Medical assistance may be provided to Foster Children (FC) in:

• Category 91 - State FC, U-18 related;

• Category 92 - Title IV-E FC - AFDC related;

• Category 96 - State FC - Medically Needy - EC; and

• Category 97 - State FC - Medically Needy - SD.

The services specified in the pamphlet "Your Guide to Medicaid Services in Arkansas" are available to eligibles in any of the Foster Care categories, including Early and Periodic Screening, Diagnosis and Treatment (EPSDT), and Family Planning Services. The exception is that EPSDT is not available to Cat. 97 (FC-SD).

To be eligible for services in State FC (Cat. 91), the individual must meet the eligibility criteria of U-18 category (Re. MS 6040).*

To be eligible in Title IV-E-FC (Cat. 92), the individual must meet AFDC eligibility requirements, as specified in FA 5000. If a IV-E child has a child, of her own living in the same household, the minor parent's child shall be deemed to be a recipient of AFDC and will be eligible for Medicaid in Category 92 (but will not be eligible for an AFDC grant).

To be eligible in State FC Medically Needy (Cat. 96 or Cat. 97), the individual must meet the U-18-MN requirements (Re. MS 7340).*

Each child will be evaluated as a one person household unit against the appropriate criteria. Consideration of parental income/resources will cease effective the month a child enters Foster Care by the Court awarding custody to the Agency. If a parent voluntarily relinquishes custody of a child into foster care, that child will not be eligible for IV-E FC (Category 92).

A child taken into Foster Care on the basis of an emergency order only may be determined Medicaid eligible. If custody is later established by a judicial determination, the Family Service worker (DCFS) will be required to provide a copy of the order to the Service Representative for the Foster Care Medicaid record.

*The exception to eligibility guidelines for State FC-U-18 Related (Category 91) and State FC-MN (Categories 96 and 97) is that eligibility for Foster Children in these categories may continue up to age 21, provided that the child has signed an agreement to remain in FC and that the Division of Children and Family Services continues to provide FC Services to these children.

Children entering Foster Care will be referred by the Service Specialist to the Service Representative for initial determination of Medicaid eligibility. Referral should be made within one working day after the child's entry into Foster Care.

The Service Specialist will complete the EMS-95 (or EMS-98 for Title IV-E, Category 92) and forward the application along with any other available information to the Service Representative.

If a IV-E minor parent has a child living in the same household, the Service Specialist will complete a separate EMS-98 for the minor parent's child.

If the identity of a child entering foster care is unknown and the Service Specialist is unable to obtain birth verification through family, hospital, Bureau of Vital Statistics or other records, the court order placing the child in foster care may be used as acceptable verification of age, residence and citizenship provided the court order gives the name, age, residence and assumed citizenship of the child. The SSN enumeration requirement, however, cannot be waived.

1. The Service Representative will have the EMS-95 (or EMS-98) registered on WIMA.
2. In determining eligibility the following income and resource levels are applicable:

1. Category 91 - AFDC
2. Category 92 - AFDC
3. Category 96 - Medically Needy
4. Category 97 - Medically Needy

3. After determination of eligibility (Re. MS 6520 for applicable manual policy sections), certification of eligible Foster Children will be done by completion of EMS-57. The Service Specialist responsible for the FC case will be entered as the "Guardian/Authorized Representative" on the EMS-57, and Code A will be entered in the Payee Type field.
4. If a case number has previously been obtained by the Service Specialist for the Foster Care record, this number will be the case number of the Medicaid case. If the Service Representative approves the Medicaid case prior to opening of the Foster Care case, the Service Specialist will be notified via the EMS-91 of the system generated case number that will also be used for the Foster Care record.
5. If a IV-E child has a child of her own living in the same household, the minor parent and her child will be set up in separate category 92 cases. The only eligibility requirements to be considered for the minor parent's child are:

1. the minor parent is IV-E eligible, and
2. the child is living with the minor parent.

6. If the application is denied, the denial information will be entered on the EMS-95 (or EMS-98) for data entry.
7. The Service Specialist will be notified of the disposition of each application via Form EMS-91.
8. The Service Representative will maintain a separate case file for each child in Foster Care.

