1. Public Benefits for Youth in Juvenile Justice Pacific Juvenile Defender Center Juvenile Delinquency Roundtable November 6, 2010

2. Hypo 1 Alex Smith is a 17.9 year old child with a mental health history who is currently confined in juvenile hall on a placement order. Because of his age, Alex is unlikely to be placed by Probation absent a caregiver who is willing to take him. His godmother, Edna, has talked to Probation about having Alex placed with her, but she is concerned that there are not sufficient mental health services for him in the community. She also worries about who will pay for his treatment if he comes to live with her.

3. Program Overview Medi-Cal Foster Care – AFDC-FC CalWORKS (TANF) Kin-GAP (Kinship Guardianship Assistance) AAP SSI Education and Special Education

4. Preliminary Issues

5. Why is this so complicated? The rules don’t make sense Relatives are different – sometimes Different funding sources mean different rules Incomplete information – people who should talk to each other do not always talk at all.

6. Probation Supervised Foster Care 41 USC §672(c)(2) ACF Child Welfare Policy Manual 8.3A.1, 8.3A.8a (Question 3) WIC §11401(b)(2) (AFDC-FC) WIC §§727.1 – 727.31

7. Foster Care Placements WIC §11402 Relative Care (and NREFMs) Non-related legal guardian Foster Family Foster Family Agency Group Home Community Treatment Facility

8. Medi-Cal

9. Medi-Cal Eligibility Categorical –Foster care (AFDC-FC) –Transitional foster care (FFCC) –SSI –CalWORKS –Refugee Income: –FPL Programs for Children

10. Medi-Cal - EPSDT Early and Periodic Screening, Diagnosis, and Treatment

11. Medi-Cal - EPSDT Screening –Physical –Developmental –Vision –Hearing –Dental

12. Medi-Cal - EPSDT Diagnostic and treatment services necessary to correct or ameliorate defects or physical or mental illnesses or conditions

13. Medi-Cal - EPSDT Targeted Case Management Therapeutic Behavioral Services (TBS) Rehabilitation Services Related services, such as transportation

14. Medi-Cal for Former Foster Care Children (FFCC) To age 21 In foster care on the 18 th birthday 42 U.S.C. §§1396a(a)(10)(A)(ii)(XVII) & 1396d(w)(1). WIC §14005.28; ACWDL 00-41, 00-61, 01-41. Health Care Reform: 2014 to age 26

15. Inmate Payment Exclusion No FFP for services provided to individuals who are inmates of a public institution. Affects FFP, not eligibility.

16. Inmate Payment Exclusion “Inmate” and “public institution” have specific definitions. Eligibility vs. coverage Suspension vs. termination issue

17. Inmate Payment Exclusion: Federal Law 42 USC §1396d(a)(27)(A) 42 CFR §§435.1009 -1010 HCFA and CMS Guidance and letters

18. Inmate Payment Exclusion: State Law WIC §§, 11016, 14011.10, 14029.5, &14053 22 CCR § 50273 Medi-Cal Eligibility Procedures Manual, Article 6

19. Inmate Payment Exclusion: Medi-Cal Policy Ends on the day inmate status ends CMS 1997 Letter: –Suspension of coverage not termination of eligibility –Obligation to provide immediate coverage

20. Inmate Payment Exclusion: State Developments SB 1469 MOU with CDCR – ACWDL 09-16 SB 1147 San Francisco and Santa Clara v. Department of Health Care Services

21. Inmate Payment Exclusion: State Law ACWDL 07-34 -- SB 1469 Implementation ACWDL 08-36 -- SB 1469 Contacts ACWDL 09-10 -- SB 1469 Contacts ACWDL 09-16 -- MOU with CDCR ACWDL 10-06 -- SB 1147 Implementation

22. Hypo Questions If Alex stays in juvenile hall until 18, will he be eligible for extended FFCC MediCal when he is released? If Alex is placed with his godmother by Probation, what types of services can be put in place to keep him in the community? –Will Alex have MediCal to cover those services if he is placed with his godmother? –Will Alex have MediCal to cover those services if he is released to his godmother?

23. Foster Care: AFDC-FC

24. Hypo 2 Alex has been placed with his godmother, Edna. Edna’s grandson, Mark Sanchez, is also a 602 and is placed with Edna one week later. Mark has been diagnosed with borderline intellectual functioning and depression. Edna is on a fixed income and is struggling financially to care for these children. If she does not receive assistance, the children may lose this placement.

25. Who is a relative? An adult related to the child by blood, adoption, or marriage within the fifth degree of kinship. Includes: Aunts and Uncles (great, great-great) First cousins First cousins once- removed Nieces and nephews Spouse of any relative on list (even if relative is divorced or deceased) Mother Father Stepparents Siblings Step-Siblings Grandparents (great, great-great, great-great- great) Everyone else is a non-relative!

26. Aid to Families with Dependent Children-Foster Care (AFDC-FC) Title IV-E of the Social Security Act –42 U.S.C. § 670 et seq. –45 C.F.R. § 1356 et seq. Cal. Welf. and Inst. Code § 11400 et seq. California’s Manual of Policy and Procedure (MPP) § 45-200 et seq.

