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



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204.06.06 Regular Foster Care Procedure


(Eff. 01/01/14)

Procedure for When a Child is Taken Out of the Home and Placed in Foster Care

When a child is taken out of a home situation and placed in Foster Care, the case must be reviewed to see if the family remains eligible in that current category or qualifies under any other Medicaid coverage group. The Eligibility Worker must re-budget the case using information that is readily available (including case record documentation and system interfaces information) with minimal contact with the Applicant/beneficiary.






204.06.07 Eligibility of Foster Care Children


(Eff. 01/01/14)

Effective February 1, 2013, SC DHHS began a streamlined eligibility process for Foster Care children. The Foster Care Health Initiative is a collaborative effort between SC DSS and SC DHHS to expedite Medicaid enrollment and to provide the best care possible for foster children. SC DSS will provide a daily file of children currently enrolled in SC DSS’ Foster Care Program, who are assigned to a licensed Foster Care home. The file is retrieved electronically and placed into the Foster Care Database at SC DHHS. These children will either be in Payment Category 31, 60, or 80. A specialized unit and SC DSS-sponsored workers will be responsible for enrolling these children in Medicaid.


The file sent by SC DSS must include the following for all Foster Care Children:

  • A SC DSS unique ID # for the Foster Child,

  • SSN,

  • First name,

  • Last name,

  • Date of birth,

  • A valid mailing address (including city, state, and zip) to reflect the foster home address and foster parent name,

  • A valid residence address (including city, state, and zip),

  • Foster Care Effective Date,

  • County of residence,

  • License number/type of facility and address, and

  • Change Indicator to reflect any changes made on the foster care case record.

Other information:



  • The Eligibility Worker must also update changes in address, living arrangements, etc. for children already eligible for Medicaid.

  • The Eligibility Worker must make and act on decision for all of the new members loaded into the system.




Procedure for Determining Eligibility of Foster Children


MEDS Procedure:


  • The eligibility start date for MEDS will be provided in the file from DSS. The Eligibility Worker will make the child eligible as of the first day of the month indicated by the start date field (i.e. 08/16/2012 Start Date would equal to an eligibility start date in MEDS of 08/01/2012). The payment category for the child will not be limited to a foster care Payment Category, and may include Payment Category 80.

  • The child will be enrolled into a health plan with an enrollment start date the same as the eligibility start date for Medicaid coverage.

  • DSS must report in a timely manner any changes necessary to establish or terminate eligibility for those children approved for Foster Care.






204.06.08 Foster Care Children, Ages 18-21


(Eff. 01/01/14)

Children between the age of 18 and 21 may be eligible in the Foster Care category if they meet certain requirements. Should eligibility be determined in the Foster Care category, the individual must reside in a licensed foster home or other approved facility, and the income must be below 62% of the FPL. The determination to allow a child to continue in foster care after he/she reaches the age of 18 is made by the DSS human services worker.
For a child who remains in foster care after age 18, Medicaid may continue in Payment Category 60 only if the following conditions are met:


  • The child is totally dependent on DSS for care, and meets one of the following:


Annual reviews are not required between the ages of 18 and 21.

204.06.09 Foster Care Children, Ages 18-21, Who Leave Foster Care


(Eff. 01/01/14)

Children who (i) were in foster care, (ii) Medicaid-eligible on their 18th birthdays, and (iii) have not yet reached age 21 may continue to be eligible for Medicaid benefits in Payment Category 60 until their 21st birthdays if they are not eligible under any other Medicaid coverage group. Eligibility may continue until age 21 without regard to the individual’s living arrangement, income, and/or resources.
Eligibility should be terminated if the individual moves out of South Carolina or dies. Eligibility should be re-instated if the individual returns to the state before his 21st birthday. These cases are not subject to annual reviews; however, when the individual reaches age 21, an ex parte determination must be completed to determine if the individual may continue to receive Medicaid under another payment category.

204.06.10 Coordination between DSS and DHHS Workers


(Eff. 01/01/14)

Procedure of DSS and DHHS Workers’ Process

The following is a description of the process that must be followed when a child in Foster Care is referred to the SC DHHS Medicaid Eligibility Worker for an eligibility determination:




  • If a child remains in the care of DSS, or DSS retains custody after the 72-hour Probable Cause hearing, the DSS human services worker completes the DHHS Form 3400, Healthy Connections Application, or the DSS Form 3068, Foster Care Medicaid Application (even if the child is already a Medicaid beneficiary). The worker attaches a copy of the DSS Form 2738, Foster Care-Child Support Referral Form, and forwards to the Medicaid Eligibility Worker.

  • Within 45 days of the receipt of the application, the DHHS Medicaid Eligibility Worker will obtain the required verification and approve or deny the application. Notification of the case decision must be sent to the DSS human services worker.



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