AZ
| CT | DC | FL |
HI | HIBH | IL
| IN | IA | KY |
ME | MD | MI | MN
| MO | MT | NE |
NEBH | NH
NJ
| NM | NY | NC |
OH | OK | PA | PABH
| TN | UTMH | VA
| WV
AZ
"6. ENROLLMENT AND
DISENROLLMENT...
Eligibility for the various
AHCCCS coverage groups is determined by one of the following agencies:
…
Department of Economic Security
(DES)
DES determines eligibility
for…the Adoption Subsidy Program, Title IV-E foster care children…"
Arizona Contract, page 18.
CT
"Appendix K...
HUSKY A Medicaid Coverage
Groups...
DCF Children…" Connecticut
Contract, Appendix K, page 1.
DC
"G. ENROLLMENT, EDUCATION,
AND OUTREACH
1. Classes
of person eligible for enrollment
a. Except as
provided in paragraph 'b' of this section, the following persons are eligible
for enrollment under this contract:...
b. Individuals
who meet the requirements of paragraph 'a' of this section and are included
in one or more of the following categories, are excluded from enrollment
under this contract: ...
(2) foster
children, except those who reside in the District and whose care giver
elects to enroll the child with Provider..." District of Columbia
Contract, page 15.
FL
"7. Eligible Recipients. The categories of eligible recipients authorized to enrolled in the plan are… Foster Care…" Florida Contract, page 9.
HI
“All ABD recipients, with
the exception of the following: ...
6) children in foster care
in out-of-state placement ...will be enrolled into a QUEST plan...” Hawaii
RFP, unnumbered page.
“20.120 Hawaii QUEST (QUEST)...
QUEST includes the individuals
in the: ...
* Foster Care...” Hawaii
RFP, page 4.
“20.120 Hawaii QUEST (QUEST)...
ABD recipients who will
remain in Medicaid’s fee-for-service program and will NOT be enrolled into
QUEST include persons who: ...
6) are children in foster
care or subsidized adoptions placed out-of-state...” Hawaii RFP, page 5.
“40.230 Categorical
Requirements...
Children in out-of-state
foster care placement will also be excluded from the QUEST program and
remain in fee-for-service...” Hawaii RFP, page 43.
HIBH
"20.300 Hawaii QUEST
(QUEST)...
• Foster Care..."
Hawaii Mental Health Contract, page 4.
"20.500 HCFA Contingency...
ABD members who will remain
in Medicaid's fee-for-service program and will NOT be enrolled into QUEST
include persons who…
6) are children
in foster care or subsidized adoptions placed out-of-state; and
7) are disabled children/youth
below the age of 19 and disabled children/youth below the age of 21 in
foster care/subsidized adoption…" Hawaii Behavioral Health RFP, page
7.
"20.740 Disabled Children
and Youth Managed Care Plan Carve Out (DCYMC)
Disabled children…foster
children and children under subsidized adoption below the age of 21 shall
not be enrolled in the QUEST BHMC plan. This population will be enrolled
in a separate managed care plan carve out for disabled children and youth
to be implemented at a later date" Hawaii Behavioral Health RFP,
page 10.
"40.110 Basic Criteria
All members must meet the
following basic eligibility criteria:
• Be a U.S. citizen
or legal resident alien
• Intend to reside
in the State of Hawaii
• Provide a verified
Social Security Number (SSN)
• Not reside in a
public institution, including correctional facilities and the Hawaii State
Hospital
40.200 QUEST Eligibility...
40.230 Categorical
Requirements...
Children in out-of-state
foster care placement will also be excluded from the QUEST program and
remain in fee-for-service. Disabled children/youths below the age
of
19 and in foster care or subsidized adoptions below the age of 21 will
be excluded from this contract and will remain in fee-for-service until
the separate 'carve-out' plan is implemented in 1998…" Hawaii Behavioral
Health RFP, pages 36-37.
IL
"Eligible Enrollee means
a Client or KidCare Participant except one who: ...
• is a ward of the
Department of Children and Family Services..." Illinois HMO Contract,
pages 2-3.
IN
"4.5.1 Determination
of Recipient Eligibility
The OMPP is responsible
for the identification of recipients eligible for enrollment in Hoosier
Healthwise RBMC. The following Medicaid eligibility categories are eligible
for enrollment in Hoosier Healthwise RBMC: ...
* Wards of
the state and foster children may enroll on a voluntary basis." Indiana
RFP, page 4-11.
IA
"Medicaid eligible recipients
will be excluded from enrollment with a HMO if they: ...
