Eligibility Criteria for Minor Consent Services

Minor consent applicants do not have to provide the same level of verification as an applicant for full-scope Medi-Cal.

A minor must be considered to be living in the home to be eligible for Minor Consent services. If they are away temporarily (i.e. school/college), they are considered living in the home. If the minor is living temporarily with another relative or friend, they are considered living in their parent’s home if their parent(s) are legally and financially responsible for the minor (i.e. minor is claimed as a tax dependent).

If a public agency has legal responsibility for a minor, he/she is not eligible for Minor Consent services. If a minor is a Seriously Emotionally Disturbed (SED) child they are considered living in the home in regard to determining Medi-Cal eligibility. An SED child may apply for Minor Consent. However, Minor Consent will not cover mental health treatment or counseling that is required by the child's Individual Educational Plan (IEP), whether the SED child is in 24-hour care or a day treatment program.

Citizenship/Alien Status

Lack of verification of satisfactory immigration status does not prevent eligibility for Minor Consent.
IEVS and SAVE requirements do not apply to Minor Consent.
Non-citizen minors must be advised that USCIS will not be contacted regarding his/her immigration status.

Note: Any Minor Consent applicant who STATES THAT HE/SHE IS NOT LEGALLY PRESENT IN THE
U.S. must be denied benefits. However, the EW may not request verification of any child’s immigration status if the child does not have easy access to such verification. For example, if the child states that he/she does not know his/her status or where his/her documentation papers are, the EW is to assume that he/she is here legally and will not pursue verification of immigration status.

Identity

The identity of a child applying for Minor Consent services does NOT have to be verified. Minor consent applicants are NOT required to provide any identification. Minor consent applicants are NOT required to provide their Social Security Number (SSN) for eligibility. If the minor provides his/her SSN at application, the EW must not use the SSN for screening purposes or for any eligibility determination.

Responsible Relatives

The parents of the child are not responsible in any way towards the services the child may receive as part of Minor Consent.

Parental responsibility rules do not apply to a child applying for Minor Consent services. (Tax dependency requirements do not apply.)

Other Health Coverage

If a minor is included in his/her parent’s case and the child's parent(s) have other OHC, the EW must remove the OHC code from the minor's paper immediate need card. EWs must not report OHC information for children who are applying for Minor Consent services unless the minor has his/her own OHC through an employer.

If an immediate need card is being issued to the minor based on the parent's Medi-Cal case and the minor has an OHC code on MEDS, the EW 15 transaction should be used to immediately and permanently remove the OHC code for that individual. This will avoid any situation in which the Health Insurance System (HIS) will put back the OHC code before the minor receives the Minor Consent services. If a minor no longer needs Minor Consent services, then the OHC must be reentered into MEDS before the next month of eligibility. This action will make sure that services are correctly tied to the OHC.

Note: OHC information must not be entered in CalWIN.

The chart below shows the required EW actions when a Minor Consent applicant has OHC.

Procedures for Minor Consent with OHC

When the Minor...	Then the EW...
Is not currently active in a Medi-Cal case, but has any OHC (from parents, guardians, or other relatives),	Establishes Minor Consent in the minor's own separate case: Indicate the minor has no OHC.
Is active in another Medi-Cal case (for example, parents) and coded for OHC,	Processes the Minor Consent application in the minor's own separate case: Indicate the minor has no OHC.
Is active in another Medi-Cal case (for example, parents) as a child: With no share of cost (SOC), Who is eligible for full-scope benefits, and Who has no OHC,	Denies the Minor Consent application. Provides appropriate denial Notice of Action (NOA). Issues an immediate need paper BIC from the active Medi-Cal case. (DO NOT issue a replacement BIC, as this will deactivate the child's BIC which may be in the parent/caretaker's possession.) Exception: Outpatient mental health services, or Alcohol and drug abuse services These two services are not available under Managed Care and the minor must be processed for Minor Consent eligibility.

Health Care Options

If a child is enrolled in a Medi-Cal Managed Care plan as a health care option instead of fee-for-service Medi-Cal, deny the Minor Consent application and provide NOA (print immediately and hand the NOA to the client in the office).

