Continuous Eligibility For Children (CEC) 7J/7K

[Section 50189 of Title 22]

AB 2900 (Chapter 945, Statutes of 2000), established Medi-Cal provision; CEC effective January 1, 2001. CEC ensures that children under age 19 who are determined eligible for zero share-of-cost Medi-Cal maintain their eligibility until the next redetermination.

Any adverse changes in the family’s circumstances including income, property, are disregarded until the end of the CEC period. The statute establishes CEC for children for up to a 12-month period, which ends with the date of the next RD due date or the child’s 19th birthday, whichever occurs first.

Children, under age 19, who are discontinued from the Adoption Assistance and the Kin-GAP Programs meet the qualified population for CEC. Children or youth in FC under 18 years where court dependency is dismissed are also eligible for this program.

Transfer to CEC Program

In order to meet the state mandate, children under age 19 who are discontinued from AAP, or Kin-GAP must be transitioned to CEC. Children who are discontinued from FC where court dependency is terminate and the child is under 18 years old must be transitioned to CEC.

CEC and FFY

The FFY MC program takes priority over the CEC program. Individuals who were in Foster Care on their 18th birthday are eligible to receive zero SOC Medi-Cal until their 26th birthday. A Foster Care youth who is court dependent on their 18th must be transitioned to the FFY MC program.

CEC Eligibility Rules

The following eligibility rules apply to the CEC program:

• The CEC period begins with the first month following the termination of FC, Kin-GAP or AAP.
• The CEC period continues for up to a 12-month period, and ends the last day of the month in which the annual RD is due, or the end of the month in which the child turns age 19, whichever occurs first.
• Financial eligibility changes, such as income, which would otherwise move a child under age 19 from no SOC to a SOC category or ineligibility are disregarded.
• Any changes in financial eligibility, such as income reported by the family during the CEC period, which would cause the child to have a SOC or financial ineligibility in the succeeding month are NOT to be considered until the annual RD.

Exceptions

CEC does not apply in the following circumstances:

• Child turns age 19,
• In the event of death,
• Parent(s), guardians, or adoptive parent(s) request,
• In the event of incarceration section, and
• Child(ren) moved out-of-state.

 

Note: If the child’s parent(s), guardians or adoptive parent(s) at anytime request the child’s Medi-Cal to be discontinued, then CEC must be discontinued on their request.

CEC Procedures

When a FC, AAP, or Kin-GAP child is determined eligible for CEC, the child must be transitioned to CEC using the appropriate aid code either 7J or 7K.

The FC EW must take the following action for all children, under age 19, who are discontinued from the FC, AAP or Kin-GAP programs:

• If a child was on Kin-GAP, and the child is under 19 and discontinued, then the child must be set up on the CEC program (7J) through either the end of the next RD, or until the child turns 19, whichever occurs first.
• If a child was on the FC, and the child is under 18 and is discontinued where court dependency is terminated, then the child must be set up for CEC (7J or 7K), through either the end of the next RD, or until the child turns 18, whichever occurs first. FFY takes precedence over CEC.

  • Note: A FC child who is discontinued at 18 is eligible for FFY.

• If a child was on AAP, and the child is under 19 and is discontinued, then the child must be set up on CEC (7J), through annual Medi-Cal RD, or until the child turns 19, whichever occurs first.

Children eligible for CEC MC are kept at the Foster Care Bureau until CEC has ended or when notified they child is active on another Medi-Cal program.

CEC Case Examples

Case Example #1Case Example #1

Case Example #2Case Example #2

Annual Redetermination (RD)

For purposes of the CEC program, the eligibility redetermination refers to the annual RD pursuant to Section 50189 of Title 22. This states that the annual RD is completed within 12 months. The annual RD date is based on case status not the individual status.

The CEC period ends the last month covered by that annual RD period or the last day of the month that the youth reaches age 19, whichever occurs first.

Reminder: The annual RD date follows the case not the child.

Listing and Processing CEC Packets

Cases with CEC must be maintained at FCE until the end of the CEC period or when FCE has determined the child is active on another Medi-Cal case. A BO listing is generated monthly for the FC Bureau with the upcoming CEC RD’s due dates.

Upon receipt of the listing and 75 days prior to the discontinuance of CEC, Central Services will mail a packet with the following forms to all FC, Kin-GAP, and AAP cases that are in receipt of CEC:

• Notice of Language Services (GEN 1365),
• FC CEC RRR Coverletter (SCD 2385 FC) or (SCD 2385 AK),
• FC Identification and Intake Record (SCD 41 FC), and
• Request for Tax Household Information (RFTHI) (SCD 2350)
• Additionally, for AAP and Kin-GAP cases that are not eligible for CEC and in aid code 38, a copy of the CCRFM 604 must be included in the packet.
• Packets returned to FCE must be sent to VMC for processing.

Returned Packets sent to VMC

The VMC MC Liaison is the point of contact for cases that are forwarded to VMC. The Liaison serves as the contact person and must follow-up on all issues related to the returned packet.

When a packet is returned to FCE either by walk-in or mail, FC Clerical Staff will pony the packet to VMC adding “Attention the Office Specialist (OS) II”. A new MC case must be established. The VMC OS II will follow their current policy and forward the packet to the VMC OS III for application registration, task request, and case assignment.

If the applicant contacts FC Phone Support (FC EW or Clerical) to inquire about the packet, FCE
staff must advise the client to either call VMC or return the packet to VMC.

Non-Citizen/Undocumented Children

Any undocumented Foster Care child with PRUCOL status who has been terminated from Foster Care and is under the age of 18, must be transitioned into CEC. Aid code 7K is designated to qualified children under age 19 who do not have satisfactory immigration status.

Documentation

FC EWs must document in a CalSAWS journal entry when the CEC period begins and ends.

Inter-County Transfers (ICT)

Procedures for eligibility of CEC are treated the same way as current Inter-County Transfers. ICTs for AAP, FC and Kin-GAP are physically mailed and received between the counties. Electronic ICT are not used. The FC EW must:

• Review information contained in the case file prior to transfer, and
• Ensure the child’s zero SOC Medi-Cal continues during the CEC period.

When completing the ICT the FC EW must include the following documents:

• A completed “Notification of Medi-Cal Intercounty Transfer” (MC 360),
• The “Sending County” portion of the “Medi-Cal Intercounty Transfer Packet Receipt” (MC 360), 
  and
• When available a copy of the most recent MC 250.

FC EWs cannot discontinue the child’s CEC Medi-Cal until the receiving county has placed the child in zero SOC Medi-Cal.

Request for CEC Discontinuance

The parent(s), guardians, and adoptive parent(s) of eligible CEC children may request their discontinuance of CEC MC benefits at anytime during the CEC period. When a request is made for discontinuance, the FC EW must discontinue benefits and send the appropriate NOA.

Related Topics

Medi-Cal