South carolina department of health and human services medicaid policy and procedures manual



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204.06.11 Reporting Changes


(Eff. 01/01/14)

The DSS human services worker is responsible for reporting changes in the child’s status to the DHHS Medicaid Eligibility Worker. For example, a worker should report a change if:






204.07 Former Foster Care


(Eff. 11/01/14)

Former Foster Care (FFC) is a MAGI group that offers Medicaid coverage to individuals who were previously in foster care. FFC is designated as Payment Category 61.


An individual is eligible for this group if he/she:

  1. is under the age of 26,

  2. was in foster care in South Carolina,

  3. was enrolled in Medicaid on his/her 18th birthday, or at the time he/she aged out of foster care, and

  4. is ineligible for any other Medicaid group.

Once eligible, the FFC beneficiary will receive Medicaid coverage until the individual turns 26 years old. Therefore, no review is required for the FFC eligibility category. If a blended household includes a FFC beneficiary at review, the FFC beneficiary will not receive a review. The other beneficiaries within the household will receive a review. If a review form is required from another beneficiary within the household and not returned, the beneficiary’s case must be closed; however, the FFC beneficiary will remain eligible.


Procedure for Assessing for Former Foster Care Coverage


MEDS Procedure:
Eligibility Workers will process Former Foster Care applications in MEDS until instructions are issued to begin processing them in the Healthy Connections ACCESS (ACCESS) system. In MMIS the payment category will show as PCAT 61.
Note:

  • MEDS was updated to allow coverage for those individuals under the Former Foster Care (FFC) Coverage group through the month that they turn age 26.

  • A new closure code reason – “026 - You have reached age 26 and are over the age limit for this program” was added.

  • You cannot approve someone with an application date entered in the same month they turn age 26. Eligibility for that month must be added with the correction process.

1. If the applicant is not eligible for full Medicaid benefits effective January 1, 2014 under another MAGI Category determine their eligibility under FFC Coverage. Do not use the MAGI workbook, because their determination is not based on the workbook since there is no income test. Use MEDS Screen HMS54.

Note: FFC is a coverage category for individuals who are not eligible for any other coverage category.
2. From OnBase retrieve the application for processing. Review the application to determine if the applicant is eligible for coverage based on the FFC category if the applicant reports they were enrolled in SC Medicaid in a Foster Care Coverage group on their 18th birthday.

3. Check MEDS for the following information. This information indicates eligibility for FFC Coverage.

a. Review the HMS54 screen to verify their Foster Care Status. The Foster Care PCAT would be 31 or 60;

b. Review the HMS06 Household Member Detail for Living Arrangement, which should reflect Foster Care if the information was updated to Living Arrangement to Foster Care. Remember, the individual could have been eligible in another PCAT, but had a foster care living arrangement.

c. Check the case notes in MEDS Notes or OnBase;
4. If verified, applicant will be eligible for Medicaid up to age 26. There is no income test, but the applicant must attest that they are currently a SC resident.

5. Is the applicant eligible for Medicaid under the 2014 MAGI rules for the FFC category?

If yes, then:

a. In MEDS, pend the individual in a household of one and a PCAT of 60.

b. Approve the case in MEDS. Set the next review date to one year from the act on decision date. Enter “Home” as the living arrangement. Enter “$9.99” on the Countable Income field on the ELD01 screen.
Note: MEDS still requires entry of a review date even though persons age 22-26 in the FFC coverage group do not have to be reviewed.
c. Send an approval notice

d. Virtually print the approval notice into OnBase

e. Annotate on the MEDS and OnBase notes screen, that the “Applicant (First and Last Name) is eligible for FFC.” Include the application effective date.
If no, then proceed to Step 6.
6. Applications processed in MEDS for individuals who do not have Medicare and who are either denied for full benefits or approved for Family Planning (PCAT 55) must be referred to the FFM. An email must be sent to FFMTransfer@spmail.scdhhs.gov.


  1. Subject Line of the email: Household Number

  2. Body of the email: First and Last Name

7. Determine if the applicant is eligible for Family Planning, see the Eligible Family Planning Only under 2014 MAGI Rules section.
ACCESS Procedure:


  1. Assess for eligibility under Former Foster Care Coverage.

            1. To qualify for Former Foster Care Coverage, the Applicant must have been a Medicaid recipient in the State of South Carolina at the time they aged out of the Foster Care System. Do not use the MAGI workbook because there is no income test for eligibility.

            2. Applicants who report that they were eligible for Medicaid as a Foster Care Recipient in South Carolina at the time they aged out of Foster Care are to be verified by a MEDS search for prior eligibility under any PCAT with a living arrangement of Foster Home.

            3. The individual is eligible through the end of the month of their 26th birthday as long as they are a resident of South Carolina.

  2. If the Applicant is eligible for Former Foster Care coverage, the worker is to print and send a notice and annotate the MEDS NOTES screen. The manual notice should be virtually printed into OnBase.



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