Wraparound and Medical

Children or youth who are eligible for Wraparound Services are also eligible for Medi-Cal benefits under the Medically Needy Program or under other potentially applicable Medi-Cal programs and shall remain eligible for Medi-Cal during their participation in Wraparound Services. Youth sent home, without a change in the individual’s status as an adjudicated dependent or ward of the juvenile court is not cause for a redetermination for either Federal or Non-Federal FC unless necessary to obtain federal financial participation for Medi-Cal.

Note: The Wraparound program does not cover medical expenses that are covered by Medi-Cal.

 

Additionally, BHS, formerly the DMH, requires local mental health managed care plans to establish a procedure to ensure access to outpatient specialty mental health services for FC children/youth placed outside of their county of origin. This would include Medi-Cal eligible youth receiving Wraparound Services.

Children/youth (including NMDs) in Wraparound Services who receive benefits under Title IV-E (Federal) are eligible for Medi-Cal benefits as long as Title IV-E FC payments are made on the individual’s behalf. Children should be placed in aid code 42 and NMDs placed in aid code 49. Children who are evaluated for non-federal FC benefits use aid code 40 and non-federal NMDs use aid code 43.

Individuals who receive AAP benefits are to remain on their respective Medi-Cal program while receiving Wraparound Services (aid code 03 for the Federal program and aid code 04 for the State program). Only federal youth are eligible for extended benefits under the EFC, these youth are to be placed in aid code 07.

Children receiving Wraparound who have returned home to their biological parents and are in a district office CalWORKs and/or Medi-Cal (MC) case, must have Medi-Cal established by FCE under aid code 45 while the district office case remains open. Under no circumstances should aid codes 4H/4L be used in this situation. In order to complete this, the Eligibility Worker will have to perform a Bottom Line Override (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. The Wraparound payment is issued under aid code 40.

Youth receiving Medi-Cal under Aid Code 45 are only eligible for this program while receiving Wraparound Services. There is no eligibility for Medi-Cal Aid Code 45 upon termination of Wraparound after the end of the month. When Wraparound is terminated and the youth is under 18 the youth is eligible for CEC MC benefits. The Aid Code must be changed the following month after Wraparound is terminated to 7J (using BLO) until the next RRR date unless the youth is added to another zero-share of cost Medi-Cal program. These children/youth must be evaluated for a different Medi-Cal program prior to the RRR due date. When Wraparound Services is terminated for a youth 18 or older, the youth is eligible for FFY MC. For more information regarding CEC and FFY eligibility, refer to the 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.

  • Note: SB 87 rules apply for all Medi-Cal redeterminations.

Closing Wraparound Cases

When the Wraparound invoice shows an end date the assigned FC EW must terminate the Wraparound Program. When there is an underlying FC, AAP or CalWORKs case the Wraparound case must be closed. When there is no underlying FC, AAP or CalWORKs case, Medi-Cal under the wraparound case will remain open until the end of the CEC period. SB 87 rules must be applied before terminating Medi-Cal.

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    1. To Close the Wraparound Program EWs will do the following:
      1. From the Search for Issuance window, determine what “Aid Code” the last Wraparound payment was made.
      2. Update the Wraparound Program Detail Window with the “Effective End Date” taken from the Invoice list.
      3. On the Collect Withdraw/Deny/Cancel/Terminate Program Detail window
        1. Select status Withdraw.
        2. Enter the Effective Begin Date with the date taken from the Invoice List (Should be the same date entered on the Effective End Date from the Wraparound Program Detail window).
        3. Enter the Reason “Child not in Wraparound.”
      4. Enter the Presumed Aid Code which was determined above. See Foster Care Update 12-05.

        1. Note: Case Status will change to “Closed.” EDBC does not need to be run when the only program is Wraparound. When Medi-Cal is attached to the Wraparound EDBC must be ran to discontinue the Medi-Cal and Wraparound must be withdrawn as stated above.

    2. Closing the Medi-Cal portion of the case follows normal closing procedures for discontinuing cases.
    3. When both Wraparound and Medi-Cal are terminated, verify Wraparound has been withdrawn and Medical has been discontinued.
    4. When the case has been closed, follow the FCE closing case procedures.

Related Topics

Wraparound Program