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Janeen Newby CA Medi-Cal Eligibility 1 Medicaid: Finding a Way Through the Maze of Non IV-E Eligibility.

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Presentation on theme: "Janeen Newby CA Medi-Cal Eligibility 1 Medicaid: Finding a Way Through the Maze of Non IV-E Eligibility."— Presentation transcript:

1 Janeen Newby CA Medi-Cal Eligibility 1 Medicaid: Finding a Way Through the Maze of Non IV-E Eligibility

2 2 HISTORY In 1986, the Interstate Compact on Adoption and Medical Assistance (ICAMA) was created to create a framework for the interstate cooperation originally envisioned in PL (the Adoption Assistance and Child Welfare Act of 1980). The ICAMA provides uniformity and consistency of policy and procedures when either a special needs child is adopted by a family in another state or the adoptive family moves to another state.

3 3 While ICAMA promotes reciprocity of medical services, not all states provide Medicaid coverage to non-federally eligible children who have a signed adoption assistance agreement from another state.

4 4 How can States provide Medicaid for state funded adoption assistance eligible children? States have the option of extending Medicaid to children receiving state funded adoption assistance through another state.

5 5 FEDERAL LAW Section 1902(a)(10)(11) of the Social Security Act allows states to make medical assistance available to all children for whom there is in effect an adoption assistance agreement other than an agreement under part E of Title IV between the state and an adoptive parent.

6 6 COBRA In 1985, the Consolidated Omnibus Budget Reconciliation Act (COBRA) required states to grant Medicaid eligibility to children whose families signed a Title IV-E adoption assistance agreement with another state. However, COBRA did not provide for implementation of this requirement. The COBRA also gave states the choice of providing Medicaid to non-federally eligible children receiving state adoption assistance.

7 7 Consolidated Omnibus Budget Reconciliation Act (COBRA) States can provide Medicaid eligibility for adoption assistance children through the COBRA option. 49 States and the District of Columbia have elected the COBRA option.

8 8 COBRA ELIGIBILITY CRITERIA In order for a child to qualify for the COBRA option the following is required: An existing, legally executed adoption assistance agreement between the State and the adoptive parent(s). A pre-existing need for special medical rehabilitative care that the State finds would have precluded adoption absent the medical assistance.

9 9 COBRA ELIGIBILITY CRITERIA cont. Before or at the time the adoption assistance agreement was executed, the child would have been eligible for medical assistance given his/her own income and resources (i.e. Title IV-E criteria used to determine payment for children in foster care rather than standards and methodologies of the State’s AFDC program under Part A of Title IV) OR

10 10 COBRA ELIGIBILITY CRITERIA cont. the child was receiving or was eligible to receive Medicaid as either mandatory or optional categorically needy.

11 11 STATE COBRA OPTION RECIPROCITY with AlabamaYes ICAMA States AlaskaYes All States ArizonaYes All States ArkansasYes All States CaliforniaYes All States ColoradoYes All States ConnecticutYes ICAMA States DelawareYes All States District of Columbia YesNoUndetermined

12 12 FloridaYes ICAMA States GeorgiaYes All States HawaiiYesNo IdahoYes All States IllinoisNo IndianaYes All States IowaYesNo KansasYes All States KentuckyYes ICAMA States

13 13 LouisianaYes All States MaineYes All States MarylandYes All States MassachusettsYes All States MichiganYes All States MinnesotaYes All States MississippiYes All States MissouriYes All States MontanaYes ICAMA States NebraskaYesNo NevadaYesNo

14 14 New HampshireYesNo New JerseyYes ICAMA States New MexicoNo New YorkYesNo North CarolinaYes ICAMA States North DakotaYes ICAMA States OhioYes All States OklahomaYes All States OregonYes All States PennsylvaniaYes All States Rhode IslandYes ICAMA States

15 15 South CarolinaYes All States South DakotaYes All States TennesseeYes All States TexasYes All States UtahYes ICAMA States VermontYes ICAMA States VirginiaYes ICAMA States WashingtonYes All States West VirginiaYes All States WisconsinYes All States WyomingYes All States

16 16 NO RECIPROCITY? What do you do when a state funded adoption assistance eligible child moves to a state that does not have reciprocity?

17 17 RESPONSIBILITY OF MEDICAID The state of residence is responsible for the provision of Medicaid when the child is Title IV-E eligible, but when a child is state funded and is not living in the adoption assistance state, and the residence state does not offer reciprocity or does not extend reciprocity to the adoption assistance state, the adoption assistance state may be responsible for providing Medicaid.

18 18 There are various ways of approaching this situation. The best way is to plan ahead. The family should be advised that states can have different eligibility requirements for Medicaid programs. The family should research to determine if the state they are moving to will provide Medicaid to their child.

19 19 The family can apply for Medicaid in the resident state. If they do not meet the Medicaid eligibility criteria of the resident state, they can locate providers in the resident state that will provide services and bill the adoption assistance state.

20 20 Example: A state funded adoption assistance eligible child from California moves to a state that does not have reciprocity. The family finds a provider for the child in the new resident state and they agree to provide services. The provider will be required to submit an application for enrollment as a Medi-Cal provider in order to submit claims. To view the California Web go to: cal.ca.gov/pubsdoco/provappenroll/PEB_Reference_chart.pdf

21 21 For more information on the out-of-state provider enrollment process in your state you can go to the State Medicaid web site and look for “Provider Enrollment”.


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