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Medi-Cal Eligibility for Former Foster Youth (FFY) 18 to 26 Years of Age Aid 4M
Background
The FFY Medi-Cal program, formerly known as the FFCC Program was established under the Federal Foster Care Independence Act of 1999 authorizing continued Medi-Cal coverage for all youth who are in Federal Foster Care under the responsibility of the state on their 18th birthday. With the implementation of the ACA eligibility for this program is extended until their 26th birthday. This requirement includes youth that have exited federal or state FC from any state in the United States. It also includes youth that had their Medi-Cal terminated due to turning 21 years old. Their benefits must be restored if they are under the age of 26.
Youth eligible for FFY Medi-Cal are exempt from a MAGI determination and all income is disregarded for this group. Youth eligible for this program are entitled to full scope zero share-of-cost Medi-Cal benefits, including Early and Periodic Screening, Diagnosis, and Treatment services. These youth must be moved seamlessly into the FFY program without being terminated, having to reapply, or having to provide any additional information.
FFY on SSI or CalWORKs must stay on their current program but if either program is discontinued, their FFY MC status must be reactivated.
DHCS established aid code 4M to be used for youth eligible for FFY MC. Guidance on handling enrollment to the FFY MC program is provided by the California DHCS which in includes handling of MCG and OCG.
The MCG includes youth who were receiving Medi-Cal in foster care under the responsibility of the state or tribe on their 18th birthday, or a later age, regardless of the aid code assigned while in foster care.
The OCG is a new category of former foster care youth that received non-Federal Foster care payments but were not approved for Medicaid. This group includes youth that have exited foster care at 18 and received their non-federal foster care payments outside of California. Medi-Cal benefits for youth eligible under the OCG program terminate at 21.
Note: Validation for the OCG must be provided by the state that had jurisdiction over the youth on their 18th birthday, otherwise the youth is eligible for the MCG.
Youth eligible for FFY MC can apply through the CalHEERS system. The application will be interfaced from CalHEERS to CalSAWS for processing.
Eligibility for FFY Medi-Cal
Foster Care youth under the MCG who were in the following aid codes on their 18th birthday are eligible for FFY MC until the age of 26 under aid code 4M. Former Foster Care youth that are eligible for Medi-Cal under the OCG are aided under aid code 4U. Aid code verification under the OCG must be provided by the state where the youth exited FC. Until DHCS provides instructions for the use of aid code 4U all former foster youth from the other states use aid code 4M.
Foster Care youth who were in one of the following aid codes on their 18th birthday are eligible for FFY MC. This includes youths in probate Non-Related Legal Guardianships who aged out at 18.
| Aid Code | Description |
| 40 | AFDC-FC; Non Federal |
| 42 | AFDC-FC, Federal |
| 43 | AFDC-FC NMD, State Cash/FFP Medi-Cal |
| 45 | Foster Care |
| 46 | out of Non-Federal Foster Care; CA Medi-Cal |
| 49 |
AFDC-FC NMD Title IV-E; Federal/FFP Medi-Cal |
| 4H | foster Care Child in CalWORKs |
| 4N | CalWORKS NMD, State Cash/FFP Medi-Cal |
| 5K | Emergency Assistance, Child in Foster Care |
| 9X | County Funded Foster Care Payment |
| 2S | ARC + Federal CalWORKs |
| 2T | ARC + State CalWORKs |
| 2U | ARC + State NMDs |
| 2P | ARC Only |
| 2R | ARC Only (NMDs) |
Note: There are situations where it is verified the youth was in FC on his/her 18th birthday, but not enrolled in any of the s listed above; these youth are also eligible for FFY Medi-Cal.
Youth Receiving CalWORKs
Relatives who were not eligible for FC payments for a dependent child or youth may choose to apply for CalWORKs or the ARC Funding Option. If the youth is discontinued from CalWORKs or ARC with court dependency at age 18, the youth is eligible for FFY MC. Contact with the SW/PO may be required to determine if dependency exits on their 18th birthday.
If the former FC youth is receiving CalWORKs they are automatically linked to Medi-Cal therefore FFY MC is not necessary. When the youth is discontinued from CalWORKs and is under the age of 26, the FFY MC must be restored. The CalWORKs EW must send a NOA advising the youth FFY MC benefits will be restored and notify the FC bureau to restore their FFY MC case. No additional application is necessary to restored FFY MC. Youth entering in Santa Clara County from another county or state and are eligible for FFY MC, their information must be sent to the FC bureau to have a FFY MC case established.