Reevaluations will be completed within six months of the initial certification, or the last reevaluation, and will be completed in the child's county of residence.

If a Foster Child is placed in another county, the receiving county will complete a reevaluation within 30 days.

1. The Service Representative will be responsible for notifying the Service Specialist via the EMS-91 that an EMS-95 or EMS-99 (for IV-E) is needed for reevaluation.
2. Determination of continuing eligibility will be made by the Service Representative, using the same criteria that were used for determining initial eligibility.
3. If eligibility continues, the Service Representative will update the EMS- 57 for data entry. If the child is ineligible, the EMS-57 will be completed for closure.
4. If the child meets the eligibility criteria for any other Medicaid category, the EMS-95 will be registered on WIMA in that category and an EMS-57 will be completed to reopen the child in the appropriate category. (If the child was IV-E, an EMS-95 must be obtained).
5. The Service Specialist will be notified by EMS-91 of continuing eligibility or case closure. If ineligible, the reason for closure must be given and, if due to excess income, an estimated amount of Spend Down liability will be provided.

The Service Specialist will be responsible for notifying the Service Representative of any change in the child's circumstances via the EMS-91. Notice will be made when there is a change in income, resources, Foster Care case status (closure), change of residence, or when adoptive placement is made.

The Service Representative will record the changes on EMS-57 and submit for data entry on WASM.

When a child is placed in another county, both the Medicaid record and the child's Foster Care records will be transferred to the new residence county under the same cover memo. The Service Specialist will notify the Service Representative of the transfer and request the Medicaid record.

Any changes necessary in the Medicaid case must be processed on WASM by the Service Representative prior to the transfer action on WAFC by the Service Specialist.

IV-E Foster or Adoptive Children

Non IV-E Foster or Adoptive Children

If a foster child is returned to his natural/adoptive parent(s) on trial placement, the FC Medicaid case will be closed. Continuing eligibility for Medicaid will be determined with inclusion of all parental income and resources in the appropriate Medicaid category. If the child is returned to FC, reapplication and redetermination of FC Medicaid eligibility will be required in order to reopen the FC Medicaid case.

When a child is entering an adoptive placement from Foster Care, the Service Representative will complete the EMS-57, adding the Adoption Specialist as "Guardian/Authorized Representative", and changing the recipient mailing address to the office address of the Adoption Specialist. These changes will be entered on WASM prior to transfer on WAFC by the Service Specialist. The Service Specialist will system enter the child's new residence county number in the "FH/NH CO" field via WAFC to enable the County to reevaluate the case and will enter the appropriate code in the "FHNO" field so that the child's Medicaid card will be mailed to the child's new address.

When the Medicaid-FC record has been system transferred on WAFC, the Medicaid record will be mailed to the County Office in the child's new county of residence. The Foster Care case record will be sent to the office address of the Adoption Specialist in charge of the case.

NOTE: When the adoptive placement of a non IV-E child is out-of-state, the above system procedures will be followed except that a new residence county number in "FH/NH CO" field will not be entered and the Medicaid-FC record will not be transferred. The county from which the child has moved will maintain responsibility for continuing eligibility and will keep the Medicaid-FC record.

Medicaid coverage for children in State FC, U-18 Related (Cat. 91) and State FC Medically Needy (Cat. 96 or Cat. 97) may continue until the adoption is finalized, if eligibility requirements continue to be met (Prospective parents' income and resources will be disregarded).

The Adoption Specialist responsible for the case will provide all information relative to eligibility, reevaluations and changes, and will be responsible for notifying the County Office when the adoption is final.

Medicaid coverage for Title IV-E-FC (Cat. 92) children who are adopted may be continued until the child's 18th birthdate, provided the child remains eligible for IV-E subsidy payments.

Reevaluations of adopted Foster Children cases should be made at six month intervals.

Reevaluation of IV-E Foster Children placed for adoption will be limited to verification that the IV-E subsidy remains in effect. This verification should be obtained in writing from the Adoption Specialist. No other forms or documents are needed for the IV-E adopted child's reevaluation.

