Extended Medi-Cal Eligibility for Former Foster Youth (FFY) 18 to 26 Years of Age

Youth eligible for FFY Medi-Cal are exempt from a Modified Adjusted Gross Income (MAGI) determination and all income is disregarded for this group. Youth eligible for this program are entitled to full scope zero SOC MC 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, CalFRESH, GA or CalWORKs must stay on their current program but if the program is discontinued, their FFY MC status must be reactivated. In order to determine correct eligibility for aid code 4M the client’s FFY status must be verified by the Foster Care unit, DHCS established Aid Code 4M to be used for youth eligible for FFY MC. Effective January 21, 2014, CalWIN began interfacing with the California Health care Eligibility Enrollment and Retention System (CalHEERS). Youth eligible for FFY MC can apply through the CalHEERS system. The application will be interfaced from CalHEERS to CalWIN for processing.

Who is Eligible

Eligible Youth 18-26

FFY who were in one of the following aid codes on their 18th birthday are entitled to FFY MC:

Aid Code	Program 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 State 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)

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.
FFY 26 years old and older.
FFY 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 FFY 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 district office and completing any Medi-Cal application or by completing an application through CalHEERS. The applicants may also apply by telephone, e-mail, Benefits CalWIN (BCW) or SSApp, FAX, or mail. All applications on which the client declares to be an FFY must be screen by the Foster Care unit to verify their FFY status.
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 the application.

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.

All FFY MC applications require expedite processing and must be approved immediately with a 30 day reasonable opportunity to verify their eligibility. Aid Cod 4M must be used. FC EWs are required to validate eligibility for the FFY MC program.

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 Transitional Housing Placement Plus (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.
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.
A new FFY MC case must be established when the youth received FC in another county or state or an ICT.

The youth may decline MC coverage under the FFY program, they can be enrolled in unsubsidized Covered California coverage however, they would not eligible for “Advance Premium Tax Credit” (APTC)/Cost Sharing Reductions” (CSRs) because they are eligible for MC and declined it. If they qualify for free MC and choose to keep a Covered California plan, their monthly premium will increase.

Deemed Eligible Infant with FFY Youth Parent

When the FFY youth has an infant the infant is added to the same case. 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 be sent to the former FC youth.
The FFY MC must remain active in the FFY MC Aid Code. The case will remain in DO unless the former foster youth loses custody of the child and the child is no longer in their care, the FFY only case can then be transferred to the Outstationed Foster Care unit.
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 MC rules.

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.

Non-Minor Dependent (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 the following must be sent to the client:

The Application for Health Insurance (CCFRM 604) and,
Self-Stamped Envelope to be returned to MBA for processing.

When a case is established the former FC youth must remain active in the FFY MC Aid Code until 26. The district office case must remain in district office during the eligibility period for FFY MC unless the former foster youth loses custody of the child and the child is no longer in their care.

Eligibility of the former FC youth’s child must be established based on existing MC rules.

FFY and CalHEERS

Youth may apply for FFY MC through CalHEERS. CalHEERS will interface their application with the CalSAWS system.

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 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 Qualified Health Care Plan (QHC), the youth must be disenrolled. When CalSAWS is updated a transaction is sent to CalHEERS to update the youth’s record.

Former Foster Youth (FFY) Application Process

An application for Former Foster Youth linked Medi-Cal can be submitted at any intake office, the FFY status must however be verified by the Foster Care Unit prior to the approval of the 4M aid code.
Follow the process below to determine if the applicant is eligible for FFY MC and who is responsible for application processing:

Applicant
1. Declares on their application that they are FFY.
Intake Eligibility Worker (EW)
1. Sends an e-mail to the Foster Care unit via the FosterCareDEBSTriage e-mail box in order to confirm FFY status and includes the following client information:
  1. Name
  2. Date of Birth
  3. SSN
Foster Care Unit Triage EW
1. Confirms if the client is in fact a FFY and responds via e-mail to the Intake EW.
Intake EW
1. Receives response from the Foster Care Triage EW and takes the following action:

If the Client is ...	And...	Then...
Not an FFY	N/A	Evaluates the applicant for other potential MC eligibility based on existing business process.
Confirmed to be an FFY	Has also applied for and is eligible for CW	Evaluates the applicant for CW and approves the CW aid code Forwards case to appropriate DO (these cases are not maintained by the FC bureau) Note: A determination for 4M is not required at this time.
Confirmed to be an FFY	Is applying for MC only (and is the only AU member)	Forwards the application to the Foster Care unit via the FosterCareProcessing e-mail box for processing.
Confirmed to be an FFY	Is applying for MC with other non FFY AU members or is applying for additional benefits (i.e., GA, CF)	Determines eligibility for all HH members, including the FFY individual Forwards case to appropriate DO (these cases are not maintained by the FC bureau)

Refer to JA Medi-Cal Former Foster Youth (FFY) 4M Process.

Important: If a client is active on FFY Medi-Cal (4M) and they apply for CF and/or a cash program the Intake EW must request that the FC EW discontinue the existing 4M case and open a new case in order to approve the MC and new program eligibility.