When the FFY returns to live with his/her parents who are receiving Medi-Cal or CalWORKs, the FFY MC case or status (mixed household) must remain active. Eligibility for other family members is determined based on existing Medi-Cal rules established outside of FCE. Their applications must be sent to a DO.
Note: It is important to note the only eligible person in the FFY MC case is the FFY. When the youth has a family that may be eligible or would like to apply for Medi-Cal an eligibility determination cannot be established under the FFY case. The family must be given an application and referred to DO, existing MC rules apply except the FFY MC status must remain under aid code 4M.
Youth Not Eligible for FFY
- Youth ages 18-26 who are institutionalized or incarcerated, their benefits must be suspended.
- Emancipated Minors under the age of 18 years old.
- Youth exiting foster care before age 18 years old and court dependency is terminated.
- Youth exiting the AAP program on their 18th birthday.
- Youth exiting the Kin-GAP program on their 18th birthday.
- Former Foster Youth 26 years old and older.
- Youth requesting to be terminated from FFY MC.
- FFY on SSI (If SSI is terminated and youth is under 26 FFY MC must be restored).
- FFY with verified residency in another state (If the youth returns to California and is under 26 FFY MC must be restored).
Reminder: Youth under age 19, who are discontinued from AAP or Kin-GAP are eligible for CEC.
General Eligibility Rules
A former foster care youth may apply for benefits by going to any DO and completing any Medi-Cal application or by completing an application through CalHEERS. The applicants may also apply by telephone, e-mail, BCW or SSApp, FAX, or mail. Applicants are not required to complete a full application or provide any additional information beyond what is requested on the “Application for Medi-Cal for Former Foster Care Children” (MC 250A). Although an application is not necessary to approve FFY MC it is used to expedite processing.
FFY MC applicants are not required to provide proof they were in foster care placement on their 18th birthday, they can self-attest their foster care placement on their application. Self-Attestation is explained here.
All FFY MC applications require expedite processing and must be approved immediately with a 30 day reasonable opportunity to verify their eligibility. The FC EWs are required to validate eligibility for the FFY MC program.
Eligibility for FFY Medi-Cal is based on court dependency or in a FC at the age of 18.
The following rules apply:
- Youth in California that were discontinued from FFY MC because of turning 21 and are under 26 must have their FFY MC reinstated.
- Youth who are discontinued from FC or court dependency because of age, must be transferred to FFY MC and must remain in this program until their 26th birthday, regardless of any change in circumstances as long as he/she continues to meet the criteria and wishes to retain Medi-Cal coverage. This includes youth enrolled in the THP+ program.
- Youth that were on the run (runaway) from their placement on their 18th birthday and court dependency was not terminated until on or after their 18th birthday.
- Former FC youth can “Self-Attest” eligibility for FFY Medi-Cal program.
- There are NO income or resource tests, regardless of the youth’s living arrangements or with whom they reside.
- There is NO share-of-cost.
- There are NO additional forms required.
- The youth is set up in his/her own former foster care case unless the youth is receiving CalWORKs or on SSI.
- A new FFY MC case must be established when the youth received FC in another county or state or an ICT. Refer to BEnDS 2014-3 for instructions.
The youth may decline Medi-Cal coverage under the FFY program. They can be enrolled in unsubsidized Covered California coverage however, they are not eligible for APTC/CSR because they are eligible for Medi-Cal and declined it. If they qualify for free Medi-Cal and choose to keep a Covered California plan, their monthly premium will increase. For more information regarding APTC/CSR refer to Medi-Cal Handbook Chapter.
Deemed Eligible Infant with a FFY
When the FFY youth has an infant the infant is in the same case until another Medi-Cal case is established. The following rules apply:
- The infant is deemed eligible until one year old.
- The “Newborn Referral” (MC 330) for the infant’s Medi-Cal must sent to the former FC youth.
- The returned MC 330 must be forwarded to District Office.
- When District Office establishes a case the FFY MC must remain active in the aid code 4M. The DO case will remain in DO during the eligibility for FFY MC unless the former foster youth loses custody of the child and the child is no longer in their care.
- The former FC youth’s eligibility for FFY MC must continue under aid code 4M/4U until no longer eligible for the program.
- Eligibility of the former FC youth’s infant must be established based on existing Medi-Cal rules.
Note: It must be noted that if the youth loses custody of their child or the child is no longer in their care and control and the youth is under 26 years their FFY MC case must be restored at the Foster Care Bureau.
Enrollment in a Managed Care Plan is optional, unless the individual lives in a county that has a COHS where enrollment is mandatory. To enroll in COHS, MEDS must be updated with the current resident code.
