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



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204.06.04 Effect of Living Arrangement


(Eff. 01/01/14)

The type of arrangement in which the individual lives determines if (i) he/she is treated as (a) an individual or (b) a member of the household in which the individual’s parents live, and if (ii) the parent’s income of the individual is counted for him/her.


A child who is included in a MAGI household at the time of entry into a facility will be looked at as an individual beginning the month their Medicaid eligibility terminates.

204.06.05 Application Procedures for DJJ Children in Out-of-Home Placement Facilities


(Eff. 01/01/14)

Children in out-of-home placement facilities that are not considered inmates may be eligible for full Medicaid benefits. When the DJJ-sponsored Medicaid worker is notified of a placement, a new Medicaid application must be completed for the child.




Procedure for Processing an Application for a Child in a DJJ Out-of-Home Placement Facility:




  • The DJJ Sponsored Medicaid Worker receives a referral from DJJ.

  • The DJJ Sponsored Medicaid Worker checks MEDS to determine if the child is currently eligible in the community.

  • If the child is eligible in the community, the DJJ Sponsored Medicaid Worker notifies the appropriate county that the child has been placed in a DJJ Out-of-Home Placement Facility and is currently in an active BG (Budget Group) in their county with other family members.

  • Upon verification of the Out-of-Home Placement, the local non-DJJ Sponsored Medicaid worker is responsible for terminating eligibility and removing the child from the BG and/or HH (Household). Eligibility for the remaining family members is determined and maintained by the local non-DJJ Sponsored Medicaid worker. The DJJ Sponsored Medicaid Worker must annotate the NOTES screen (HMS63) in MEDS with the household information for the other family members so that it is readily accessible in the future.

  • Note: The Division of Central Eligibility Processing is responsible for terminating eligibility for any TEFRA child that may be placed in an out-of-home placement.

  • Communication between the DJJ Sponsored Medicaid worker and the non-DJJ Sponsored Medicaid worker is important. Written correspondence, e-mail or telephone is a proper way for these workers to communicate.

  • The DJJ Sponsored Medicaid Worker takes a new application for the child in a new household using the DHHS Form 3400, Healthy Connections Application.

  • Any system generated notices should be directed to SCDJJ. The DJJ Sponsored Medicaid Worker will enter the following address as the mailing address of the child:




Mailing Address: South Carolina Department of Juvenile Justice

Post Office Box 21069

Columbia, South Carolina 29221-1069



MEDS Procedure:


  • The DJJ Sponsored Medicaid Worker enters the application in MEDS.

  • On HMS04 (Primary Individual Screen), the DJJ Sponsored Medicaid Worker must enter the Sponsor Code of 4013 (Richland County DJJ). The sponsor code is a designation given to each facility to capture Medicaid work.

  • On HMS04, enter “40” (Richland County Code) as the Applicant’s county, regardless of which Out of Home Placement Facility the child is in.

  • The address of the DJJ Out of Home Placement Facility should be entered in the Residence Address on HMS04 (Primary Individual Screen).

  • The mailing address should be entered on HMS04 as:

South Carolina Department of Juvenile Justice

Post Office Box 21069

Columbia, South Carolina 29221-1069




  • All correspondence must be sent to the mailing address listed on HMS04 (Primary Individual Screen).

  • The HMS05 (Authorized Representative) screen must be completed.

  • On HMS06, (Household Member Detail) screen, the Living Arrangement of GHOM (Group Home) must be entered.

  • On HMS07 (Household Members) screen, category 88 must be entered in the CAT1 field.

  • If an application is withdrawn due to worker error, the DJJ Sponsored Medicaid Worker should ALWAYS enter “W” at the WITHDRAW APPLICATION (W/C/N) prompt on HMS04. This will not generate a notice unnecessarily.

  • Once the application is locked in MEDS, the DJJ Sponsored Medicaid Worker will proceed to ELD00 to determine eligibility for the child.

  • The DJJ Sponsored Medicaid Worker will ensure that the Sponsor Code on ELD00 (Medicaid Eligibility Decision) is 4013 (Richland County DJJ).

  • Set the next review date on ELD01 for one year from the current date. The child’s case will be reviewed annually as long as the individual is in the out of home placement facility.

  • Do not set an anticipated closure date.







Procedure for the Release of a Child from a DJJ Out-of-Home Placement Facility:




  • DJJ will notify the DJJ Sponsored Medicaid Worker of the child’s release.

  • The DJJ Sponsored Medicaid Worker will check MEDS to see if there is an active BG (Budget Group) related to the child that has other family members in it. The child’s former household information should have been annotated on the NOTES screen (HMS63).

  • If there is an active BG, the DJJ Sponsored Medicaid Worker will close the DJJ related case using reason code 004 on ELD01. A closure notice will not be generated. The DJJ Sponsored Medicaid Worker will notify the appropriate county by written correspondence, e-mail or telephone call, that the child is no longer in the DJJ Out of Home Placement Facility.

  • Upon notification, the non-DJJ Sponsored Medicaid Worker will close the non-DJJ related case for the other family members using reason code 004 on ELD01. A closure notice will not be generated. The DJJ Sponsored Medicaid Worker will transfer the child released from the DJJ Out of Home Placement Facility to the HH (Household) with the other family members. The non-DJJ Sponsored Medicaid Worker will create a new BG to include the appropriate members in the budget group.

Note: If the family is ineligible and the child is in a protected period (PPED), eligibility must continue for the child through the protected period.

  • Close the DJJ-related case using reason code 004 on ELD01. A closure notice will not be generated.

  • Create a new application in MEDS for the child. Note: A paper application is not required.

  • Update the sponsor code to 4000 on HMS04 and change the living arrangement to “HOME” on HMS06.

  • Perform Make Decision from the ELD01 screen.

  • Perform Act on Decision from the ELD02 screen, making sure eligibility dates are correct.

  • Transfer the new budget group to the appropriate county.


Note: If there are other family members in the household who wish to be considered for Medicaid, then the family should be given the opportunity to apply.




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