7. are eligible as
foster care children." Iowa Contract, page 140.
KY
"VI. ENROLLMENT AND
DISENROLLMENT
A. Eligibility
The Contractor shall
follow eligibility procedures and requirements in accordance with Sections
7.10.1 through 7.10.6 and Attachment X of the RFA…" Kentucky Contract,
page 25.
"Several categories of Department for Community Based Services (DCBS) clients, including children in foster care, children receiving adoption assistance, and adult wards for whom DCBS has been appointed the legal guardian are included within The Partnership's Member population." Kentucky RFA, page 93.
"Eligibility For Enrollment
Listed below are categories
of Medicaid recipients who are eligible to enroll in the Partnership's
Network: ...
Under the age of
eighteen (18) years, placed in foster care and under supervision of a Kentucky
public or private child welfare agency* [* The Partnership shall phase-in
the enrollment of these members as an individual plan of care for each
child is developed and implemented by the Partnership. See Attachment
XVI.]." Kentucky RFA, Attachment X, pages 94-95.
ME
"II. DEFINITIONS.
A. The following terms
used in this Contract shall be interpreted as defined herein, except to
the extent that the context may clearly require otherwise: …
12. Covered Population, Target Population, or Eligible Persons consists of...Foster Care Children within Regions I and II who are not considered excluded or exempt recipients...
30. Foster Care Children are children in the care or custody of the Department of Human Services living in Phases I and II and for whom the Department is responsible for custodial and parental decisions." Maine Contract, pages 2-3, 6.
MD
"Chapter 63 Maryland
Medicaid Managed Care Program: Eligibility and Enrollment
.01 Eligibility.
B. A recipient is
not eligible for the Maryland Medicaid Managed Care Program if the recipient:
...
(4) Is a child
receiving adoption subsidy who is covered under the parent's private insurance;
(5) Is a child
under State supervision receiving adoption subsidy who lives outside of
the State; or
(6) Is a child
in an out-of-state placement." Maryland COMAR 10.09.63.01.
MI
"II-E MEDICAID ELIGIBILITY
AND CHCP ENROLLMENT...
3. Medicaid Eligible Groups
Excluded From Enrollment in the CHCP: ...
*Children in Foster Care
or Child Care Institutions…" Michigan Contract, pages 16-17.
MN
"Section 3.1.1. Eligibility…
C. Eligibility Determinations
for MA and GAMC. Eligibility for MA and GAMC and eligibility for participation
in PMAP and PGAMC will be determined by the Local Agency. All persons who
receive MA or GAMC and reside in the Service Area will participate in PMAP
or PGAMC, except for Recipients who are members of the following MA and
GAMC populations...
2)
Children under the age of 21 years receiving MA who are in foster care
placement, unless they enroll in PMAP on a voluntary basis.
3)
MA Recipients receiving MA through an adoption subsidy…
13) Children
who prior to enrollment in PMAP are determined to be in need of protection
and are receiving MA services through a provider who is not a Participating
Provider in PMAP. These children are eligible to enroll in PMAP on a voluntary
basis." Minnesota Contract, page 17.
"D. The following MA
and/or GAMC populations are excluded on the effective date of this Contract,
but may become eligible for mandatory enrollment (or voluntary enrollment
for the population described in paragraph 5) during the term of this Contract...
1) Children
receiving MA who are in foster care placement.
2) Children
receiving MA through an adoption subsidy…" Minnesota Contract, page
19.
MO
"b. Eligibility of
Other Medicaid Children: All children in the legal custody of the
group Department of Social Services; all children placed in not-for-profit
residential group home by a juvenile court…
c. Medicaid
eligibles in the above specified eligibility groups who are: ...
4) receiving
foster care or adoption assistance under part E of the Title IV of the
Social Security Act;
5) in foster
care or otherwise in out-of-home placement…" Missouri RFP, page 15.
"Group Eligibility Criteria...
AFDC-Foster Care…"
Missouri RFP, Attachment One.
MT
"ELIGIBLE GROUPS
The eligibility subtypes
targeted for the HMO program are: ...
foster care - IV-E
foster care-CWS...
People in these subtypes are not eligible to enroll in HMOs if they…or are children under court ordered absent parent child support…" Montana Contract, Attachment 4, page 63.
NE
"9.2.1 Mandatory for the
NHC Basic Benefits Package: The following Medicaid-eligible clients are
required to participate in the NHC, if the client’s eligibility assistance
case is managed by the Health and Human Services (HHS) District Office
in the designated coverage areas, unless excluded pursuant to Section 9.2.5
of this contract: ...