27. AFDC-FC: Basic Eligibility Removed From Home: Removed by court Required findings –remaining in the home would be contrary to the child’s welfare –reasonable efforts were made to avoid removal

28. AFDC-FC: Basic Eligibility Relinquished for adoption or parental rights terminated Voluntarily placed by parent or guardian Living with non-related legal guardian, OR In foster care under the Indian Child Welfare Act

29. AFDC-FC: Basic Eligibility Placement: Licensed foster family home, group home, or foster family agency Approved home of a relative or non-relative extended family member Home of a non-related legal guardian

30. Federal AFDC-FC: Linkage Requirement Meet the 1996 AFDC criteria in the home of removal –in the month the petition is filed OR –in any of the 6 months prior to the month the petition is filed.

31. AFDC-FC: What Do They Get? Monthly cash benefit Medi-Cal Other, such as clothing allowance

32. AFDC-FC: Cash Benefit Foster Family Homes: –Basic rate: $446 - $659 –Specialized Care Increments: $18 - $1413 Foster Family Agencies: –Non-Treatment: $ 373 - $522 –Treatment: $1430 - $1679 Intensive Treatment: –$2687 - $ 4028 Group Homes: $2118- $8974 Rates Are Per Child!

33. AFDC-FC Out of County Youth When a child is placed in a county different from the county with payment responsibility: –the county pays the host county basic rate and the host county specialized care rate If the host county has no specialized care rate, then the county pays its own specialized care rate. When a child is placed out of state, the Interstate Compact on the Placement of Children applies. –The sending agency continues to have financial responsibility for the child.

34. AFDC-FC: Regional Center Clients Receive AFDC-FC benefits, and Regional Center clients Eligibility for regional center services: –Mental retardation, cerebral palsy, epilepsy, autism, and the “5 th Category”

35. AFDC-FC: Regional Center Clients Standard rates July 1, 2007 Current placements grandfathered Lower rates raised to July 1, 2007 level Vendored providers get DDS rates

36. AFDC-FC: Regional Center Clients Regional Center: $2006 per month Regional Center, Extraordinary care and supervision: $1000 county discretion (ACL 08- 54) Regional Centers must purchase or secure services in the child’s IPP or IFSP

37. AFDC-FC (Federal or State): When Does It End? Age 18 OR Age 19 IF: In foster care AND Full time high school or equivalent training, or pursuing high school equivalency AND Reasonably expected to graduate, complete the program or receive a high school equivalency certificate, before his or her 19th birthday.

38. AFDC-FC (Federal or State): When Does It End? Leonard v Wagner Fostering Connections AB 12

39. Hypo Questions What benefits are Alex eligible for? –What other information do you need? –What needs to happen so that Alex can receive these benefits? What benefits are Mark eligible for? What other information do you need? What needs to happen so that Mark can receive these benefits?

40. Temporary Assistance for Needy Families (TANF) & California Work Opportunity and Responsibility to Kids (CalWORKs) “Title IV-A”: Title 42 of the Social Security Act, Chapter 7, Subchapter IV, Part A 42 U.S.C. § 601 et seq. 45 C.F.R. § 260 et seq. Calf. Welf. and Inst. Code § 11200 et seq. California’s Manual of Policy and Procedure (MPP) § 45-200 et seq.

41. CalWORKs: Who Gets It? Children living with relatives: Not in foster care – informal care In foster care but do not qualify for federal Title IV-E foster care benefits

42. CalWORKs: Who Gets It? Needy caretaker relatives when the child receives: CalWORKs AFDC-FC Kin-GAP, or SSI

43. CalWORKs: What Do they Get? Payment Decreases Per Child! REGION 2 AU SizeMAP ExemptMAP Non- Exempt 1363326 2598533 3740661 4879788 51003897 611251007 712361104 813471205 914571302 1015641398 10+15641398 REGION 1 AU SizeMAP ExemptMAP Non- Exempt 1382345 2627561 3776694 4923828 51050941 611801057 712961162 814141265 915271367 1016411469 10+16411469

44. CalWORKs: When Does It End? Age 18 OR Age 19 IF: Reside with the relative caregiver AND Full time high school or equivalent training, OR pursuing a high school equivalency certificate AND Reasonably expected to graduate, complete the program or receive a high school equivalency certificate, before his or her 19th birthday

45. CalWORKs: When Does It End? Fry v Saenz Youth with disabilities have no completion requirement

46. Hypo Are Alex and Mark eligible for CalWORKs? –What other information do you need? –What is the best possible benefit available to Alex thus far? Mark?

47. Supplemental Security Income/ State Supplemental Payment (SSI/SSP) Title 42 of the Social Security Act, Chapter 7, Subchapter XVI 42 U.S.C. § 1381 et seq. 20 CFR § 416 et seq. “Foster Care Social Security and Supplemental Security Income Program,” Calif. Welf. and Inst. Code § 13750 et seq. “State Supplementary Program for the Aged, Blind, and Disabled,” Calif. Welf and Inst. Code § 12000 et seq.

