Payment Rules

This section is saved for historical purposes.

Wraparound payments are not for the child’s basic placement needs. Payments are sent to the designated providers for services. The payments are based on either a contracted rate or the Santa Clara County standard rate.

Contracted Wraparound Services

Contracted or Independent Services Agreements for Wraparound Services are negotiated but cannot exceed the state approved rate Refer to Wraparound Services Program. The facility must not be one listed in Table 22-1, Wraparound Providers. In most instances, before approving the contracted services, the SWS for both FC and adoptions must determine the wraparound rate for the provider.

ExampleExample

When the contract is executed for youth with a current FC placement or under the supervision of JPD, the payment must be approved with county-only funding. The FC EW will be provided with a “Placement Expense” (SCZ 414Z) form to issue payments.

AAP youth receiving Wraparound Services are eligible for the state-approved wraparound rate regardless of their funding status. The adoption SWS may negotiate a rate that is not the standard rate approved by the county of residence. When the state-approved rate is used, the monthly benefits paid to the AAP parents are deducted from the wraparound rate.

Note: FC EWs are not required to have a copy of the agreement when issuing AAP contracted wraparound rates, they will only receive payment instructions. Monthly invoices are required.

ExampleExample

Santa Clara County Approved Wraparound Rates

Prior to July 1, 2012, when the child/youth was in a FC placement and also receiving Wraparound Services, the cost of placement was subtracted from the Wraparound rate and the remainder was paid to all providers.

FC Cases effective July 1, 2012, are no longer the requirement to subtract the cost of placements. Wraparound benefits are set at a flat rate of $3,500 per month beginning July 1, 2012. Payments are made based on filled slots.

When an adoptive family agrees to participate in Wraparound, the amount of the AAP benefit is increased to the appropriate GH rate (RCL 10.5 or 13). The family continues to receive their negotiated AAP benefit – including any SCI – and the remaining funds are used to pay the provider for Wraparound Services.

Effective July 1, 2013, there is no longer the requirement to subtract AAP benefits from the Wraparound payment. AAP Wraparound flat rate is $3,500 per month. Payments are made based on filled slots.

Wraparound Invoicing and Payment Due Dates

The Wraparound provider is required to submit monthly invoices to the Placement SWS by the seventh (7th) day of the month following services. The Placement SWS submits the invoice list to FCE for payment. FCE will issue payments by the twenty-fifth (25th) day of the following month.

The invoice must specify the last and first name of the child, date of birth, the start date and end date (if applicable) and the number of invoicing days. Invoices from Uplift Family Services (formerly Families First) must include either “Matrix” or “Uplift” and Invoices from Seneca Family of Agencies must include “Seneca Plus” or “Seneca Connections” Payment Rules . When services do not begin on the first of the month or end on the last day of the month, benefits are pro-rated based on the number of days the service was provided. The invoice list must provide the number of days.

Note: Wraparound invoices must be submitted monthly from all facilities providing services, including contracted facilities.

Wraparound and CalWORKs

Children/youth are eligible for Wraparound Services while on CalWORKs. These youth must be under the supervision of DFCS or JPD. When a family is receiving CalWORKs and has a child/youth at home in the Wraparound program, the child/youth is included in the AU and the family continues to receive CalWORKs, CalFresh and Medi-Cal if otherwise eligible. The Wraparound payment is not considered income in the CalWORKs case nor is the CalWORKs considered income in the Wraparound case. It is not considered a duplicate payment.

If the family receives a lump sum payment or other items of need through the Wraparound program, they are treated as income or resources in the month of receipt (this is rare).

Children/youth on CalWORKs residing with biological parents and receiving Wraparound will remain in district office CalWORKs/Medi-Cal case and have a Medi-Cal case opened in FCE under aid code 45. In order to complete this, the Eligibility Worker will have to perform a BLO in CalWIN for aid code 45 and suppress MEDS transaction in CalWIN. The worker must then submit a “Request for Online Transaction” form (SCD 1296) to activate aid code 45 in MEDS. The youth’s record in MEDS will display aid code 45 on the Q1 screen and the CalWORKs aid code on the QM Screen.

Children/youth receiving Wraparound and residing with caretaker relatives receiving non-needy CalWORKs (not ARC) remain on 4H Medi-Cal aid code.

When Medi-Cal is terminated on the CalWORKs case and Wraparound remains active, FCE must add Medi-Cal to the Wraparound case using Aid Code 45. Medi-Cal is to remain active until Wraparound is terminated. Once Wraparound is terminated there is no eligibility for Aid Code 45.

When there is no other active Medi-Cal program FCE will convert Aid Code 45 to CEC or Aid Code 7J the month following the termination of Wraparound until the next RRR date as long as the youth is under 18. If the youth is 18 or older they are eligible FFY Medi-Cal, refer to Continuous Eligibility For Children (CEC) 7J/7K [Section 50189 of Title 22] and Medi-Cal Eligibility for Former Foster Youth (FFY) 18 to 26 Years of Age Aid 4M.

