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Interstate Compact on Adoption and Medical Assistance (ICAMA)
ICAMA
WIC Sections 16170-16177, ACIN I-29-02
The Interstate Compact on Adoption and Medical Assistance (ICAMA) protects the interests of special needs children by ensuring the delivery of Medicaid and other services to AAP and federally eligible Kin-GAP children when they move with their families to another state. The District of Columbia and 49 states are members of ICAMA. The State of Wyoming is a non-member.
Verification of ICAMA member states and contact information can be found on the “Association of Administrators of the Interstate Compact on Adoption and Medical Assistance” (AAICAMA) website at https://aaicama.org or AAICAMA and in S:\Sharelib-DFCS\EW Tools\ICAMA.
The California Department of Social Services (CDSS) and the Department of Health Care Services (DHCS) are state co-compact administrators of the ICAMA. State administrators work with the AAICAMA for all member states in accordance with ICAMA bylaws, procedures, and forms. All member states must comply with ICAMA procedures and use only approved ICAMA forms.
Contact Information for AAICAMA
AAICAMA
727 15th Street, NW, 12th Floor (Suite1200)
Washington, DC 20005
help@aaicama.org
Phone (202) 913-3266
AAICAMA website: https://aaicama.org
Contact Information for California ICAMA Administrator
ICAMA Deputy Compact Administrator
Adoptions Policy & Support Unit
8880 Cal Center Drive, Suite 330, MS 19-30
Sacramento, CA 95826
Telephone: (916) 574-2460
Fax: (833) 421-8505
Email Address: ICAMA@dss.ca.gov
Federal Kin-GAP and ICAMA
Sections 473(b)(3)(C) of the Social Security Act
Effective October 7, 2008, Public Law 111-351 added provisions to the Social Security Act to include Kin-GAP as a third category of assistance under Title IV-E (federally funded) along with FC and AAP. This provision included federally recognized tribes beginning October 1, 2009. The provision added the requirement for Medicaid coverage for children/youth eligible for Title IV-E Kin-GAP so that these children are automatically eligible for Medicaid the same as AAP children/youth without a separate Medicaid application or an annual Medicaid eligibility redetermination. Thus, this population is categorically eligible for Medi-Cal in the state of California and must follow the same requirements as the AAP ICAMA program. This provision includes both initiating and responding to ICAMA requests.
These children or youth will use the Medi-Cal aid code 4T or 4S until the state provides an appropriate aid code.
Note: There is no requirement for non-federal Kin-GAP children/youth to automatically receive Medicaid services.
For paper-based cases, the ICAMA Form 7.01 is modified to include Title IV-E GAP (federally funded Kin-GAP). When the Kin-GAP child has changed address, the SCD 2339 must be sent. Refer to Change of Address Within California.
CDSS ICAMA Responsibilities
As Co-Compact Administrator, the CDSS works with officials in California and other states to facilitate the provision of healthcare benefits and services for children who are Title IV-E AAP or Kin-GAP eligible. CDSS monitors and enforces compliance with ICAMA guidelines and procedures, serves as an information resource and acts as a liaison for counties, adoptive families, and the AAICAMA.
DHCS ICAMA Responsibilities
As Co-Compact Administrator, DHCS confirms that for incoming cases, the child is Medi-Cal eligible and has the appropriate aid code by performing a file clearance in the Medi-Cal Eligibility Data System (MEDS). The DHCS will ensure that Medi-Cal eligibility is established and provide technical assistance for questions regarding Medi-Cal to California counties when needed.
County Responsibilities
The County must process both incoming and outgoing ICAMA requests. Incoming requests are received by the Foster Care Program Coordinator.
A child who is eligible for Medicaid benefits based on the Title IV-E AAP or Kin-GAP agreement is automatically eligible to receive Medicaid in the receiving state. However, a child who receives state-funded AAP does not qualify for Medicaid in the receiving state unless that state has a reciprocal agreement with California to provide health care services (refer to EW Tools Folder for reciprocity chart). For state-funded AAP cases, the county should advise the family that the child will retain Medi-Cal eligibility to receive health care services from an out-of-state provider who is willing to accept payment under Medi-Cal.
Note: Incoming state-funded Kin-GAP cases are not eligible for Medicaid in California.
For incoming cases, the counties are responsible for verifying eligibility, activating new Medi-Cal cases, updating the status of existing Medi-Cal cases, and providing notifications of action to families and agreement states. This needs be completed within 48-72 hours.