NMD or Youth Exiting FC With A Child Over 1 Year Old
When the youth is no longer eligible for FC and has a child and the child is over 1 year old, another Medi-Cal case must be established.
The following documents must be sent to the FFY:
- The Application for Health Insurance (CCFRM 604) and,
- Self-Stamped Envelope to be returned to VMC for processing.
When VMC establishes a case the former FC youth must remain active in the FFY MC until 26. The DO case must remain in DO during the eligibility period unless the former foster youth loses custody of the child and the child is no longer in their care. The FFY MC must restored at the FC bureau.
Note: It must be noted that if the youth loses custody of their child or the child is no longer in their care and control and the youth is under 26 years their FFY MC case must be restored at the Foster Care Bureau.
Eligibility of the FFY’s child must be established based on existing Medi-Cal rules.
FFY and CalHEERS
Youth may apply for FFY MC through CalHEERS. CalHEERS will interface their application with the CalSAWS system. The interface will update the Collect Individual Demographic Detail window with the following new field:
A “Verification Source” the will include one of the following entries:
- California Documents,
- American Indian or Alaska Native Tribal Document,
- Not Received,
- Out of State Document, or
- Questionable.
The window will also include a “State Verification Source” that will include one of the following entries:
- Electronic and Service Center,
- Electronic Only, or
- Service Center Rep Only.
The FC EW is required to validate the “Verification” only and update the verification “Source” if necessary. The “State Verification” will be interfaced from CalHEERS and requires no validation.
When the youth applies for FFY MC through CalHEERS and CalHEERS has inappropriately enrolled the youth in a Covered California QHC Plan, the youth must be disenrolled. When CalSAWS is updated a transaction is sent to CalHEERS to update the youth’s record.
Hospital Presumptive Eligibility Program
The Patient Protection and ACA of 2010 was amended by the Health Care and Education Reconciliation Action of 2010 requires the implementation of the HPE Program (refer to Medi-Cal Handbook Chapter 35.1). Eligible FFY may be hospitalized and enrolled in the HPE program under 4E.
MEDS will generate a new worker alert 9068 for counties to immediately move HPE FFY in 4E to 4M. The alert 9068 will be displayed and include the following information:
- FFY ATTESTED-ESTABLISH 4M ELIG AND VERIFY FFY STATUS,
- District,
- Foster Care Case Worker Number, and
- Foster Care Case Number (when there is no case number a new case number must be generated and assigned as urgent).
The youth’s FFY MC must be still be validated. The process detailed in Self Attestation applies to this population.
Self Attestation
When the potential former foster care youth is applying for FFY MC and was court dependent at the age 18 outside of Santa Clara County 4M must be immediately established based on “Self-Attestation” (the youth declaring being in foster care at age 18). It is the responsibility of the FC EW to determine eligibility under the FFY MC program. A reasonable period of 30 days must be established. During this period the FC EW must approve aid code 4M then verify the county of jurisdiction where the youth was in FC on their 18th birthday.
FC EW must use all available resources to validate eligibility including but not limited to:
- The FFY MC application,
- MEDS,
- Child Welfare Services/Cases Management System CWS/CMS,
- CalWIN,
- E-mails to the county or state where dependency was established,
- Phone contact, or
- Any resources available to determining the youth’s eligibility.
When FFY MC is authorized, the FC EW must issue the “Conditional Approval of Eligibility for FFY (MC 239 FFY-2). After verification is received and the youth is eligible for FFY MC, the “Approval of Eligibility for FFY (MC 239 FFY-1) must be sent.
Not Eligible for FFY
When the FC EW has determined the youth is not eligible for MC under the FFY program the FC EW must thoroughly document their efforts in CalWIN Case Comments and send the following to the youth:
- Manually generate a Denial/Discontinuance of Benefits NOA (239A) using Code M10809 with the application date and the discontinued date at the end of the second month.
- The reason for denial/discontinuance is free from text and must include the following:
- This Notice applies to: The applicant’s name
- The Reason for the Denial: We have determined that you are not eligible for Former Foster Care Children Medi-Cal benefits. Our records indicate you were not in foster care on your 18th birthday.
- You have failed to provide all the necessary information listed here: Proof that you were in foster care placement on your 18th birthday. To be evaluated for another Medi-Cal program the enclosed documents must be completed and returned in the enclosed envelope for Medi-Cal Eligibility processing “California Code of Regulations, Title 22, Sec 5 Section 14005.28”.
- The reason for denial/discontinuance is free from text and must include the following:
The FC EW must also include the following additional documents:
- The CCFRM 604, and
- Self-Stamped Envelope returned to VMC for processing.