(c) Clients participating
in the Child Welfare Payments and Medical Services Program, i.e., IV-E,
Non-IV-E, Former Wards, Subsidized Guardianship cases pursuant to 479 NAC..."
Nebraska Contract, page 31.
NEBH
"9.2 Mandatory and
Excluded Clients
9.2.1 Mandatory for the
Nebraska Health Connection (NHC) Mental Health/ Substance Abuse Package:
The following Medicaid - eligible clients are required to participate in
the NHC, unless excluded pursuant to Section 9.2.5 of this contract: ...
(c) Clients
participating in the Child Welfare Payments and Medical Services Program
i.e., IV-E, Non-IV-E, Former Wards, Subsidized Guardianship cases pursuant
to Title 479 NAC." Nebraska Behavioral Health Contract, page 32.
"9.2.5 Excluded Clients:
The following clients are excluded from the NHC (based on the information
known to the HHS eligibility system): ...
(j) Clients participating
in the Subsidized Adoption Program, including those who receive a maintenance
subsidy from another state pursuant to 469 NAC)…" Nebraska Behavioral
Health Contract, pages 33-34.
NH
"Eligibility
Those individuals eligible
to be enrolled in Contractor under this Agreement are those who are eligible
for, and recipients of:
A. The Medical Assistance
Program, Categorically Needy only, and...
(2) Foster Care (IV-E)
Program, or
(3) C W S Medicaid
Program: Covering any child under age eighteen (18) or age eighteen (18)
and a full time student, but who will complete (graduate) their secondary
education
or an equivalent before turning nineteen (19), for whom public agencies
are assuming full or partial financial responsibility; and who are in foster
homes or private child caring institutions" New Hampshire General Agreement,
Exhibit A.5., page 10.
NJ
"ARTICLE 5
PERSONS ELIGIBLE FOR ENROLLMENT
5.1 Except as specified
in Section 6.1, all persons, who are not institutionalized, that are eligible
for the following eligibility categories and who reside in any of the enrollment
areas... shall be eligible for enrollment in the contractor's plan…
E. Individuals
who are eligible through the Division of Youth and Family Services…" New
Jersey Contract, page 36.
NM
"All Medicaid eligible clients
are required to participate in the Medicaid managed care program except
for the following: ...
2.B.1.e Children and
adolescents in out-of-state foster care or adoption placement..."
New Mexico Contract, page 22.
NY
"5. ELIGIBLE, EXEMPT
AND EXCLUDED POPULATIONS
5.1 Eligible Populations
b) All Medicaid eligible
individuals in the following categories may be eligible for enrollment
in the Contractor's plan at the LDSS' option, as indicated by an X below...
i) Foster care children
in the direct care of LDSS...
5.3 Excluded Populations...
i) Foster children in the
placement of a voluntary agency...
l) Foster children in direct
care (unless LDSS opts to enroll them see Section 5.1(b))…" New York
Contract, pages 5-1-5-5.
NC
"3.1 Persons Eligible
for Enrollment
To be eligible to enroll
in the Plan established pursuant to this Contract, a person must be a Recipient
in the North Carolina Medical Assistance (Medicaid) Program in one of the
aid categories listed below; and residing in Mecklenburg County; and not
eligible for Medicare…
h. Foster Care Children
(HSF, IAS - Eligible at discretion of DSS and guardian.)." North
Carolina Contract, page 5.
OH
"B. Background
Program History and Status...
Currently, MCP-enrolled
children whose custody has been legally transferred from legal parent or
guardian to another entity, such as a public children service agency (PCSA)
are automatically disenrolled form the plan following notification to ODHS.
PCSAs have the option to enroll children in their custody in an MCP…"
Ohio RFP, page 3.
OK
"1.2 General Information
for Applicants...
1.2.2 Covered Populations
The following categories
of Medicaid and Title XXI beneficiaries in the three urban areas will be
mandatorily enrolled into Health Plans awarded contracts through this procurement:
...
• The populations…excluding
those persons…in state custody…" Oklahoma RFP, page 2.
"2.4.6 Exceptions to
Health Plan Enrollment
The following categories
of members who otherwise qualify will be excluded from participation in
the managed care program: ...
• Children who are in subsidized
adoptions and
• Children who are known
to the Authority to be in custody as reported by the Department of Human
Services. If such children are already enrolled in a Health Plan when they
are taken into or found to be in custody, as reported by DHS, they will
be disenrolled by the Authority effective on the day in which the action
by the Authority is taken..." Oklahoma RFP, page 18.
PA
"C. HealthChoices Program...