For outgoing cases, the counties are responsible for providing requests for new Medicaid cases as well as status updates for existing cases to families and residence states.
For ICAMA cases where the transfer of Medicaid for an adopted child of an Indian tribe is involved, the county will collaborate with the tribe and CDSS to ensure the transfers are executed properly.
Making Contact with Another State or County
Individual state contact information is available via https://aaicama.org/cms/. The most recent California county contact list is saved to the S:\Sharelib-DFCS\EW Tools\Resource\Contact List folder. Intake and Continuing EWs may reach out directly to individual ICAMA state or county contacts.
ICAMA Definitions
Agreement State (AS)
The AS is the state that signs the Adoption Assistance or Kin-GAP agreement regarding benefits to a particular child(ren). It is referred to as the "Sending State."
Residence or Receiving State (RS)
The RS is the state in which the child currently lives. It is obligated to provide Medicaid/Medi-Cal to the child.
When To Apply ICAMA
ICAMA applies to an AAP or federally eligible Kin-GAP child who:
• Moves across state lines, or
• Is initially placed out of state for adoption, or
• Is in residential treatment in a state other than the AS.
ICAMA System
The ICAMA System is the vehicle for communication and collaboration between states to open/close Medicaid and ensure the continuous receipt of support benefits for both AAP and federally eligible Kin-GAP cases. It replaces the existing paper-based forms (7.01 and 7.5) process for all new ICAMA cases (both outgoing and incoming) initiated on and after August 2023. Directions on how to use the System are located in the shared drive EW Tools Folder/ICAMA System.
While other documentation (such as agreements) can be uploaded to the System, the ICAMA 7.00 is the only form used within the System to exchange information for requests, redeterminations and updates.
Reminder: All forms generated or received in the System must be imaged to the case file.
Effective August 2023, the ICAMA System will be used by California and its counties for all new incoming and outgoing ICAMA cases.
New York (NY) will continue to complete "paper" forms (7.01 and 7.5), provide wet signatures and send requests via email or fax. NY is the only state from which an EW may request a wet signature. California counties must continue using paper forms when sending a referral or communicating information with New York.
Existing ICAMA Cases
All existing ICAMA cases that started with ICAMA 6.01, 7.01, and 7.5 paper forms will continue to use paper forms until the case is closed. These cases will not use the 7.00 form or the ICAMA System for any activity.
However, if an outgoing CA case was initiated with paper forms, then the child and family move to another state, we may initiate a new referral to the new resident state via the ICAMA System.
Using the ICAMA System
For new cases established on or after August 2023, states communicate with one another on the System by using ‘teams’. This allows the AS and RS to organize and share all relevant information about a single child or youth in a central location.
System Workflows
Incoming Case at Intake
1. The FC Program Coordinator receives a 'team invite' via the System from the CA State Compact Administrator regarding the case.
2. The Coordinator emails the 7.00 form to FC Clerical for task assignment.
3. Clerical assigns the task to an EW and copies the Coordinator.
4. The Coordinator sends a team invite to the assigned EW Intake Supervisor via the System.
5. The Intake Supervisor sends a team invite to the assigned Triage EW.
6. Triage EW opens the case in the System and reviews documents.
7. After review, the Triage EW forwards documents to Clerical and requests case transfer to Intake.
8. Clerical assigns case to Intake.
9. Intake Supervisor removes the Triage EW from the System team and sends an invite to the assigned Intake EW.
10. Intake EW processes the case, alerts the Intake Supervisor, and requests Clerical to assign the case to MC-Only Continuing EW.
11. Clerical assigns the Continuing EW and alerts the Intake Supervisor.
12. Intake Supervisor removes the Intake EW from the System Team and sends an invite to the MC-Only Continuing EW.
Incoming Case at Continuing
1. The Continuing EW receives a task to manage the incoming case.
2. The Continuing EW receives the System team invite and removes the Intake Supervisor from the Team. The FC Program Coordinator remains on the team as the backup point of contact.
3. Continues case maintenance process.
Outgoing Cases
When a family moves from California to another state:
1. The assigned EW will enter the case into the ICAMA System, upload required documents, and add team invites to the RC, the California ICAMA administrators, and the FC Program Coordinator (as a backup).
Reminder: The 7.00 form and uploaded documents must be imaged to the case file.
2. The RS receives team invite and processes the Medicaid request.
ICAMA Required Forms
Only the ICAMA 7.00 will be used in the System for all activities. A copy has been saved to the DEBS Forms Library.