The RRR date is determined by the month in which the FC, AAP, CalWORKs or Medi-Cal began. When the RRR packet is returned to FCE and the youth is on CalWORKs it is forwarded to the district office with the active case to be evaluated for another eligible Medi-Cal program. [Refer to Wraparound Redeterminations (RRR)].

Foster Care Wraparound Youth Placed in Group Homes (GH)

Effective July 1, 2012, FC youth placed in GHs are not eligible for Wraparound Services unless payment is approved with county only funding. DFCS will provide “Blanket Approvals” to use county only funds to pay for youth receiving ITWS. Blanket Approvals are renewed at the discretion of DFCS, and currently approved quarterly. Blanket Approvals are posted to the SSA intranet as Foster Care Updates.

ITWS are currently only provided by Uplift Family Services and Seneca Family of Agencies. Additional providers may be added at the discretion of DFCS. Currently, the two agencies providing ITWS have two different Wraparound programs:

• Uplift Family Services provides:
  • Matrix, and
  • Uplift.
• Seneca Family of Agencies provides:
  • Seneca Plus, and
  • Seneca Connections.

When either Uplift Family Services or Seneca Family of Agencies sends monthly invoices they must specify which of the above services they are providing. AAP cases will always use Seneca Connections.

If Wraparound Services are approved for a youth placed in a GH and that is not covered by the Blanket Approval, the FC EW must return request or invoice to the Wraparound placement SWS. A SCZ 414Z is needed to issue payments and will be approved every six months.

When the youth returns to a provider that is not a GH or FFAs receiving THPP, and is still receiving Wraparound Services county funding is no longer necessary. The

Note: When payments are issued for youth placed in GHs or FFAs receiving THPP, FC EW must follow the instructions provided in Payment Issuance.

Foster Care Wraparound Youth Placed in Transitional Housing Placement Program (THPP)

THPP placements are treated the same as GH placements when determining the use of county only funds. The THPP program can be approved for youth placed in GHs or FFA.

When a youth is changing placements from a foster family home to a THPP placement the use of county funds is needed to pay for Wraparound Services. The FC EW must notify the Wraparound SWS that the placement has changed. The Wraparound SWS must provide a SCZ 414Z to issue the wraparound payment, when the placement is not covered under the Blanket Approval.

Wraparound and Juvenile Probation Department (JPD)

Normally a juvenile who is incarcerated due to criminal activity is not eligible for Medi-Cal. Therefore benefits must be suspended. However, a juvenile awaiting placement for Wraparound Services in a juvenile detention center is eligible for Medi-Cal if all eligibility requirements are met. Youth in juvenile hall remain there for their protection or their best interest.

Note: When the youth is under the supervision of JPD and is receiving AAP benefits, the post-adoption SW must be notified when considering or approving wraparound services.

JPD provides Wraparound services with three options:

• JPD Wraparound with placement orders,
• JPD without placement orders, and
• JPD ranch Re-Entry.

JPD youth can leave juvenile hall pending Medi-Cal approval. When JPD approves a youth for Wraparound Services a “Medi-Cal Application Transmittal Information Form” labeled “Wrap Case” is sent to FCE. At that time Medi-Cal should be approved if not already active.

Note: There are JPD youth that remain at home with their parents or guardians but are at risk of being removed; These youth are under the supervision of JPD and also eligible for Wraparound. Eligibility criteria are the same as JPD youth without placement orders.

After the youth appears in court, JPD forwards the disposition minute order to FCE. JPD youth receiving Wraparound Services remain under the jurisdiction of JPD, but the Wraparound payment is paid by FCE.

JPD Wraparound With Placement Orders

JPD youth preparing for release with placement orders, are youth that will go into foster care placement under the authority of JPD. JPD refers these youth to RISC for Wraparound services. When RISC approves Wraparound, JPD forwards a Medi-Cal packet and the RISC referral to FCE. These youth remain in juvenile hall until Medi-Cal is approved.

JPD Without Placement Orders

When JPD youth returns home with Wraparound services, they are not required to have placement orders. These youth can return home pending Medi-Cal approval. These youth also remain under the jurisdiction of JPD and eligible for Wraparound Services.

Many times these youth will return to their biological family and have an active CalWORKs case with Medi-Cal. Youth that are not in juvenile hall but are under the supervision of JPD are also eligible for Wraparound. These youth will remain part of the CalWORKs/Medi-Cal case and FCE will open Medi-Cal under aid code 45. In order to complete this, the Eligibility Worker will have to perform a BLO in CalWIN for aid code 45 and suppress MEDS transaction in CalWIN. The worker must then submit a “Request for Online Transaction” form (SCD 1296) to activate aid code 45 in MEDS. The youth’s record in MEDS will display aid code 45 on the Q1 screen and the CalWORKs aid code on the QM Screen. These youth must remain active on Medi-Cal for specified period included in the ISP.

