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ICPC for Aid Code 40 (AFDC-FC State-Only)
Children placed out of state who are in receipt of federal funding are generally automatically eligible for Medicaid in the state of placement according federal regulations. Federal law permits but does not require states to provide Medicaid coverage for children who receive state only foster care benefits from another state.
The California DHCS has made a decision to extend full-scope out-of-state Medi-Cal coverage to California foster children placed in another state under aid code 40. When the child is not placed in a facility such as a GH, the facility where the child receives medical services must apply to become a Medi-Cal provider.
County Action on Medi-Cal Eligibility Data Systems (MEDS)
Counties must manually identify these children with the specific residence code “99” in the residence field on MEDS in order to provide Medi-Cal benefits when children are placed in an out-of-state GH. The child’s out-of-state address must be entered into MEDS along with the out-of-state residence code of “99” for Medi-Cal to pay out-of-state claims to those out-of-state Medi-Cal enrolled providers.
Note: The FC EW must complete an SCD 1296 to have the Residence Code “99” added to the residence field in MEDS for all non-federally eligible placements.
Providers and Billing Information
DHCS Providers Enrollment will enroll out-of-state entities to provide medical services to child placed by counties under ICPC. The entities must be linked to a residential care facility certified by CDSS and they will be enrolled in accordance with federal and state Medicaid rules in effect at the time the application is submitted. The current list of out-of-state care facilities can be found at https://secure.dss.ca.gov/CareFacilitySearch/ by selecting one of the Facility Types.
Information and applications for enrollment as a Medi-Cal Provider can be found on the Medi-Cal website at www.medi-cal.ca.gov by selecting “Provider Enrollment”.
Applications submitted by the out-of-state entities to enroll as Medi-Cal providers must have the letters “ICPC” writing on the top of the application. This will enable DHCS PED to identify the request. The request must be submitted on the requesting facility’s letter head. Applications for out-of-state provider are assigned and reviewed expeditiously. When the provider requests additional information refer them to the above Medi-Cal website.
Providers interested in providing dental services to out-of-state children with an aid code 40 may contact the Denti-Cal Enrollment unit by calling Delta Dental, the dental fiscal intermediary contractor at (916) 853-7373 and request to be connected to the Enrollment Unit. The provider’s handbook which explains how to submit a claim, current and statewide maximum allowance rates, required documents are available online at www.denti-cal.ca.gov.
Incoming AFDC-FC State Only ICPC
Per ACWDL 21-28, non-federally eligible ICPC youth are not eligible for Medi-Cal. Effective immediately, Eligibility Workers must not place this population in aid code 45 Medi-Cal. The ICPC Coordinator must verify the sending state is covering the youth’s Medicaid while in California and no longer refer these cases to Foster Care Eligibility.
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