When it is determined that the youth is not eligible for FFY MC, the FC EW will allow at least 30 days from the date the above documents were sent before closing their case unless notified by DO that a new case is established. If the documents are returned to the FC bureau they must be sent to VMC for Medi-Cal expedited eligibility processing. The FC EW cannot close their case until the documents are reviewed by VMC staff. The case must remain in 4M until a new Medi-Cal program is approved.
Note: The “Not Eligible for FFY” process also applies to potential former foster care youth that were determined to be not eligible for FFY MC and applies for the program again. In this circumstance the 30 day eligibility period is not required.
ICT Requirements for FFY Child
When the former FC youth moves to another county FFY MC follows the youth.
- The following forms must be sent when initiating an ICT:
- Documentation that the youth was receiving FC on their 18th birthday. Which may include the following:
- Copy of FC discontinuance NOA.
- MEDS screen with month the youth went from Foster Care to FFY MC.
- When available, a copy of the order that terminated dependency.
- When available, a copy of the last MC 250 or MC 250A.
- A completed “Notification of Medi-Cal Intercounty Transfer” (MC 360),
- The “Sending County” portion “Medi-Cal Intercounty Transfer Packet Receipt” (MC 360 R), and
- If not a citizen, MC 13 and copy of an immigration document if available.
Note: The above documents are also required for incoming ICTs, however, if the youth “Self Attest” the FFY MC eligibility MC must be established based on the Self Attestation process.
Retroactive Eligibility for FFY
Former FC youth under the FFY MC program may request retroactive Medi-Cal coverage.
Note: For more information regarding the Retroactive Medi-Cal Handbook Chapter 5.18.
FFY and SSI
Former FC youth that received SSI benefits may receive FFY MC when they are under the age of 26 and they are no longer eligible for SSI benefits. If, however, they are receiving disability-based SSI benefits, they must remain in the appropriate SSI. When SSI is terminated, FFY MC must be restored.
Current Residence Address
A current California address is necessary for the youth is to continue to receive FFY Medi-Cal benefits without any interruption. When a current address is unknown, the FC EW must use the address at “The Hub Resource Center” which is at 591 North King Road Suite 1, San Jose, CA 95133. When the current address is known and the FFY is living out of state, the FFY must be notified that MC will be discontinued (see “Not Eligible for FFY,” page 34-33).
Forms/Verifications/NOA
The primary method of establishing entitlement to the FFY Medi-Cal program is through the CalWIN and MEDS query completed during the applicant ID process. If it is determined that the applicant was in one of the appropriate s on their 18th birthday, they are entitled to FFY MC. Information related to eligibility may be obtained from the closed foster care case record, the county or state with jurisdiction over the former FC youth on their 18th birthday or any resources available that can validate the youth’s dependency or in a FC at 18 years old.
The following NOAs were developed for the FFY MC program:
- Important Notice About a Change in Medi-Cal (MC 239 FFY)
- This NOA is used when the youth is approaching the age of 26.
- Approval Of Eligibility for FFY (MC 239 FFY -1)
- This NOA is for FFY whose former FC status has been verified and benefits are approved.
- Conditional Approval of Eligibility for FFY (MC 239 FFY-2)
- This NOA is to notify the FFY that they are pending verification of the former foster care status, including self-attesting youth.
- Automatic Renew of Eligibility for FFY Medi-Cal Program (MC 239 FFY-3)
- This NOA is for the annual redetermination process who are currently in 4M and are under 26 years old.
- Notice of Continuing in Medi-Cal Coverage through FFY Medi-Cal Program (MC 239 FFY-4)
- This NOA is used for FFY who were placed in an incorrect aid code and their Medi-Cal benefits were placed into the correct FFY coverage group. These individuals may consist of FFY who were assigned an incorrect aid code through CalHEERS or CalWIN. This NOA is also utilized to inform the youth exiting FC at age 18 or older that they have been automatically approved for the FFY MC program.
Note: The above NOAs are available in CalSAWS must be manually generated.
Statement of Facts
DHCS developed a one-page Statement Of Facts for individuals between the ages of 18 and 26 who were in Foster Care placement on their 18th birthday. The form is the “Application and Statement of Facts For An Individual Who Is Over 18 and Under 26 And Who Was In Foster Placement On His Or Her 18th Birthday” (MC 250A).
Individuals can apply for FFY MC using the MC 250A however if an individual applies using any other form of application (i.e. mail in application, BCW, or SSApp, or CalHEERS it must be accepted. No other application is required.
