Children or Youth Eligible Under 45 [MEM 50161, 50163]

All children entering the Foster Care Program are considered an immediate need applicant. Expedited case processing is required. Children removed from their homes and placed in FC must have immediate proof of eligibility for Medi-Cal ensuring immediate access to health care services.

These children or youth are eligible for full scope medical with no SOC under aid code 45 when pending FC placement or when approved for Wraparound Services and there is no other Medi-Cal program available. These children or youth are also eligible for retroactive Medi-Cal.

Note: For more information regarding Wraparound Services refer to the Foster Care Handbook Chapter 25 “Wraparound Program,” page 25-1.

Eligibility for Aid Code 45

Medi-Cal aid code 45 is used when a child/youth is not living with a parent or relative and/or when living with a parent or relative and a public agency is assuming financial responsibility for the child’s/youth’s care, in whole or in part.

The following children/youth are eligible for Medi-Cal under aid code 45:

Children or youth removed from the home and placed in FC by the DFCS.
Children or Youth removed from the home and placed in FC by the JPD and are pending or in transitional placements.
- Note: Incarcerated children or youth are not eligible for Medi-Cal. Their Medi-Cal must be suspended. Refer to Suspension of Medi-Cal Benefits for Incarcerated Juveniles [Senate Bill (SB) 1147, WIC 14029.5].
Undocumented children/youth are eligible for Medi-Cal under PRUCOL. The “Statement of Citizenship, Alienage and Immigration Status” form (MC 13) must be completed by SW/PO.
Children or youth receiving Wraparound Services and have returned home to their parent or legal guardian and are not on any Medi-Cal related program. Normally, These are children or youth are supervised by JPD.
Children or youth receiving County-Only funded foster care payments.

Approving Aid Code 45 in CalWIN

To approve aid code 45 in CalWIN the FC EW must update the Collect Individual Attributes Detail window and access the “Living Arrangement” tab. The FC EW must answer “Y” in the “Supported by Public Assistance” field. When the youth is no longer eligible for aid code 45, the same process must be completed except the “Supported by Public Assistance” field must be changed to “N”. This process must be done to ensure the child or youth is properly evaluated for other Medi-Cal programs.

Note: When the annual FC redetermination packets are late, the FC child must maintain Medi-Cal eligibility under the FC program. Aid code 7J/7K is not appropriate. The above process must be completed to continue MC under aid code 45.

Required Forms and Verifications for Aid Code 45

The FC EW must complete or have the following forms completed by the SW/PO. Youth under the supervision of JPD must have the required documents completed prior to sending them to FCE.

MC 210A - Completed by the SW/PO when requesting retro Medi-Cal.
MC 250 - Completed by the SW/PO or FC EW. The MC 250 is completed by JPD when the child/youth is supervised by a PO.
SAWS 2 Plus - Completed by SW or FC EW as needed to clarify the beginning date of MC.
MC 13 - Required if the child is NOT a U. S. citizen and is to be completed by the same person who completes the MC 250 (SW/PO).
The child’s/youth’s birth certificate or immigration documents must requested by the FC EW if not on file.
The Social Security Number must be on file, or an application for an SSN must be completed when the child’s birth certificate is received.

Forms/Verifications Not Required for Aid Code 45

The following forms and/or verifications are NOT required:

Important Information for Persons Requesting Medi-Cal (MC 219).
Child/medical support referral.
Verification of identity and residency (MC 212), however it is assumed that the county will have some type of documentation on file, and a birth certificate must be requested if not on file.
A MC 13 is NOT required for a child who is any of the following:
- U.S. born citizen,
- Naturalized U.S. citizen,
- U.S. Nationals, or
- Child with acquired or derived U.S. citizenship.
The income and property of the child and his/her parents are not counted in the Medi-Cal determination.

Continued Eligibility for Aid Code 45

When the foster care youth returns home and continues to receive Wraparound Services and there is no other Medi-Cal program, the youth must continue to receive Medi-Cal under aid code 45.

Youth currently receiving County-Only funded FC benefits are eligible for continued Medi-Cal with aid code 45 until the County Funded payments stop.

No Longer Eligible for Aid Code 45

When the youth is no longer eligible for aid code 45, the FC EW must update the Collect Individual Attributes Detail window in CalWIN and access the Living Arrangement tab. The FC EW must answer “N” in the Supported by Public Assistance field. This process must be done to ensure the child or youth is properly evaluated for other Medi-Cal programs.

The following are reasons children or youth are no longer eligible for aid code 45:

When the child or youth is approved for AFDC-FC funding. The approved ADFC-FC funding will override aid code 45. However, the Collect Individual Attributes Detail window must be updated for reasons as stated above.
When the child or youth has returned home to his/her parent’s or relative’s home, eligibility for Medi-Cal under 45 continues until the end of the month. CEC under aid code 7J/7K applies for youth under 19 and continues until the youth is 19 years old or the next redetermination is due date, whichever is first (See CEC Policy section).
When the youth has received County Funded FC and the County Funded payment is terminated while the child under the age of 18 years old, aid code 45 is no longer appropriate, the child or youth is eligible for CEC under aid code 7J/7K.
When the youth is discontinued from aid code 45 and 18 years old or older the youth is eligible for FFY Medi-Cal under aid code 4M. These youth are entitled to Medi-Cal until the age of 26. This would normally happen to youth receiving county only funded FC payments or youths terminating from the Wraparound Program at the age of 18 years old or older. (See FFY policy section)