ICAMA Outgoing to Another State

A.    If the AAP/Kin-GAP child is federally eligible:
Update the address in CalSAWS and send the following documents to the adoptive parent(s) or legal guardian(s), the receiving state and the California ICAMA administrators:

a.    A copy of the “California and New York Request for Medicaid Case Activation” form (ICAMA 7.01) for paper-based cases or the 7.00 form for System cases.
b.    A copy of the most recent “Adoption Assistance Program Agreement” form (AD 4320) (request from the Post Adoption SW), or the "Kin-GAP Program Agreement Amendment" form (SOC 369A). 
c.    Image all documents to the case file.

B.    If the AAP child is non-federally eligible: NOTE: Non-fed Kin-GAP cases are not eligible for Medicaid.
a.    Workers must first verify that the receiving state has “Cobra Option/Reciprocity” by viewing the reciprocity chart in the EW Tools Folder under "ICAMA System."
b.    If the receiving state does have reciprocity, follow procedures as indicated in Step A.
c.    If the receiving state does not have reciprocity, the AAP EW must advise the adoptive parent(s) 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. Otherwise, advise the adoptive parent(s) to apply for Medicaid in their new state as they may be eligible under a different program.

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Continuing Benefits Processing