3. Phase-IN...
Foster children categorized
as AFDC-FC are not mandated for inclusion until July 1, 1997...
Mandatory recipient inclusion
for the Second Phase of program eligible groups:
July 1, 1997: …Children
in Substitute Care…" Pennsylvania RFP, pages 6-7.
"H. Coordination with
Out-of-Plan Services...
3. Members Admitted
to Juvenile Detention Centers (JDCs)
Any child receiving MA benefits will continue to receive those benefits during placement in a JDC. Children enrolled in an HMO and placed in JDCs both in and outside the HealthChoices project area will continue to be covered by the HMO in effect on the date of placement for a maximum of thirty-five (35) consecutive days.
A child already residing in a JDC will not be permitted to newly enroll in an HMO until after release from the JDC...
EPSDT screening results or other health care needs detected during the period of the JDC placement should be provided to the covering HMO. Should a covered Service be identified that cannot be provided at the JDC, the JDC must contact the HMO in order to arrange for the covered service to be provided…
10. Medical Foster
Care Services
Medical foster care services
provided to children with special or chronic medical conditions or physical
disabilities who are in the custody of the county children and youth agency
and placed in foster family care...
Medical foster care services are provided by both county and private children and youth social service agencies. Although direct care is provided by the foster parents who are under contract with the agency, the licensed foster care agency is enrolled as a Provider Type 50 with MA and claims reimbursement is through the FFS Program…Therefore, even though the HMO is responsible to provide medically necessary services to children residing in medical foster care homes, the HMO is not responsible for the medical foster care services identified in four (4) levels of care. These four (4) levels of medical foster care are described in detail in the HealthChoices Bidders' Library…" Pennsylvania RFP, pages 51-62.
PABH
"Request for Proposals (RFP)
Definitions
For the purpose of this
HealthChoices behavioral health services RFP, the definitions set forth
shall apply...
Children and adolescents in Substitute Care - Children and adolescents living outside their homes in the legal custody of a public agency, in any of the following settings: shelter homes, foster homes, group homes, supervised independent living, residential treatment facilities, residential placement (other than youth development centers) for children and adolescents who have been adjudicated dependent or delinquent; see Part IV, C.4.d." Pennsylvania Behavioral Health RFP, pages 3-4.
"HealthChoices Program Eligible
Groups...
d. Children
and Adolescents in Substitute Care Issues
The following provisions
apply only to children and adolescents in substitute care as defined in
the definitions.
If a child
in substitute care is determined eligible for MA outside the five county
HealthChoices project area and is placed in Foster care inside the five
county HealthChoices project area, s/he will be covered under the fee-for-services
(FFS) program.
If a child in substitute care is determined eligible inside the five county HealthChoices project area and is placed outside of the five county HealthChoices project area s/he will be covered under the FFS program (except for the provision of juvenile detention centers). For children and adolescents who are not in substitute care, the MCO is responsible for payment of all medically necessary behavioral health services (including Residential Treatment Facilities (RTF), regardless of where they are placed…" Pennsylvania Behavioral Health RFP page 45.
TN
"2-3 Benefit/Service Requirements
Limitations…
c. Specialized Services...
2. CHILDREN'S
PLAN SERVICES
Children who are
in state custody or who are at risk of entering state custody are eligible
for participation in the Children's Plan…" Tennessee Contract, pages
7-15.
UTMH
"Article II
ENROLLMENT
B. Enrollment Exclusions...
2. Foster care
children are enrolled under this Contract only for inpatient services;
they are not enrolled for outpatient mental health services. The
CONTRACTOR who is indicated on the child's Medicaid card will receive the
monthly inpatient premium and be responsible for all inpatient mental health
services for that child." Utah Mental Health Contract, pages 2-3.
"Rate Cells..
Separate rates will be established
for each eligible group as follows: ...
10. Foster Children
(rates are for inpatient premiums only)…" Utah Mental Health Contract,
page 23.
VA
"D. ELIGIBILITY AND
ENROLLMENT...
1. Medicaid and CMSIP
Eligible Individuals Excluded from Medallion II
The Contractor shall cover
all Medicaid and CMSIP eligible individuals, with the exception of individuals
excluded from Medallion II, as defined in 12 VAC 30-120-370. The
Department shall exclude individuals meeting the exclusion criteria listed
below: ...
e. Individuals who
are participating in foster care or subsidized adoption programs…"
Virginia Contract, pages 21-22.
WV
"1.1 BACKGROUND
The program will enroll…
SSI populations. In addition, foster children will be enrolled under
the initiative…" West Virginia RFA, page 1.