Advise the minor to seek care under that plan.
Issue an immediate need paper BIC from the active Medi-Cal case. (DO NOT issue a replacement BIC, as this will deactivate the child's BIC which may be in the parent/caretaker's possession and would breach confidentiality.)

Exception: If the services requested are for outpatient mental health or alcohol and drug abuse, do NOT deny a Minor Consent applicant child enrolled in a Medi-Cal Managed Care plan instead of fee-for-service Medi-Cal.

These two services are not available under Managed Care and the minor must be processed for Minor Consent eligibility as there is no Managed Care code for this program.

Income

The following rules apply in the treatment of income in a Minor Consent case:

Only the child's available income is used to determine SOC.

Example Example Social Security Administration benefits for a child are sent to the parent or guardian. This income is considered unavailable to the child and not included in the child's budget.

There is no income in-kind to the child from parents or guardians.
The student exemption on earned income applies to Minor Consent clients.

Property

Only the child's available property is used to determine eligibility. The property of parents or guardians is NOT considered. DO NOT contact parents or guardians about resources held in trust for the child.

Case Rules

A minor applying for Minor Consent MUST BE in his/her own separate case. DO NOT add other family members (including newborns) to a Minor Consent case..

Maintenance Need

The maintenance need would normally be for one (1) person (the minor). However, a pregnant minor would have a maintenance need for 2 persons.

Minor Consent Aid Codes

Only four aid codes are used for Minor Consent.

Aid Code	Description
7M	Restricted to minors who are at least 12 years old and requesting Minor Consent solely for sexually transmitted diseases, drug and alcohol abuse, family planning or sexual assault services. NOT TO BE USED FOR MENTAL HEALTH SERVICES.
7N	Used only for pregnant minors with no age restriction. Limited to pregnancy-related, family planning, and postpartum services. (Always has a zero SOC.)
7P	Restricted to minors who are at least 12 years old and requesting Minor Consent for OUTPATIENT MENTAL HEALTH and sexually transmitted diseases, drug and alcohol abuse, family planning, or sexual assault services.
7R	Restricted to minors under 12 years old who are requesting Minor Consent for family planning and sexual assault services. NOT TO BE USED FOR MENTAL HEALTH, DRUG OR ALCOHOL ABUSE, OR SEXUALLY TRANSMITTED DISEASES.

Selection of the appropriate aid code is based on two factors:

Age of the child, and
Type of service requested.

Note: When a pregnant minor requests a service outside the scope of those provided under aid code 7N (pregnancy related), two Minor Consent aid codes will be necessary.

ExampleExample

A 13-year-old pregnant minor applies for Minor Consent. The EW approves Minor Consent using aid code 7N for pregnancy related services. The Minor also requests mental health services with appropriate documentation. EW approves the other Minor Consent service using aid code 7P. Only one MC 4026 is required and only one NOA is issued. One paper BIC must be issued.

Notice of Action

A child applying on the basis of Minor Consent must be given an NOA in the office at the end of the interview and eligibility determination (if interviewing in person), or be mailed with a NOA to an address provided by the minor consent applicant.

NOAs are to be issued for each month a Medi-Cal eligibility determination is made.

The MC 239 V is the appropriate NOA to use for Minor Consent situations. This NOA has the citation sections pre-populated on the form. The EW should advise the applicant to read and destroy the NOA if confidentiality may be at risk due to their living situation.

EWs may also use the county form, Medi-Cal Approval Notice (SCD 1225) (8/97).

Reminder: All minor consent cases are confidential. Notices of Action (NOAs) or paper BIC cards shall not be sent to the home address, to preserve the confidentiality of the minor’s case.

Period of Eligibility

Minor Consent cases are certified for one month at a time. If an ongoing need exists for Minor Consent then:

The minor must reapply each month, and
A new MC 4026 (except for outpatient mental health services) is completed and eligibility redetermined.

Note: For outpatient Minor Consent mental health services, the minor must reapply each month. A new SCD 558 or other acceptable mental health statement is required EACH MONTH to redetermine eligibility for ongoing Minor Consent. The minor is not required to complete an MC 4026 each month.

Reporting Responsibility

Children receiving Minor Consent, including mental health services, are required to report to their EW each month, changes which may impact their eligibility. The changes may be reported to the EW either in-person or by telephone; mail; email; fax, or any other means.