Title 16
15000 AFDC-TANF Related Programs
Federal policy 42CFR 435.222 defines foster children as:
"Children in foster homes or private institutions for whom a public agency is assuming full or partial financial responsibility."
Foster children through age twenty are eligible for Medicaid if their income and resources are below the appropriate limit as stated in the financial section that follows. These children are placed in a child care home/facility or in a medical facility awaiting placement to a foster home.
15400.1 Application Process
The application for Medicaid must be made on the child's behalf by an employee of the Department of Services for Children, Youth and Their Families (DSCYF). All Divisions within that Department may file Medicaid applications for children in their care. The application form may be completed by the legal parent(s), but must be signed by a DSCYF worker.
15400.1.1 IV-E Children
Foster Children who are eligible for foster care maintenance payments under Title IV-E are automatically eligible for Medicaid. The IV-E determinations are made by staff at DSCYF. If there is any question about the correctness of the IV-E determination or the determination has not been received, Medicaid will assume that the child is non-IV-E until a resolution is reached.
Foster Children who are eligible for IV-E payments, are eligible for Medicaid in the state where they live. They are referred to as Interstate Compact children. Interstate Compact children coming to Delaware from another state do not require an application or income/resources verification. Redeterminations are not required. See the end of this section for procedures on authorizing coverage for Interstate Compact children.
15400.2 Technical Requirements
The following requirements are specific to eligibility under Foster Care Medicaid.
15400.2.1 Placement in a Child Care Home or Facility
Child must be placed in a foster home or private institution approved by DSCYF. DSCYF does not need custody or voluntary consent to place.
15400.2.2 Awaiting Placement
If the child is in a medical institution awaiting placement, the child must be in legal or voluntary custody of DSCYF. Legal or voluntary custody may be permanent or temporary and may or may not be court ordered. If voluntary custody is given by way of a Consent to Placement form, the consent must be signed by the parent or guardian and dated. A Consent to Placement form is valid for 90 days from the date signed. Court ordered custody must be signed by a judge. Medicaid cannot be approved prior to the date of custody or consent to place.
If child is in a medical institution awaiting placement, a written copy of the plan for placement must be provided to assure that the plan is not to return the child to his family.
15400.2.3 Age
Child must be under age 21.
15400.2.4 Payment by a Public Agency
A public agency must be making payments to the home/facility on the child's behalf. Payment is defined as any continuous payment made on behalf of a child such as board payments, subsidies or clothing and incidental payments.
15400.2.5 Child Support Referral
A referral must be made to the Division of Child Support Enforcement (DCSE) or a copy of the Termination of Parental Rights (TPR) must be provided. If it is verified the child was on TANF within the six months preceding the application, you can consider the child support criteria to be met and a referral to DCSE is not needed.
15400.2.6 Minor Parents Who Are Foster Children
If a minor parent is a foster child, is IV-E eligible and has her child living with her, DSCYF will include the child in the IV-E foster payment of the minor parent.
If the minor parent is a foster child, is not IV-E eligible and has her child living with her, the minor parent may receive public assistance for the child. The minor parent cannot be included in the TANF grant but she may be payee for her child. If the minor parent cannot care for the child or cannot handle the funds, an adult in the household may be payee for the child. The child will be covered under TANF or GA depending on the relationship of the adult to the child.
15400.3 Financial Requirements
Eligibility is based on meeting income and resource limits.
15400.3.1 Income
Follow TANF income standards and methodologies (disregards, exclusions, allocations). If two or more siblings are placed in the same foster care home, they must be budgeted together. In this case, the appropriate TANF standard for two or more individuals will apply.
15400.3.1.1 Income at Redetermination
At redetermination, financial eligibility for IV-E children can be determined by comparing the net monthly income to the appropriate board rate or the TANF standard, whichever is more beneficial to the child. The board rates are changed each year in July.
For non-IV-E children, the income at time of redetermination must be less than TANF standard of need.
See History 15400.3.1.1 Income at Redetermination - History
15400.3.2 Resources
Resources must be less than the TANF resource limit. Follow the TANF rules on resources.
15400.4 Effective Date of Coverage
The child is eligible effective the date of placement. Children who are required to enroll in managed care are not eligible for retroactive Medicaid.
15400.5 DSCYF Responsibilities
DSCYF will:
a) report to Medicaid foster child worker any changes in a child's circumstances immediately
b) return the Medicaid card of any child who leaves placement or who moves to a non-covered facility (i.e., a facility that is not approved for child care)
c) be responsible for reimbursement to DSS of any Medicaid funds expended on behalf of a foster child during a period of ineligibility if the ineligibility period was due to DSCYF's failure to report changes in circumstances immediately.
15400.6 Interstate Compact Children
The Interstate Compact is an agreement between states which facilitates the receipt of medical services to children who are IV-E eligible and receiving foster care. It came about as a result of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) and is effective 10/1/86. The Interstate Compact on the Placement of Children mandates the state of residence to provide the child with a Medicaid card from that state as long as the child remains IV-E eligible and continues to receive foster care board payments from the state of origin.
15400.6.1 Out-of-State Residence
The DSCYF worker will send all documentation to the state of residence to indicate the child is IV-E eligible, his/her vital statistics, location, and a request the child be covered under the Interstate Compact on the Placement of Children (ICPC). The worker will notify the state of residence of the date Delaware Medicaid will terminate.
15400.6.2 Delaware Residence
The DSCYF worker will send the Delaware Medicaid worker documentation that the child is IV-E eligible and that the child is in approved placement. Medicaid can be effective the date the child arrived in Delaware. If the DSCYF worker does not provide the arrival date, Medicaid will be effective the date the IV-E documentation is received.
Redeterminations are not required because the other state is responsible for the eligibility determination. If the foster family moves, the change of address can be reported on a child payment form or an Interstate Compact Report on Child's Placement Status.
There should be no need for other documentation to be provided to the Medicaid office in Delaware (the state of residence) because, under the ICPC the state of origin has responsibility to determine the child is eligible and the state of residence is mandated to provide coverage once the documentation of eligibility is provided to the Interstate Compact Office.
