Miscellaneous Medi-Cal Only Determinations for Foster Care and Kin-GAP

FC Child’s Income Exceeds Cost of Care

When a child or youth is removed from the home and placed in FC Medi-Cal aid code 45 is established. When aid code 45 is established and the child or youth is not eligible for AFDC-FC funding because the child or youth has returned home, CEC is available for children under the age of 18 years old.

When child or youth receiving foster care or Kin-GAP benefits has income that exceeds their income limit and benefits are terminated before their 18th birthday, the child or youth is eligible for CEC. When FC benefits are terminated because of income and the youth is 18 years old and under 21 the youth is eligible for FFY until the age of 26. See Medi -Cal Eligibility for Former Foster Youth (FFY) 18 to 26 Years of Age Aid 4M.

Exception: The youth may remain a dependent of the court but FC payments are terminated because of income, aid code 45 may still be used.

Child Residing in a Home for the Developmentally Disabled

If a child is residing in a board and care home for the developmentally disabled (i.e. San Andreas Regional Center), and SSI is pending:

Although the regional center may be providing financial assistance, aid code 45 may not be used unless the court has appointed the regional center as the child’s conservator, guardian or executor.
The parent(s) or legal guardian must complete the “Application for Health Insurance” (CCFRM 604) if they are still financially responsible for the child; however, the regional center may complete their own application if the parent or guardian is not available.

Children or Youth Receiving Wraparound Services

Children or youth who are eligible for Wraparound Services are also eligible for Medi-Cal benefits under the Medically Needy Program or under other potentially applicable Medi-Cal programs and shall remain eligible for Medi-Cal during their participation in the Wraparound Services Program.

Children/youth in Wraparound Services Program who receive benefits under Title IV-E (Federal) are eligible for Medi-Cal benefits as long as Title IV-E Foster Care payments are made on the individual’s behalf. These individuals are placed in aid code 42 and when they are NMD, they are placed in aid code 49. Children who are eligible for Non-Federal Foster Care benefits will be placed in aid code 40 and NMDs will be placed in aid code 43.

Individuals who receive AAP benefits are to remain on their respective Medi-Cal program while receiving Wraparound services in aid code 03 for the Federal program and aid code 04 for the Non-Federal program. Only Federal AAP youth are eligible for extended benefits under the extended AAP program, therefore these youth are to be placed in aid code 07.

Individuals who are currently wards under the jurisdiction of JPD shall have Medi-Cal established by FCE and Wraparound is added to the established Medi-Cal case. The Wraparound payment is issued under aid code 40 but the Medi-Cal is active under aid code 45.

Children receiving Wraparound who have returned home to their biological parents and are in a district office CalWORKs and/or MC case, must have Medi-Cal established by FCE under aid code 45 while the district office case remains open. Under no circumstances should aid codes 4H/4L be used in this situation. In order to complete this, the Eligibility Worker will have to perform a BLO in CalWIN for aid code 45 and suppress MEDS transaction in CalWIN

The worker must then submit a “Request for Online Transaction” form (SCD 1296) to activate aid code 45 in MEDS. The youth’s record in MEDS will display aid code 45 on the Q1 screen and the CalWORKs aid code on the QM Screen.The Wraparound payment is issued under aid code 40.

Youth receiving Medi-Cal using aid code 45 are only eligible for this program while participating in Wraparound Program. When Wraparound is terminated, their aid code must be changed the following month after Wraparound is terminated to 7J until the next RD date or FFY when the youth is 18 years or older under 4M. There is no eligibility for Medi-Cal aid code 45 upon termination of Wraparound after the end of the month.

Note: For more information regarding the Wraparound Program refer to Wraparound Program.

Infants Born to Youth in FC and Kin-GAP

Infants born to FC and Kin-GAP recipients are eligible for Medi-Cal benefits under their parent’s case. These infants are Deemed Eligible (DE) based on their parent’s current FC or Kin-GAP placement. There is no separate Medi-Cal application or eligibility determination needed on the parent or the child. The infant must be added to their parent’s case when notified by the SW/PO, provider, or any other outside sources including applications received from CHDP Gateway program (refer to Medi-Cal Handbook Chapter 29.3). This provision includes mothers in the EFC and Extended Kin-GAP program.

When the FC EW is notified by any source other than the “The Statement Of Facts Supporting Eligibility for AFDC-FC” (FC 2), Medi-Cal must be established immediately. The FC EW must follow-up with the SW/PO by requesting a completed FC 2.

If at any time the infant becomes a dependent of the court and removed from the mother a new case must be established and infant supplements under the mother’s case must be terminated.

Note: In addition to MC, Infants born to FC and Kin-GAP recipients are entitled to infant supplements. Refer to Infant Supplement for more information.

Medi-Cal Aid Codes for the Infants

Using the minor parent’s aid code and case number, the infant is added to the parent’s case with the same aid code. Infants born to NMD parents in EFC or Extended Kin-GAP program use their parent’s case number however, the infant cannot use their parent’s aid code and must use the aid code as stated below.

Note: Parenting fathers may include their child in their FC or Kin-GAP case and are also eligible for infant supplements.

The following apply to infants born to parents receiving FC or Kin-GAP: