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 immediately move HPE FFY in Aid Code 4E to Aid Code 4M. 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, and
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 be still be validated. The Self Attestation process detailed in the next section.

Self Attestation

When the potential former foster care youth is applying for FFY Medi-Cal and was court dependent at the age 18 outside of Santa Clara County Aid Code 4M must be immediately established based on Self-Attestation (the youth declaring being in foster care at age 18). It is the responsibility of the FC Bureau to verify MC eligibility under the FFY MC program. A reasonable period of 30 days must be established. During this period the 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 applicant,
MEDS,
Child Welfare Services/Cases Management System CWS/CMS,
CalSAWS,
E-mails to the county or state where dependency was established,
Phone contact, or
Any resources available to determining the youth’s eligibility.

Not Eligible for FFY

When the FC Bureau cannot validate the youth’s eligibility or has determined the youth is not eligible for MC under the FFY program the EW must thoroughly document their efforts in the CalSAWS Journal and send the following to the youth:

Manually generate a Denial/Discontinuance of Benefits Notice of Action (NOA) (MC 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 from 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 EW must also include the following additional documents:

The CCFRM 604, and
Self-Stamped Envelope returned to MBA 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 is 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 their case until the documents are reviewed by VMC staff. The case must remain in Aid Code 4M until a new Medi-Cal program is approved.

Note: The “Not Eligible for FFY” process also applies to potential former foster care youth that were determined to be not eligible for FFY MC and applies for the program again. In this circumstance the 30 day eligibility period is not required.

MFBU Rules

The FFY child is considered PA and is excluded from the MFBU of other family members.

Note: For this program, the FFY child does not provide linkage to the parents.

Income of FFY Child Who Resides With Their Parents and Other Family Members

Income paid to the parents or other family members, for reasonable living expenses, is exempt. Only income in excess of reasonable living expenses is considered income to the MFBU of other family members.

ExampleExample

MFBU family members, including the FFY child, consist of a family of four. The family’s total living expenses (rent and utilities) is $2000. The pro-rated amount ($2000 divided by family of 4) is $500. Each family member’s share of living expenses is $500. The FFY child pays his/her parents $500 monthly for his/her share of living expenses. Since the income to the family does not exceed what is considerable reasonable living expenses, the income is NOT counted to the Other Family Members MFBU.

Retroactive Eligibility

Former Foster Care Children (FFY) entitled to this program may request retroactive Medi-Cal coverage. Retroactive coverage may begin no earlier than October 1, 2000.

FFY and CalWORKs

Relatives who were not eligible for FC payments for a dependent child or youth may choose to apply for CalWORKs. If the youth is discontinued from CalWORKs with court dependency at age 18, the youth is eligible for FFY MC. Contact with the FC bureau may be required to determine if dependency exists on their 18th birthday.

If the FFY 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 NOA advising the youth FFY MC benefits will be restored and notify the FC bureau to restore their FFY MC case. No additional application is necessary to restored FFY MC. Youth entering in Santa Clara County from another county or state and are eligible for FFY MC, their information must be sent to the FC bureau to have a FFY case established.

When the FFY returns to live with his/her parents who are receiving Medi-Cal or CalWORKs, the FFY MC case or status (with mixed households) must remain active. Eligibility for other family members is determined based on existing Medi-Cal rules.

Note: It is important to note the only eligible person in the FFY MC case when the case is active at the FC bureau 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 based the FFY case. The family must be given an application and existing MC rules apply. The former FC youth can be included in the case, however, Aid Code 4M must be used for the FFY.

FFY and SSI

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

District Office Procedures

Application Process

CSTs/EWs in Intake District Offices must screen all MC applicants from 18 through 26 years of age, whether applying in person, or through the mail-in application process, to determine if they are entitled to the extended Medi-Cal program. All applications received via mail-in, BCW, or CalHeers must be reviewed to verify if the applicant has self identified themselves as FFY. If it is determined that the applicant is a FFY youth, then the application is to be forwarded to the Foster Care Bureau for case processing.

Walk-in applicants must be screened by CST’s, while in District Offices, in order to identify and to provide the appropriate application. Screening may include but is not limited to the following questions:

Were you receiving Foster Care benefits on your 18th birthday?
Was the applicant terminated from FC because they reached the age of 18, 19, 20, or 21?

