The Department of Social Services is only one agency from which the DHHS Medicaid Eligibility Worker will receive applications for children in special living arrangements. Children’s placements may be facilitated by other agencies. The type of placement, rather than the placing agency, determines how a child is treated in the eligibility determination process. An exception to this rule is children placed by the Department of Juvenile Justice (DJJ). These children are treated as individuals although legal custody resides with their parent(s) because DJJ exercises control. Listed below are some of the agencies that place or sponsor children in special living arrangements.
Continuum of Care for Emotionally Disturbed Children (CCEDC)
Department of Disabilities and Special Needs (DDSN)
Department of Education (DOE)
Department of Juvenile Justice (DJJ)
Department of Mental Health (DMH)
Department of Social Services (DSS)
The two major agencies that place or sponsor children are the Continuum of Care for Emotionally Disturbed Children and the Department of Juvenile Justice. Listed below is a brief explanation of these agencies roles in placing or sponsoring children. Continuum of Care for Emotionally Disturbed Children (CCEDC) The Continuum of Care for Emotionally Disturbed Children is a division of the Governor’s Office that works with severely emotionally disturbed children throughout the state. The agency works to coordinate services among all agencies to secure the best and most appropriate services for the child. Efforts are made to keep children in their home environment. CCEDC is a direct provider of Medicaid case management services. More than one third of the children served by CCEDC are in the custody of DSS. CCEDC may place children in residential treatment facilities, inpatient psychiatric facilities, or high or moderate management group homes. The children may be placed by DSS or by the parents through CCEDC. Department of Juvenile Justice (DJJ) The Department of Juvenile Justice has a mission to protect the public from juvenile crime and provide troubled children with opportunities to obtain the skills necessary to become productive members of society. To accomplish this mission, DJJ is authorized to provide both community-based and institutional services. Community services range from prevention to parole, and focus on meeting the needs of children and their families within their homes, schools, and community neighborhoods. DJJ may also place children in group homes, residential treatment facilities, inpatient psychiatric facilities, or high or moderate management group homes. The Marine Institutes are used almost exclusively by DJJ for placement as an alternative to incarceration. Children who are remanded to the Willow Lane facility for girls or the John G. Richards facility for boys are considered inmates and are not eligible for Medicaid. (Refer to MPPM 102.09.01 for exceptions.)
Only those children whose custody is held by DSS are considered Foster Care children. Eligibility is determined without consideration of the parent’s income.
Children living in the Department of Mental Health (DMH) facilities, including those group homes licensed by DSS, who are not in foster care (see #1) and who are not Medicaid-eligible at the time of entry, should have their eligibility determined as an individual in other applicable categories such as Partners for Healthy Children (PHC). This would include children in facilities licensed primarily for the care of the mentally ill.
Children who are included in a Parent/Caretaker Relative (PCR) or Foster Care MAGI household at the time of entry into a DMH facility, are considered as individuals beginning the month their PCR or Foster Care eligibility terminates.
Children in residential treatment facilities who are not in foster care are treated as a member of their family, if the stay in the facility is 30 days or less. If the stay is longer than 30 days, these children are considered as individuals effective with the beginning of the month in which the 31st day falls.
Children who are in individual or group homes sponsored by the DJJ are treated as individuals. These children are not considered under the custody or control of their parents, even though custody has not been taken away from the parents by the court. Each placement must be evaluated on its own merits to determine if the child meets the definition of an inmate.
To determine the status of children placed in wilderness camps under the auspices of DJJ. (See # 4.)
A child in a public or private hospital or ward/section thereof, is to be treated as if he/she were still part of his/her living arrangement before hospitalization. This absence is considered temporary. If the child meets Social Security disability criteria, after 30 days in a general hospital, he/she is considered an individual.
Children in Intellectual Disabilities and Related Disabilities (ID/RD) facilities structured for custodial care are treated as individuals. (Most of these individuals are SSI-eligible.)
Children in ID/RD facilities structured primarily for educational or training purposes are considered as part of their family.
Pregnant women in maternity homes are treated as individuals. Eligibility for Medicaid should be determined under the Optional Coverage for Pregnant Women/Infants (OCWI), designated as Payment Category 87.
A child in an alcohol or drug treatment (detoxification) facility who is not in DSS custody is treated as a member of his/her family if the stay in the facility is 30 days or less. If the stay is longer than 30 days, the child is considered as an individual effective with the beginning of the month in which the 31st day falls.
Children in educational facilities are to be treated as if they are still a part of their family unit. These absences are considered temporary for receiving an education.
An adoptive parent’s income is not counted in determining the adopted child’s eligibility before the adoption becomes final.