JPD Ranch Re-Entry

When Wraparound is approved the “Medi-Cal Application Transmittal Information Form” labeled “Wrap Case” must be sent to FCE three days prior to the release date (the transmittal must include the release date in order to be processed).

FCE will determine whether the youth must be added to the CalWORKs (all Ranch Re-Entry youth return home) or if Medi-Cal is required. When there is no underlying CalWORKs, FC, or Medi-Cal case, a Medi-Cal case must be opened and approved by FCE. FCE will establish a Medi-Cal case based on the application packet submitted by the JPD. Wraparound is added to the established Medi-Cal case.

FCE must ensure and advise JPD that Medi-Cal is active either on the release date or within the week of being released.

Wraparound Services For Youth Receiving Supplemental Security Income (SSI)

SSI youth will always have active Medi-Cal. When an SSI eligible child/youth is residing with a parent, the parent shall be the payee for the SSI benefits. The SSI is not counted as income and is not abated from the Wraparound payment. When an SSI youth is in FC, the County will become the payee for the SSI benefits and abate the payment from the placement cost. SSI children/youth are eligible for fee-for-service Medi-Cal, therefore will not have Medi-Cal attached to their Wraparound case.

SSI youth follow the same eligibility process as other Wraparound with the exception of the youth receiving SSI outside of Santa Clara County. These youth are not eligible for Wraparound until the SSI payee is changed to the County of Santa Clara. SSI Medi-Cal will always override all other Medi-Cal programs.

Wraparound Services for Children/Youth Permanently Residing Under Color of Law (PRUCOL)

When there is no underlying foster care or CalWORKs, Medi-Cal case must be established by FCE. The SW/PO is responsible for completing the “Statement of Citizenship, Alienage and Immigration Status” form (MC 13). Refer to PRUCOL for FC Children.

Wraparound and Non-Minor Dependents (NMD)

For NMDs Wraparound Services can continue to be addressed at any time until reaching the maximum age for EFC. To be eligible NMDs must continue to meet the eligibility requirements for participation in the EFC program. SWs/POs requesting Wraparound Services must determine the NMD is at risk of placement in a GH at a RCL of 10 or higher, or they are currently placed in a GH and will be transitioned to a lower level of care within the next three months.

Youth referred for Wraparound Services within six month prior to their 18th birthday must have a discussion with their assigned SW/PO about participating in the EFC. When the youth is approaching 18 years of age, the youth must have a SOC 161 on file to participate in Wraparound. Participation in Wraparound is completely voluntary for NMDs, and it may be terminated at any time. Youth 18 but under 21 must be participating in EFC in order to be eligible to participate in Wraparound Services. Refer to Extended Foster Care (EFC) Benefits.

Notices of Action (NOA)

When payments are made from the Wraparound case FC EWs are not required to issue approvals, changes, or discontinuance NOAs. Wraparound is a contacted service that is paid upon invoice. When the provider is overpaid a NOA addressing the overpayment must be manually generated and sent to the provider. A copy of the overpayment NOA must be sent to Collections.

Wraparound Redeterminations (RRR)

Children and youth approved for Wraparound Services must have Medi-Cal active, however, there is no redetermination needed for wraparound because the services are contracted and invoiced for payment. There are three possible scenarios for completing the RRR:

• When there is a corresponding active FC or AAP case the RRR is completed on the active FC or AAP case.
• When there is no active FC or AAP case and the Wraparound child/youth is on an active CalWORKs the RRR is completed on the active CalWORKs case.
• When there is an active Medi-Cal case with Wraparound, the RRR is completed as a Medi-Cal RRR.

  • Note: It is important to note that as long as Wraparound remains active, the redetermination follows current RRR policy for the underlying case.

When a Medi-Cal case is opened only for Wraparound and Wraparound has discontinued, the RRR packet is generated by FCE. CEC is setup the month following the termination of Wraparound as long as the youth is under 18. When the youth is 18 or older they are eligible for FFY Medi-Cal.

When Wraparound has terminated and there is no underlying FC, AAP or CalWORKs case and after CEC has been set up, the youth must be evaluated for another Medi-Cal program before Medi-Cal is terminated.

• Note: SB 87 rules apply to all Medi-Cal programs.

 

When the RRR packet is returned, the RRR packet along the “Eligibility Verification Checklist” (SCD 1121FC) with the required documents attached must be forward to district office for evaluation of a different Medi-Cal program.

All foster care placements including Wraparound are confidential, therefore a new Medi-Cal case must be opened in district office. Normally, a new Medi-Cal is not opened until CEC has ended, however, when District Office is ready to activate a Medi-Cal case and the FC case is still open, they must advise FCE to terminate their case. Communication between district office and FCE is essential to avoid disruption of Medi-Cal benefits.

Related Topics

Wraparound Program