If an applicant at District Office has self-attested themselves as being FFY, CST’s will provide the “Application And Statement of Facts For An Individual Who Is Over 18 and Under 26 And Who Was in Foster Care Placement On His/Her 18th Birthday” (MC 250A) to the applicant for completion. The MC 250A will then be forwarded to the Foster Care Bureau to process.

Note: It is crucial to ask these questions up front to prevent having the former foster care applicant complete any unnecessary MC applications.

Forms/Verifications/Notices of Action (NOAs)

MC applicants who are FFY may complete the MC 250A when requesting Medi-Cal. The MC 250A is a simplified one-page application that takes the place of the “Application for Cash Aid, Food Stamps, and/or Medi-Cal/State CMSP” (SAWS 2 PLUS). The MC 250 A provides all the required information to establish eligibility for the FFY Program.

There are no additional application forms required. However, if an individual self-attests as being FFY and has applied using any other form of application (i.e., mail in application, BCW, or SSApp) it will be accepted and another application will not be required.

Note: An MC 210A must be completed if retroactive MC coverage is requested.

Phone Application Requests

The following procedures must be followed when a phone application request is received.

CSTs/Eligibility Workers/Information Supervisors in the Intake district offices must screen requests for MC from individuals ages 18 through 26, regardless of their living arrangements, with the following questions:

Were you receiving Foster Care benefits on your 18th birthday?, and
Were you terminated from FC because you reached the age of 18, 19, 20, or 21?

Independent Living Program (ILP)

Many former foster care youth are in receipt of services through the Independent Living Program (ILP). ILP makes referrals to Intake offices for youth who were in foster care on their 18th birthday, and have exited the foster care system due to age. Due to the nature of this program, ILP recommends a mail-in or telephone application process.

If the applicant prefers a face-to-face interview, his/her request shall be honored.

NOAs

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 Aid Code 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 MC 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.

Redeterminations

Annual RDs are not required for the FFY MC program, however, since all income and resource tests are waived, it is limited to confirming the client’s current address to verify California residency. The EW will need to complete the CalSAWS RRR process to ensure FFY MC does not shut down.

EWs are not required to make contact with the client to complete 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, deceased or notifying the 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” (MC 239 FFY-3) must be sent. CalSAWS currently will not issue the MC 239 FFY-4, it must be manually generated during the annual RD process.

During the annual RD and it is discovered the youth is incarcerated, the EW must follow the steps outlined in Juveniles in Public Institutions.

If the client does not submit a Redetermination for another program (i.e. CF, GA) that program will close and the 4M eligibility will continue. If the case becomes a FFY MC only case it may be transferred to the Outstation FC unit.

Note: There is no requirement to complete any forms at the annual RD for the FFY youth as long as they are under the age of 26 years old.

No Longer Eligible for FFY Medi-Cal and Approach 26

When the EW is able to validate that the FFY has moved out of California, FFY MC must be terminated. The EW must send a NOA to the youth at least 10 days before benefits are discontinued. The EW must set a case alert to discontinue MC at the end of the month after the NOA was sent.

When the EW determines 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.

When the EW has determined the youth is incarcerated the procedures outline in “Suspension of Medi-Cal Benefits for Incarcerated Juveniles,” page 7-10 must be implemented.

When the youth is approaching 26 years old the county must initiate the redetermination process no later than 90 days prior to the youth’s 26th birthday for youth covered under the MCG or 90 days prior to the youth 21st birthday under the OCG. The following documents must be sent to the former FC youth to determine their eligibility for another MC program:

Notice of Language Services (GEN 1365),
FC CEC RRR Coverletter (SCD 2385 AK),
Important Notice About a Change in Medi-Cal (MC 239 FFY), and
The Application for Health Insurance (CCFRM 604).

When the youth is approaching 26 years old the county must initiate the redetermination process no later than 120 days prior to the youth’s 26th birthday for youth covered under the MCG or 120 days prior to the youth 21st birthday under the OCG.

All young adults receiving MC under Aid Code 4M that are 25 years old must have their redetermination due date set to the month of their birth. CalSAWS will generate some of the required documents needed to be evaluated for another MC program 120 days before the youth turns 26.

When the young adult turns 26 years old the case must be converted to Aid Code 38 the month following their 26th birthday. Aid Code 38 is established using Bottom Line Override (BLO) and allowed for at least 30 days before closing the case. When any of the above documents are returned current MC policy applies.