The Consolidated Omnibus Budget Reconciliation Act of 1985, allows states to provide medical assistance to non-Title IV-E adoptive children with special needs.

Medicaid eligibility can be determined, or continued, when an adoption agreement is entered into for non-Title IV-E foster children under age 18 who have special medical or rehabilitative needs that would preclude adoption placement if they were not Medicaid eligible. For the non-Title IV-E Special Needs Adoptive coverage to apply, a child must be receiving Medicaid (in any category) in the month in which the adoption assistance agreement is signed, or received Medicaid in any one of the three months preceding the month of the adoption agreement, or would have been eligible to receive Medicaid (in any category) in the month of the adoption agreement or in any of the three months retroactive to adoption, had application been made.

Medical assistance will be provided to eligible Special Needs Adoptive Children in:

. Category 91 - U-18 related

The following requirements must be met to qualify for non-Title IV-E Special Needs Adoptive Children coverage.

1. Age- The non-Title IV-E Special Needs Adoptive Child must be under age 18 (eligibility may continue throughout the month of the 18th birthday) to qualify. Proof of age is required (FA 2210).
2. Citizenship or alienage requirement (MS 6700).
3. Social Security enumeration requirement (MS 1390).
4. Residency requirement (MS 2200).
5. Assignment of rights to medical support/third party liability requirement (MS 1350).
6. Financial Need- It must be determined that the special needs adoptive child, if not Medicaid certified in the month the adoption agreement is signed or Medicaid certified in any one of the three months preceding the month of adoption, would have been Medicaid eligible in the month of adoption or in any one of the three months immediately preceding the month that the adoption agreement was signed, had an application been made.

Only the income and resources of the child will be considered in making the eligibility determination for children who were not Medicaid certified in the month of adoption or in the three months preceding adoption. Any income or resources of the natural parent(s) or adoptive parent(s) will be disregarded. Once it has been established that financial eligibility exists in the month of adoption or in any month of the three month retroactive period, there will be no later income or resource redeterminations at subsequent reevaluations.

7. Special Needs- The non-Title IV-E Adoptive Child must have a special need for medical or rehabilitative care, as determined by the Division of Children and Family Services (DCFS), that would preclude adoption placement if the child were not Medicaid eligible. The special need must have existed prior to the adoption agreement (i.e., a child who develops a special need for medical or rehabilitative care after an adoption assistance agreement is in effect is not eligible for this category). Some examples of special medical or rehabilitative needs are cerebral palsy, spina bifida, Down's syndrome, psychiatric disorder, etc. Factors such as age, sex or race that might make an adoptive placement difficult do not qualify as Special Needs.
8. Adoption Agreement- A legally executed adoption agreement between the state and the adoptive parent(s) must exist before eligibility can be determined. An adoption agreement does not have to be the final decree in order for a child to receive assistance in this category. The adoption assistance agreement must remain in effect for the child to receive continuing Medicaid assistance as a Special Needs Child.

The Division of Children and Family Services will refer non-Title IV-E Special Needs Children to the DEMS Service Representative, using the DHS-91 Referral/Information Transmittal Form to identify them as children with special needs. In the comment section of the DHS-91, the DCFS worker will provide a description of the special needs of the child being referred and will also provide the date that the adoption agreement between the state and the adoptive parents is effective.

Upon referral by DCFS, the Service Representative will determine if an application is required. If the foster child referred is in an open non-Title IV-E foster care case (Category 91 or 96), or a SOBRA case (Category 61), no application will be required. If open in Category 97 Medically Needy Spend Down or if the foster child does not have an open Medicaid case, an application must be taken and registered. Applications must also be completed for SSI children who have lost SSI due to the adoptive parent(s)' income or resources.

1. Active Non-Title IV-E Foster Care and SOBRA Cases (Except Category 97, MN-SD)

There are no forms required for a non-Title IV-E foster child who is in an open Category 91, 96, or 61 case and who is eligible for coverage as a non-Title IV-E Special Needs Child. The referral form (DHS-91) will be used to document the child's special needs and the date of the adoption agreement.