Redeterminations (RD)
Annual RD are not required for the FFY MC program, however, since all income and resource tests are waived, it is limited to confirming the client’s current address to verify California residency. CalWIN was modified for this change. When necessary, FC EW will need to complete the CalWIN RRR process to ensure the case does not shut down.
FC EWs are not required to make contact with the client or required to receive an updated MC 250A for the RD process. The FFY MC must remain active until the beneficiary reaches 26, or is discontinued from the program due to moving out of state, is deceased or notifying the FC EW of the desire not to continue in the program. FFY youth must receive an annual RD NOA noting there benefits are continuing. The “Automatic Renewal of Eligibility for Former Foster Youth Medi-Cal Program” (MC 239 FFY-3) must be sent. CalWIN currently will not issue the MC 239 FFY-4, it must be manually generated during the annual RD process.
During the annual RD and it is discovered the youth is incarcerated, the FC EW must follow the steps outlined in section 34.12.14 on page 36.
Note: There is no requirement to complete any forms at the annual RD for the FFY as long as they are under the age of 26 years old.
District Office FFY MC Procedures
District Offices must screen all Medi-Cal applicants from 18 through 26 years of age, whether applying in person, by phone or through the mail-in application process, through CalHEERS to determine if they are entitled to the FFY Medi-Cal program.
In order to identify this population, screening may include but is not limited to the following questions:
- Was the applicant in FC on their 18th birthday?
- Was the applicant terminated from FC because they reached age 18, 19, 20 or 21?
FFY Medi-Cal applications received at District Offices must be accepted and forwarded to the Foster Care Bureau for processing see to Self Attestation section 34.12.7 on page 32).
No Longer Eligible for FFY Medi-Cal and Approaching 26
When the FC EW is able to validate that the former FC youth has moved out of California, FFY MC must be terminated. The FC EW must send a NOA to the youth at least 10 days before benefits are discontinued (see section on page 33). The FC EW must set a case alert to discontinue MC at the end of the month after the NOA was sent.
When the FC EW determines the youth is deceased, the “Medi-Cal NOA Discontinued Notice Deceased Person” (MC 239 R) must be sent to the last known address and the case must be closed at the end of the month.
When the FC EW has determined the youth is incarcerated the procedures outlined must be implemented.
When the youth is approaching 26 years old, the county must initiate the redetermination process no later than 120 days prior to the youth’s 26th birthday for youth covered under the MCG to determine if the youth is eligible for another MC program.
A listing called “4M Individuals Turning 26 in 120 Days” will be available in Business Objects. The following table describes the actions to be taken 120 days before a FFY turns 26 years old.
- BSC MA
- On a monthly basis, sends list of FFY turning 26 years old in 120 days to BSC Outstation FC EWs.
- BSC Outstationed FC EWs
- Receives FFY list.
- Mails FFY cover letter (SCD 2465) and “Request for Household Information” form SCD 2350.
- Write worker number on the envelope and SCD 2350 form.
- BSC Outstationed FC EWs
- If FFY provides the necessary information from the SCD 2350 over the phone, mail, or in-person, then document forms received in Search Case Comments using Case Comment Type - FFY Turning 26 Forms Received.
- BSC MA
- At least 30 days (1st of the month) before the FFY turns 26 years old, send the list of FFY turning 26 years old in the next month to BSC Outstation FC EWs. This list will exclude cases with Case Comment Type - FFY Turning 26 Forms Received.
- BSC Outstationed FC EWs
- Mail MC 355 requesting SCD 2350 or the necessary information from the form and allow 30 days.
- If forms are received, document forms received in Search Case Comments using Case Comment Type - FFY Turning 26 Forms Received.
- - If FFY provides the necessary information from the SCD 2350 over the phone, then document forms received in Search Case Comments using Case Comment Type - FFY Turning 26 Forms Received.
- Mail MC 355 requesting SCD 2350 or the necessary information from the form and allow 30 days.
A listing called “4M Individuals Turning 26 in 30 Days” will be available in Business Objects. The following table describes the actions to be taken in the month of the FFY’s 26th birthday.
| In the month of the FFY’s 26th birthday, EWs must... | Then.. |
| Search for CalSAWS Journal Type - FFY Turning 26 Forms Received, |
Note: The youth must remain in the FFY program with aid code 4M while being determined for all other MC programs.
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| Review listing called 4M Individuals Turning 26 in 30 Days, |
Review the case and imaging for the SCD 2350. (The form or necessary information may have been received since the case was reviewed 30 days ago.) Note: If the form is already in imaging (for example, the FFY provided it at initial application or there are other household members on the case with the information), then the EW can use that information to make a MC eligibility determination.
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