Existing cases (before the System implementation) will continue to use the ICAMA 7.01 and the "Case Updates" (ICAMA 7.5) paper forms.
In addition, an adoption or Kin-GAP agreement must be received for all incoming cases and sent out for all outgoing cases. The Santa Clara County versions of these agreements are the "Adoption Assistance Program Agreement" form (AD 4320) and the "Kin-GAP Program Agreement Amendment" form (SOC 369A).
For Historical Purposes
Effective June 2022, AAICAMA has obsoleted the use of the forms with an asterisk (*). This chart has been saved for historical purposes.
| ICAMA Form # | Description | Distribution |
| 7.00 | Only form used in the ICAMA System. | All persons on the team will receive an alert and be able to view/download/print the form. |
| 7.01 |
Revised form name to: California and New York Request for Medicaid Case Activation Used for paper-initiated cases. |
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| 7.02* | Notice to Families |
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| 7.02b* | Important Information for Families |
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| 7.5 |
Revised form name to: Used for paper-initiated cases. |
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| 7.5 Additional* |
Additional (only to be used in conjunction with the ICAMA 7.5) Used for paper-initiated cases. |
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7.5b* |
Important Information ICAMA Professionals |
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SCD 75* No longer used as of 2/7/24 |
Title IV-E Foster Care and Adoption Assistance Children Residing Outside of California |
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ICAMA Form 7.00
This is the only form used in the System. It is a multipurpose document used for Medicaid activation, termination, redetermination, etc.
ICAMA Form 7.01 - California and New York Request for Medicaid Case Activation
This form is only used for paper-initiated cases before August 2023.
This form notifies the new resident State that a child, who has a signed adoption assistance or Kin-GAP agreement with a California agency, has moved from California to that State and is eligible for Medicaid. This form provides information related to the child, his/her parents, eligibility, and current residence.
The child’s social security number must be used when completing this form regardless if the County is using a pseudo number in CalSAWS. The social security number is necessary for the host state to activate Medicaid. Use of the social security number in another state will not interface with the California MEDS system.
ICAMA Form 7.5 - Case Updates: Cases Opened with ICAMA 6.01 or 7.1
This form is only used for paper-initiated cases before August 2023.
This form provides notice that a Kin-GAP or adoption has been finalized; that the child has reached the age of majority; that the family has moved to another address in the state; or that the family has moved to another state. This form may be completed by either the AS or the RS.
ICAMA Redetermination Requirements
A Medi-Cal RRR must be performed annually on ICAMA cases. The Continuing FC EW must initiate the following process for ICAMA RRR’s:
• Request proof that Adoption Assistance or Kin-GAP youth is still approved by:
A. For System cases, the worker will request verification from the AS via the System. The AS will respond by sending a 7.00 form.
B. For paper-based cases, the worker will send the 7.5 to the AS via email/mail/fax.
• Complete and sign the MC 250 based on the information obtained from the initiating state.
• If the child is still in receipt of AAP or Kin-GAP benefits, then complete the RRR process.
• If the child is no longer in receipt of benefits, then follow the SB 87 process.
Note: Medi-Cal benefits must continue until the age of 18 or 21 even when no response is received from the initiating state unless it is determined the youth is no longer eligible for AAP or Kin-GAP benefits. The FC EW must notify the initiating state before discontinuing Medi-Cal benefits.
ICAMA Reporting Changes
The sending and receiving states must communicate changes to each other. In the ICAMA System, workers will use the ICAMA 7.00 form. Paper-based cases will use the “Case Updates” form (ICAMA 7.5).
When an AAP or IV-E Kin-GAP recipient family reports an address change to another state, the originating state/county is responsible for initiating the ICAMA process to the new residence state.
ICAMA Temporary Absence
During a temporary absence from the state in which a child is receiving Medicaid, the responsibility for the provision of Medicaid does not transfer between states. The responsibility for providing Medicaid remains with the state in which the child’s parent/s reside. When an absence from a state is considered temporary, the obligation to provide Medicaid remains with the state that had the obligation before the child’s temporary absence.
There is no federal guidance on the number of days that constitutes a temporary stay, it is a matter of judgment that is worked out by the Adoption SW. In general, a child’s summer vacation would be considered a temporary absence, as would a ten-day absence to receive medical care in another state.
When the states cannot agree on which state is responsible for providing Medicaid during a temporary stay, federal regulations stipulate that the state where the child is physically present when the service was received is the state responsible for providing medical services.
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