2. Foster Children not Currently Medicaid Certified (or Currently Certified in Category 97)

When DCFS refers, via DHS-91, a non-Title IV-E foster child who is not currently Medicaid certified or a child currently certified in a Category 97 Spend Down Case, the Adoption Specialist will complete an EMS-95 and submit the application along with other required information to the Service Representative. It will also be necessary to obtain an EMS-95 for an SSI foster child who lost SSI due to the adoptive parent(s)' income or resources.

In addition, the EMS-607, DHS-81, DHS-86, EMS-87, EMS-96 and EMS-662 (if appropriate) will be completed. The EMS-5 and EMS-12 will be completed if the applicant has not been previously enumerated (Re. MS 1390). The EMS-95 will be registered in Category 91.

1. Medicaid Certified at Referral

If no application was obtained (i.e., the child was in open Category 91, 96, or 61 status at referral), the Service Representative will review the case record to establish that the child will continue to be eligible for Medicaid as a non-Title IV-E Special Needs Adoptive Child. This determination should be documented on the EMS-96.

An open Category 96 foster care case must be closed to allow approval in Category 91 using the same case number. Once the Category 96 has been closed, the case can be reopened using action type "B" with reason "096", if the child meets all eligibility requirements. Code "8" will be entered on the EMS-57 for systems identification of the child as a non-Title IV-E Special Needs Adoptive Child.

For Category 61 the latest EMS-95 will be used to obtain a register number on WIMA for Category 91. The date of the DCFS referral will be used as the date of application. If the child will continue to be eligible for Medicaid as a non-Title IV-E Special Needs Adoptive Child the application will be approved on WASM with an "8" in the Lockin Indicator Field. If the child's income is over the income limit for a Category 91 case, an amount less than the income limit must be entered on ACES. (Example: A child in Category 96 has monthly income of $102.00. To recertify in Category 91, an amount of less than $81.00 must be entered on ACES).

2. Non Medicaid Certified at Referral (or Certified in Category 97)

If a child is not receiving Medicaid in the month of adoption and did not receive Medicaid in any one of the three months preceding the month the adoption agreement was signed, the Service Representative must establish that the child is Medicaid eligible in any Medicaid category in the month of adoption, or would have been Medicaid eligible in any Medicaid category for any of the three months prior to the signing of the adoption agreement, had application been made.

If a child is not currently receiving Medicaid, but did receive Medicaid in any one of the three months preceding the month of the adoption agreement, no further financial determination is needed and the child can be considered financially eligible as a special needs child.

When an application has been made and a child is determined eligible, certification will be completed on the EMS-57 and EMS-700 (EMS-55 for systems generated notice). If there is an existing case number, the case number will be used for the non-Title IV-E Special Needs Adoptive Child's case. At certification, an "8" must be entered in the Lockin Indicator Field of the EMS-57 for system identification of the child as a non-Title IV-E Special Needs Adoptive Child. As in #1 above, if the child's income is over the income limit for Category 91, a lesser amount must be entered into the system.

3. Initially, the Adoption Specialist will be entered on the EMS-57 as the "Guardian/Authorized Representative", and the recipient's mailing address will be the office address of the Adoption Specialist. When the adoption is final, the adoptive parent will become the Authorized representative and the adoptive parent(s)' address will be used. All cases will be identified as special needs cases by writing in red "Non-Title IV-E Special Needs Child" on the EMS-86 and EMS-87.
4. If an application is denied, the denial information will be entered on the EMS-95 for data entry, and an EMS-700 or EMS-55 will be mailed to the Adoption Specialist.

Coverage for non IV-E Adoptive children whose adoption agreement was in place prior to implementation of this policy may be determined eligible for the coverage provided it can be documented that:

1. at the time of the adoption agreement, the child had special medical or rehabilitative needs that made the child difficult to place;
2. there is an adoption assistance agreement in effect; and
3. prior to entering into the adoption agreement, the child was found eligible and was certified for Medicaid in any one of the three months preceding the month that the adoption agreement was signed.

An EMS-95 and all other required forms (Re. MS 6590.4 #2) will be needed for these children. With the exception of financial eligibility, all of the eligibility criteria at MS 6590.2 must be met.

