Categorically Needy Foster Care/ Adoption Support/Juvenile Rehabilitation Medical (D01/D02/D26)
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Categorically Needy Foster Care/ Adoption Support/Juvenile Rehabilitation Medical (D01/D02/D26)


Revised November 27, 2013



Who is eligible to receive D01 medical?

Who is eligible to receive D02 medical?

Who is eligible to receive D26 medical?

Who can open and close a D01/D02/D26 AU? 

What happens before opening a D01 or D02 AU?

When will D02 medical trickle to D26?

How do I screen D01/D02/D26 medical?

How do I process a pending D01/D02/D26 AU?

What do I do when a child leaves foster care, adoption support, or juvenile rehabilitation?


Who is eligible to receive D01 medical?

·         A child in foster care, foster care relative placement, adoption support, or juvenile rehabilitation, who:

o    Receives SSI and

o     Are age 0 to 21.

·         See EAZ Manual - WAC 182-505-0211 Washington Apple Health - Foster Care and EAZ Manual Foster Care/Relative Placement/Adoption Support/Juvenile Rehabilitation/Unaccompanied Minor Program.

Who is eligible to receive D02 medical?

·         A child in foster care, foster care relative placement, adoption support, or juvenile rehabilitation, who:

o    Do not receive SSI; and

o     Are age 0 to 18.

·         See EAZ Manual - WAC 182-505-0211 Washington Apple Health - Foster Care  and EAZ Manual Foster Care/Relative Placement/Adoption Support/Juvenile Rehabilitation/Unaccompanied Minor Program.

Who is eligible to receive D26 medical?

·         Adults who were in foster care on their 18th birthday (on or after July 22, 2007) who:

o    Do not receive SSI; and

o     Are age 18 to 26.

·         See EAZ Manual - WAC 182-505-0211 Washington Apple Health - Foster Care  and EAZ Manual Foster Care/Relative Placement/Adoption Support/Juvenile Rehabilitation/Unaccompanied Minor Program.

Who can open and close a D01/D02/D26 AU?

·         Only users on the Health Care Authority (HCA) Foster Care Medical Team (FCMT) and the Juvenile Rehabilitation Administration (JRA) Case manager who belong to the Office of Medicare, Medicaid, Eligibility and Policy (OMMEP) section can open or close D01, D02 and D26 AUs. Workers assigned to this unit are designated as unit type 17 in CSO 076.

·         Other users have read-only access to D01, D02 and D26 AUs. For read-only users, the address for children active on D01 and D02 appears as asterisks.

·         Only the FCMT can finalize or update D01, D02 or D26 AUs when a case is shared between the FCMT and a CSO.

What happens before opening a D01 or D02 AU?

·         The Children’s Administration Case Management System (FAMLINK) sends notifications to the FCMT for every child placed in foster care or adoption support.

·         JRA Group Homes notify the JRA case manager when a child is placed in a juvenile rehabilitation group home.

·         If a child who is placed in foster care is active on an ACES AU, an interface between ACES and FAMLINK generates Alert 190 - ACES CHILD IN FOSTER CARE - CONTACT FOSTER CARE UNIT to the CSO user of record for the active AU.

·         As soon as possible, before month end, the CSO user contacts the FCMT to determine the child’s status. If appropriate, the child is closed off all other active AUs so the FCMT can open the child on D01 or D02 medical.

·         The CSO user also processes all benefit changes for the active ACES AUs from which the child was removed. See Change of Circumstances and EAZ Manual Change of Circumstances.

·         For instructions about removing a child from an active ACES AUs, See Close an Assistance Unit/Client.

When will D02 medical trickle to D26?

·         D02 medical trickles to D26 the month following the child’s 18th birthday when the placement code entered on the DEM1 screen is one of the following:

o    F – Foster Care Placement

o    R – Relative Placement

o    T – Tribal Foster Care Placement

o    P – Interstate Compact on Placement of Children (ICPC)

·         When D02 trickles to D26:

o    Any Authorized Representatives (AREP) associated to the D02 AU remains on the D26 AU.

o    The Address Confidentiality security function is removed making the client address viewable for users with read-only access.

·         ACES AUTO terminates D26 AUs at the end of the month the child turns age 26 with Reason Code 220 – Failed Age Requirement.


NOTE:

Only FCMT staff can screen D01, D02 and D26 cases.


How do I screen D01/D02/D26 medical?

To screen a D01, D02 or D26 AU, take the following steps:

1.    From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.

2.    On the Applicant page, enter the head of household’s Name, Residential, and Mailing Addresses.

o    Enter the child as the head of household.

3.    If the child is in a Child Placing Agency foster or adoptive home, click the checkbox next to AREP/Payee so the Child Placing Agency and the foster parent(s) can both be entered as authorized representatives.

o    Child Placing Agencies are licensed organizations allowed to recruit, train, and license foster homes; recruit and train adoptive parents; place children, including children referred by the department, for foster care or adoption. Both the Agency and the foster parents may need to obtain medical services for the same child during the same month.

4.    To add the authorized representatives, see Screening – aces.online - Authorized Representatives.

o    Use AREP type FC (Foster Care Agency) for the Child Placing Agency and type NA for the foster parents.

5.    Continue with the screening process until you reach the Programs page.

6.    On the Programs page, click the checkbox next to Foster Care/Adoption Support.

o    If you are not in the FCMT, this option will be grayed-out so that it cannot be checked.

7.    Complete the screening process. See Screening an Application.

8.    On the Finalize page, aces.online defaults to the D01 coverage group. If the child does not receive SSI benefits, the program trickles to D02 when the AU is processed and finalized.

o    For D26 coverage, click the Specify Program button.

o    The Medical Coverage Group: field defaults to Washington Apple Health Post-FosterCare Coverage (D26).

o    Click Next to select this program and return to the Finalize page.

How do I process a pending D01/D02/D26 AU?

To process a D01, D02 or D26 AU, take the following steps:

1.    From AMEN, access the pending AU via Option O – Interview.

2.    On the STAT screen, enter [PN] - Applicant in the Finl Resp field for the applicant.

3.    On the DEM1 screen:

·         In the Living Arrangement field, enter the appropriate code.

o    [FC] - Foster Care Non-Title IV-E

o    [FE] - Foster Care Title IV-E

o    [AD] - Adoption Support Non IV-E

o    [AE] - Adoption Support IV-E

o    [JR] - Juvenile Rehabilitation

·         In the Placement CD and Date fields, enter the [appropriate placement code and placement date]. See <F1> Help.

o   Only placement code E - Foster Care Expansion is valid for D26 medical.


NOTE:

Only FCMT staff and JRA case managers should use Foster Care related living arrangement codes.


4.    If the child receives SSI benefits, code income type [SI] – SSI Payment, the claim number, and the monthly income amount on the UNER screen.

5.    Complete the interview following the instructions in the Interview chapter.

6.    After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.

7.    Finalize the pending AU following the instructions in the Finalize Application chapter.

What do I do when a child leaves foster care, adoption support, or juvenile rehabilitation?

·         FCMT receives a tickle from FAMLINK that the child has left the placement.

·         FCMT users redetermine the child’s medical eligibility for any medical program and closes D01 or D02 AU.

·         If the child returns to a household that has an active ACES AU, the head of household reports this change. See EAZ Manual – Change of Circumstance – Reporting Requirements.

·         When notified that the child has returned to the household, the CSO user adds the child back to the active AU(s) according to the eligibility requirements for the program(s). See EAZ Manual - WAC 388-418-0020 How does the department determine the date a change affects my benefits?

·         For instructions on adding a child to an active AU, see Add a Person.

Modification Date: November 27, 2013