2870 Redeterminations For Children In Placement | Medicaid

SHINES generates a Reimbursability Summary Page pre-populated with data entered at the initial entry into foster care. To validate the SHINES derived initial funding determination and to assure accuracy in the initial IV-E decision, all initial documentation and information is reviewed for accuracy or changes from the initial determination information at the first six (6) month review.

Redetermination criteria for all cases that are IV-E eligible and reimbursable and IV-E eligible and non-reimbursable:

Once a child meets IV-E eligibility, only the resources of the child are considered in determining if the child continues to meet financial need for ongoing IV-E reimbursement. A child’s resources may not exceed $10,000. For the month(s) a child’s countable resources exceed $10,000, the child is not IV-E reimbursable. The child may become IV-E reimbursable once the child’s resources no longer exceed $10,000 if all other criteria are met.

The child’s income cannot exceed 185% of the foster care rate. This is the only standard to which income is compared in determining if the child meets ongoing IV-E reimbursement. The AFDC Standard of Need is only used at the initial eligibility determination. Establish current financial eligibility for the child using IV-E Budgeting standards. Refer to 2840 IV-E Budgeting.

Determine that the court order is valid or has been renewed without interruption, and that a judicial determination of reasonable efforts were made to finalize the permanency plan language has been obtained in a court order if the child has been in custody at least twelve (12) months.

Determine that the child remains in an approved placement.

Determine that the child meets the age requirement for the Class of Assistance and IV-E.

Determine that there has been no lapse in custody. Reference 2820 Legal Status.

Child Welfare foster children that have been determined non-IV-E eligible have no requirement to review the determination at the first six-month review. Child Welfare foster children will require an annual Medicaid renewal.

Screen GAMMIS for a Third Party Liability. Verify with SSCM that insurance coverage continues for the foster child. If a child is no longer covered by TPL, follow procedures in Section 2230 – Third Party Liability for Health Management Systems to remove the TPL coverage.

Determine that the child did not become IV-E ineligible during the past six months.

Determine IV-E Reimbursability for the next six months. Complete Form 529, if necessary, to reflect historical periods of non-reimbursability or that the child became ineligible. This form is signed by the Revenue Maximization Supervisor who is responsible for the form’s content and forwarding to regional accounting. RMS update the Eligibility Summary Page in SHINES; upload the signed, completed Form 529 to SHINES.

Project IV-E eligibility and reimbursability for the ongoing six months. Document the IVE-E eligibility and reimbursability appropriately in SHINES and notify the SSCM of findings via SHINES NOC.

An SSI eligible child will have an active case in Gateway. Medicaid eligibility comes with SSI eligibility.

The Revenue Maximization RMS is responsible for conducting a review at six-month intervals to confirm that IV-E reimbursability still exists. These reviews must be tracked manually for IV-B cases. Complete periodic reviews by using the appropriate procedures for that Medicaid COA.

A review is not required for Adoption Assistance, but an annual review is required for a related Medicaid case.

Sixty days prior to the Adoption Assistance Medicaid review month, Rev Max provides each county with a listing of Adoption Assistance cases requiring a Gateway Medicaid renewal. Medicaid renewal not completed in the month due results in the Medicaid case closing the following month.

One month prior to the review month, Form 403, Adoption Assistance memorandum, should be reviewed by Regional PAD Case Managers. If over six months old, the PAD Manager will request information from the family to complete and upload a new Form 403. Rev Max will be notified by email of the new form upload.

The renewal process in Gateway for Adoption Assistance Medicaid is a two-part process. Adoptive parent(s) are required to initiate the Gateway renewal process by verifying current address. training on this process for adoptive parents is provided by DFCS PAD Managers and SSAU staff. The RMS is responsible for completion of the process by verifying child continues to receive Adoption assistance.

Children living outside Georgia who receive Georgia who receive Adoption Assistance from Georgia will receive Medicaid from the state of residency under COBRA Reciprocity. Children placed in states that do not participate in COBRA Reciprocity will be the responsibility of the State Adoptions Unit.