Non-Title IV-E Adoptive Children with special needs may be certified for retroactive coverage for up to three months prior to the month of application if all the conditions of eligibility are met and if there are unpaid medical bills for this period. If the adoption assistance agreement was not in effect in the retroactive months, then eligibility cannot be established under these provisions, but must be established under other Medicaid guidelines.

Once initial eligibility has been established, the agency does not have to redetermine financial eligibility (income and resources) as long as the adoption agreement remains in effect. All other eligibility requirements must continue to be met. Reevaluations of non-Title IV-E Adoptive Children with special needs will be made at six month intervals. The Adoption Specialist will verify that the child continues to reside in Arkansas with the adoptive parents, that the adoption agreement remains in effect, and that a special need still exists. Documentation will be made on the EMS-96. The only form required at reevaluation is an EMS-662.

The Adoption Specialist will have the responsibility of keeping the Service Representative informed of any changes that might affect a non-Title IV-E child's eligibility. All changes should be reported to the Service Representative (e.g., change of address, a return to foster care if the adoptive placement does not work out, etc.).

An adoption agreement will continue to remain in place for non Title-IV-E children even when the adoption decree has been finalized. Therefore, eligibility for non Title IV-E adoptive children with special medical and rehabilitative needs will not be affected by the finalization of an adoption decree.

The non-Title IV-E Adoptive Special Needs case will be closed in the month of the child's eighteenth birthday, after appropriate notice by the Service Representative.

The Consolidated Omnibus Reconciliation Act of 1985 requires, effective October 1, 1986, that children with Title IV-E adoption assistance agreements in effect and children receiving Title IV-E foster care maintenance payments will be given Medicaid coverage by the state in which they are currently residing, even though the agreements and payments originated in another state. Children with IV-E adoption assistance agreements in effect will be Medicaid eligible whether or not an interlocutory or judicial decree of adoption has been issued and whether or not the child actually receives an adoption assistance payment.

When a child under a IV-E adoption assistance agreement enters Arkansas, the sending state will notify the Administrator of the Arkansas Interstate Compact on Adoption and Medical Assistance (ICAMA) of the child's entry on a Notice of Transfer form that will include basic information needed for Medicaid certification. The sending state will also instruct the adoptive parent(s) on a Notice of Action form to contact the local Medicaid office in their county of residence in the new residence state for surrender of the sending state's Medicaid card and for assignment of rights to medical support.

When a child receiving a IV-E foster care maintenance payment enters Arkansas, the sending state will notify the Deputy Administrator of the Arkansas Inter- state Compact on the Placement of Children (ICPC) of the child's entry and will provide the basic information needed for Medicaid certification. The sending state will also instruct the foster parent(s) to contact the local Medicaid office in their county of residence in the new residence state to surrender the sending state's Medicaid card and to make assignment of rights to medical support.

The ICAMA Administrator or the ICPC Deputy Administrator will forward a copy of the Notice of Transfer and/or other correspondence received from a sending state to either the Adoption Specialist or the Service Specialist responsible for the case in the child's current residence county. The ICAMA Administrator and ICPC Deputy Administrator will serve as the liaison between Arkansas and the sending state as long as the child remains Medicaid eligible in Arkansas.

The Service Specialist or Adoption Specialist will enter the identifying information on an EMS-92 for each IV-E child and will forward this form, along with a copy of the Notice of Transfer and/or other correspondence received from the ICAMA Administrator or the ICPC Deputy Administrator to the Service Representative in the county DHS office of the child's residence county. The appropriate Specialist will have the additional responsibility of keeping the Service Representative informed of any changes that might affect the IV-E child's eligibility.

Upon receipt of the EMS-92 and related documents from the Service or Adoption Specialist, the Service Representative will schedule an office visit for the adoptive parent or foster parent. The EMS-92 and attached documents will serve as the Medicaid application, and the information received will require no further verification.

At the office interview the Service Representative will complete the income, resource and insurance sections of the EMS-92 and will obtain the signature of the adoptive parent or foster parent on the EMS-92. An EMS-662 will also be completed.

