SB 87 - Medi-Cal Eligibility Determination Process for Cases Discontinued From Foster Care

SB 87 establishes a new “ex parte” review process to be used for ALL Medi-Cal redeterminations. This means, SB 87 applies to FC, AAP and Kin-GAP.

Youth who are 18 or older when they exit the foster care system are eligible for FFY until they reach age 26. Therefore, SB 87, which requires Edwards 38 and an ex parte review to establish Medi-Cal, is not applicable to former FC youth eligible for FFY MC. However, when the youth is approaching the age of 26 SB 87 requirements are applicable.

Additionally, SB 87 requirements include youth on Kin-GAP and AAP who are receiving CEC MC to be notified prior to being discontinued from the Medi-Cal program.

Children who are under age 18 when they exit the FC, AAP and Kin-GAP are automatically eligible for CEC. CEC continues until the child reaches age 19 (except for FC children) or the RD due date, whichever is earlier.

Refer to Medi-Cal Handbook Chapter 35.7.5 for more detailed information on the SB 87 process.

Exceptions

SB 87 (aid code 38, etc.) does not apply to children discontinued from Foster Care for any of the following reasons:

  • Death,
  • Recipient requests to discontinue Medi-Cal benefits,
  • Incarceration,
  • Loss of California residency, and
  • The individual is transferring into another PA program that provides no share-of-cost Medi-Cal benefits.

Cases must be maintained in the FC bureau during the CEC MC and FFY MC period. When the case is approaching the expiration of CEC MC a BO listing is generated monthly for the upcoming CEC RD due dates. Additionally, youth approaching 26 years old must be provided with a Medi-Cal packet 90 days prior to being discontinued from Medi-Cal to be evaluated for another Medi-Cal program.

The following SB 87 ex parte procedures applies for discontinued FC, AAP, Kin-GAP, and FFY MC cases:

 

If... Then...

FC, AAP or Kin-GAP cash aid is terminated and SB 87 applies when:

  • CEC is expiring
  • FFY MC is expiring
  • The FC EW must follow SB 87 steps and ensure that the child is placed on aid code 38 until there is a determination of continued eligibility or ineligibility.
  • The FC EW must attempt to contact the former foster care youth at least 90 days before MC expires.
  • The FC EW must attempt to contact the foster parent provider, guardian, adoptive parent and/or Social Worker by phone for current address.
  • When the child’s whereabouts are unknown the FC EW must contact the SW/PO for the last known address.

FC Clerical receives CEC RD Listing or
Advised by the FC EW 90 days before the FFY MC will expire,

Approaching the end of the CEC/FFY period forwards the following;

  • 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, AAP, Kin-GAP and FFY MC cases that are not eligible for CEC and in aid code 38 must include the CCRFM 604 with the documents listed above.

Note: Any packets returned to FCE must be sent to VMC for Medi-Cal Eligibility processing.
FC EW 30 days after above documents are sent, discontinues the child/youth case with a timely NOA if unable to confirm the child’s/youth whereabouts. The NOA must be sent to the last known address of the minor or young adult and the when applicable, the assigned SW/PO.

Related Topics

Medi-Cal