IV-E reimbursability. A placement episode begins at the time the child enters foster care to the point DFCS terminates custody. When a child re-enters DFCS custody, a new placement episode begins and a new IV-E determination is required.

The determination that a child is IV-E reimbursable allows the State to obtain federal IV-E funding for the maintenance, administrative and training costs associated with the child.

SHINES System

The GA Child Welfare Information System (CWIS), SHINES, was implemented statewide in June 2008. Prior to that implementation, all foster care and adoption assistance funding and Medicaid eligibility was processed and tracked through the SUCCESS system.

The below listed forms were completed to document the interaction and exchange of information between SSCMs and RevMax staff prior to the statewide SHINES implementation:

  • Form 223 – Medicaid and Application for Foster Care and Adoption Assistance

  • Form 224 - Removal Home Income and Asset Checklist

  • Form 225 – Title IV-E Eligibility Documentation Sheet

  • Form 226 - Medicaid and IV-E Redetermination Form

  • Form 227 – Notice of Change in Foster Care or Adoption Assistance

  • Form 529 - Authorization of Foster Care Status Change/Termination

  • Form 122 – Foster Care Referral for Child Support

Authorizing Medicaid for Out-Of-State IV-E Foster Children Residing in Georgia

Reference 2852 Medicaid Application Processing for Out of State Children Placed In Georgia.