The Service Representative will obtain the sending state's most recent Medicaid card from the adoptive parent or foster parent. This card will be mailed to the ICAMA Administrator or ICPC Deputy Administrator, Division of Children and Family Services, P. O. Box 1437, Little Rock, AR 72203 with a brief memorandum attached containing information adequate to identify the child. A copy of the card and memorandum will be kept for the case record.

If a current Medicaid card is not available and if the date of Medicaid closure cannot be determined by the forms/correspondence received, the Service Representative will verify the date of Medicaid closure in the sending state by contact with that state.

Other procedures to be followed in the office visit are outlined in MS 6200.

When the EMS-92 has been completed and signed, the Service Representative will complete the top portion of the form for data entry in Category 92. Date of application will be the date the EMS-92 was signed by the adoptive parent or foster parent.

Up to 3 months retroactive coverage may be provided if it is established that the child did not receive Medicaid benefits from the sending state in the retroactive months and if the child incurred medical bills in Arkansas during the retroactive months. If a current card is surrendered during a month, coverage in Arkansas may be given effective the first day of that month.

The application process must be finalized within a 45 day time period from the date of application by approval, denial or withdrawal.

The eligibility requirements for Category 92 IV-E children entering Arkansas from other states are:

1. Verification that the child has a Title IV-E adoption assistance agreement in effect, or is receiving Title IV-E foster care maintenance payments;
2. Verification that medical coverage in the sending state has terminated;
3. Assignment of rights to medical support;
4. Social Security enumeration;
5. Referral to CSEU (for IV-E foster children, only); and
6. Personal income less than the sending state's board rate for IV-E foster children (there is no need standard set for IV-E adoptive children).

The EMS-57 will be completed for certification with the minimum record requirements for a Category 92 case (Re. ACES Manual). If the child is a IV-E adopted child, an "001" will be entered in the "CS Parent 1" Field, and a deprivation code of "70" will be used to prevent automatic IV-D referral.

1. IV-E Foster Care Income Entries

1. The MNIL Field on the SS-57 will reflect the board rate that is authorized by the sending state for the child.
2. If the child has personal income, it will be entered in the appropriate income field and the Net Countable Field. The Net Countable Income cannot be greater than the MNIL amount.

2. IV-E Adoption Assistance Income Entries

1. No adoption payment and no income, enter $1.00 in MNIL Field and "0" in the Net Countable Field.
2. No adoption payment and some personal income, enter personal income in the appropriate income field and the Net Countable Field, and add $1.00 to this amount for MNIL Field entry.
3. An adoption payment but no personal income, enter payment amount in MNIL, and "0" in Net Countable.
4. An adoption payment and personal income, enter personal income in Net Countable and the adoption payment, if greater than Net, in MNIL. If the adoption payment is less than Net, $1.00 must be added to Net for MNIL entry.

The completed case record will consist of an EMS-57, EMS-86, EMS-87, EMS-92, EMS-662, EMS-700, a copy of the Notice of Transfer, or other out-of-state correspondence for IV-E FC, and a copy of the surrendered Medicaid card from the sending state (or verification from that state that Medicaid has been terminated.)

Continuing eligibility will be determined on a semiannual basis. Reevaluations should be scheduled for completion six months after certification or last reevaluation. Reevaluation will be limited to verification from the Adoption or Service Specialist that the IV-E adoption assistance agreement or IV-E foster care maintenance payment remains in effect.

When a Title IV-E child under an Arkansas adoption assistance agreement or receiving a foster care Maintenance payment is to be placed out of Arkansas, the Adoption or Service Specialist will notify the ICAMA Administrator or the ICPC Deputy Administrator of the proposed placement.

The ICAMA Administrator or the ICPC Deputy Administrator, when notified of a IV-E child's placement out of Arkansas, will provide the receiving state with a Notice of Transfer Form and will notify the adoptive or foster parent(s) with a Notice of Action Form. The ICAMA Administrator or ICPC Deputy Administrator will also notify the DHS county office where the child's case record is maintained that the child will be moving from Arkansas.

Upon notification from ICAMA or ICPC that a IV-E child will be leaving the state, the Service Representative will send a ten day advance notice of case closure to the adoptive parent or foster parent. When the period has expired, an EMS-57 will be submitted to the terminal operator to effect the closure.