Medi-Cal Eligibility for Former Foster Youth (FFY),

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 Affordable Care Act (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 transitioned seamlessly into the FFY program without being terminated, having to reapply, or providing 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.

The Department of Health Care Services (DHCS) established aid code 4M for FFY MC and provides enrollment guidance for the program, including the treatment of mandatory coverage groups (MCG and optional coverage groups (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 who received non-Federal Foster care payments but were not approved for Medicaid. This group includes youth who 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, which interfaces with 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 who 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 Approved Relative Caregiver (ARC funding. Youth with court dependency who are discontinued from CalWORKs or ARC at age 18 are eligible for FFY MC. Contact with the SW/PO may be required to determine if dependency existed 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 notice of action (NOA advising the youth that FFY MC benefits will be restored and notify the FC bureau to restore their FFY MC case. No additional application is necessary to restore FFY MC. Youth who enter Santa Clara County from another county or state and are eligible for FFY MC must have their information sent to the FC bureau to establish a FFY MC case.

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 district office (DO for processing.

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 a 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 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 receiving Supplemental Security Income (SSI) (If SSI is terminated and the 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 age 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, email, BCW, 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 form (MC 250A). Although an application is not necessary to approve FFY MC, it does expedite processing.

FFY MC applicants are not required to provide proof that 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 expedited 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 being in foster care at the age of 18.

The following rules apply:

Youth in California who 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 continue to meet the criteria and wish to retain Medi-Cal coverage. This includes youth enrolled in the Transitional Housing Program Plus (THP+ program.
Youth who 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 the 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 SSI.
A new FFY MC case must be established when the youth received FC in another county or state or an inter-county transfer (ICT.

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 the 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 form (MC 330) for the infant’s Medi-Cal must be sent to the former FC youth.
The returned MC 330 must be forwarded to the district office.
When the district office establishes a case, the FFY MC must remain active in 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: If the FFY 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 county-organized health system (COHS where enrollment is mandatory. To enroll in COHS, MEDS must be updated with the current resident code.

NMD or Youth Exiting Foster Care With A Child Over 1 Year Old

When the youth is no longer eligible for FC and has a child 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)
Self-Stamped Envelope to be returned to VMC for processing.

When Valley Medical Center (VMC) establishes an MC 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 be restored at the FC bureau.

Note: If the FFY loses custody of their child or the child is no longer in their care and control and the FFY is under 26, 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, which interfaces with CalSAWS. CalSAWS will update the Verification Source field in the Demographics page.

A Verification Source will include one of the following entries:

California documents
American Indian or Alaska Native Tribal document
Not Received
Out-of-State document
Questionable

The page will also include a State Verification Source that will include one of the following entries:

Electronic and Service Center
Electronic Only
Service Center Rep Only

The FC EW is required to validate the Verification only and update the 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 Qualified Health Care (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 (HPE)

The Patient Protection and ACA of 2010 was amended by the Health Care and Education Reconciliation Act of 2010, which requires the implementation of the Hospital Presumptive Eligibility (HPE Program (refer to Hospital Presumptive Eligibility Program). Eligible FFY may be hospitalized and enrolled in the HPE program under aid code 4E.

MEDS will generate a new worker alert [9068] for counties to update the HPE FFY aid code from 4E to 4 M immediately. 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
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 still be validated. The process detailed in Self Attestation applies to this population.

Self Attestation

When a potential former foster care youth applies for FFY MC and was court-dependent at the age of 18 outside of Santa Clara County, 4M must be established immediately based on “Self-Attestation” (the youth declaring that they were in foster care at the age of 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.
The 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
CalSAWS
Emails to the county or state where dependency was established
Phone contact
Any resources available to determine the youth’s eligibility.

When FFY MC is authorized, the FC EW must issue the Conditional Approval of Eligibility for FFY form (MC 239 FFY-2). After verification is received and the youth is eligible for FFY MC, the Approval of Eligibility for FFY form (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 a CalSAWS Journal and send the following to the youth:

A Denial/Discontinuance of Benefits notice of action(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 form 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 FC EW must also include the following additional documents:

The CCFRM 604
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 has been 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 the 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 who were determined to be not eligible for FFY MC and apply 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. Documentation indicating that the youth was receiving FC on their 18th birthday must be sent when initiating an ICT. Documents may include the following:

Copy of FC discontinuance NOA.

MEDS screen with the 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 form (MC 360).

The “Sending County” portion of the Medi-Cal Inter-county Transfer Packet Receipt form (MC 360 R).

If not a citizen, an MC-13 and a 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, the 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. For more information, refer to

Retroactive MC.

FFY and Supplemental Security Income (SSI)

Former FC youth who received SSI benefits may receive FFY MC when they are under the age of 26 and are no longer eligible for SSI benefits. If, however, they are receiving disability-based SSI benefits, they must remain in the appropriate SSI program. When SSI is terminated, FFY MC must be restored.

Current Residence Address

A current California address is required for the youth to continue receiving uninterrupted FFY Medi-Cal benefits. 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 section above).

Forms/Verifications/NOA

The primary method of establishing entitlement to the FFY Medi-Cal program is through the CalSAWS and MEDS query completed during the applicant identification process. If it is determined that the applicant was in one of the appropriate aid codes 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 placement 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 CalSAWS. 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 the one-page 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 form(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)

All income and resource tests are waived for annual RD The redetermination is limited to confirming the client’s current address to verify California residency. When necessary, the FC EW will need to complete the CalSAWS 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 notifies the FC EW of the desire not to continue in the program. FFY youth must receive an annual RD NOA noting their benefits are continuing. The Automatic Renewal of Eligibility for Former Foster Youth Medi-Cal Program form
(MC 239 FFY-3) must be sent.

If during the annual RD it is discovered the youth is incarcerated, the FC EW must follow the steps outlined in Suspension of Medi-Cal Benefits for Incarcerated Juveniles

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, the mail-in application process, or 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.

No Longer Eligible for FFY Medi-Cal and Approaching 26

When the FC EW confirms that the former foster youth (FFY) has left California, they must discontinue MC and send a timely Notice of Action (NOA) to the youth at least 10 days prior to benefits being discontinued.
If the worker determines that 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.
If the worker determines that the youth is incarcerated, the Suspension of Medi-Cal Benefits for Incarcerated Juveniles procedures must be followed.

120 Days Before Age 26

The FC EW must initiate the redetermination process no later than 120 days prior to the youth’s 26th birthday to determine if the youth is eligible for another MC program.

CalSAWS

CalSAWS automatically mails the FFY packet 120 days prior to the youth's 26th birthday. The system also generates a Journal indicating the packet was mailed out.

Birthday Month

In the month of the FFY’s 26th birthday:

If the FFY packet is returned, the FC EW will forward the completed packet to BACAppRegTeam@ssa.sccgov.org for evaluation of ongoing Medi-Cal eligibility.

Note: All packets received prior to the FFY’s 26th birthday month will be held and forwarded to BAC during the month they turn 26.

If the FFY or their minor children are active on a district office case, the FC EW will contact the assigned worker or BACTMTTeam@ssa.sccgov.org to add and evaluate the FFY for ongoing Medi-Cal eligibility.
If the youth is not active on a district office case or does not return the FFY packet, CalSAWS will automatically discontinue the case and provide a timely NOA.