48. SSI/SSP: Basic Eligibility Children may be eligible for SSI/SSP benefits if they meet the following criteria: Income and resources –No deeming if the child is living apart from parents Citizen or certain categories of immigrant Disability

49. SSI/SSP: Basic Eligibility Disability: Marked or severe functional limitation expected to result in death or last for at least 12 continuous months

50. SSI/SSP: What Do They Get? Disabled child - $739.00 –November 1 - $737.40 In foster care – non-medical out-of-home care facility: $1086 –Must complete the SSP 22 to get the full benefit!

51. SSI/SSP: When Does it End? Continues as long as disability, income and resources criteria are met Different disability standard for adults –Continuing Disability Review (“CDR”) to determine if the youth meets adult disability criteria –Benefits continue until CDR is complete

52. Kinship Guardianship Assistance Payment Program (Kin-GAP) Designed to help children placed with relatives leave foster care without losing foster care payments. Welf. & Inst. Code § 11360 et seq. MPP § 90-100 et seq.

53. Kin-GAP: Basic Eligibility Under 18 (or 19) years old Dependent or ward Citizen, legal permanent resident, or qualified immigrant Living with same relative at least 12 continuous months Guardian appointed by juvenile court Foster care case dismissed by the court after (or at the same time as) the court appoints the relative as guardian

54. Kin-GAP: January 1, 2011 Living with same relative at least 6 continuous months Negotiated Agreement Travels out of state Extends benefits until age 21 if mental or physical handicap

55. Kin-GAP: What Do They Get? Basic AFDC-FC rate –at time of guardianship Specialized Care Increment –at time of guardianship Clothing Allowance

56. Kin-GAP: When Does It End? Age 18 OR Age 19 IF: Reside with guardian AND Full time high school or equivalent training, OR pursuing high school equivalency AND Reasonably expected to complete the program or receive high school equivalency before his or her 19th birthday.

57. Kin-GAP Issues Juvenile court guardianships in delinquency Juvenile hall detention after guardianship

58. Hypo Questions What is the best likely benefit for Alex? –What would make Alex eligible for this benefit based on what you know? What is the best likely benefit for Mark? –What would make Mark eligible for this benefit based on what you know?

59. Adoption Assistance Program (AAP) Title IV-E of the Social Security Act –42 U.S.C. § 673 –45 C.F.R. § 1356 et seq. Cal. Welf. and Inst. Code § 16115 et seq. –California Code of Regulations, Title 22 § 35325 et seq.

60. AAP: Basic Eligibility “Special needs” AND Written and signed AAP agreement with state stipulating amount of AAP (No means test)

61. AAP: Basic Eligibility Con’t AND one of the following: Meets SSI disability criteria – OR Under supervision of county welfare department – OR Relinquished for adoption and would have been at risk of dependency – OR Committed to care of dep’t pursuant to Family Code § 8805 or § 8918

62. AAP: What Do They Get? Medicaid Monthly benefit –Amount negotiated in a written adoption assistance agreement –Cannot exceed the amount that the child would have received if in a licensed or approved family home –Can include specialized care increment –No means test for parents Residential Care or Wrap Around services

63. AAP Out of County Youth If the child is placed for adoption outside of the county of financial responsibility, then the AAP can be negotiated up to, but not to exceed, the basic rate + specialized care increment of the host county OR the county of financial responsibility – whichever is higher.

64. AAP: When Does it End? Age 18 Age 21 - if the child has mental or physical handicaps that warrant continuation Continues if the family moves to another state Can continue if child is adopted after death of adoptive parents

65. Hypo Questions Can Edna receive AAP benefits for Alex? For Mark? –What information do you need to determine eligibility?

66. SSI: Mandates for Youth Preparing to Transition AB 1331 (October 11, 2007) Goal: SSI in place at emancipation Best Practice Guidelines instruct counties on screening and applications. ACL 07-10

67. SSI: Mandates for Youth Preparing to Transition Counties must: Screen every youth in foster care for SSI eligibility between ages 16.5 and 17. Assist youth determined likely eligible with SSI application. When necessary, forego federal foster care benefits for one month

68. SSI for Detained Youth Suspended if incarcerated the entire month. 20 CFR §416.211 Terminated after 12 months Watch the clock!

69. Amount of Assistance CourtSpecial needsOther services AFDC-FC $446 - $659Yes, 6 month reviews. Specialized care increments ILP, clothing allowance, reunification services, Medi- Cal, transitional housing CalWORKs $382 for first child, less with each child NoNo specialized rates Medi-Cal Kin-GAP 100% of what child received in foster care No – dependency dismissed Yes, if received in foster care ILP, clothing allowance, Medi-Cal AAP Negotiated – cannot exceed foster care NoYes – specialized rates available Medi-Cal SSI $1,086 for children with relatives No Medi-Cal

70. Resource: The Foster Care Manual Available on www.wclp.orgwww.wclp.org Ten chapters, from an overview of the foster care system to the state hearings process For legal advocates and caregivers Includes numerous advocacy and resource tips and examples Appendices includes statewide legal resources and common acronyms

71. Education

72. AB 490 Applies to children in the foster care system and often to children in the deliquency system Parent retains education rights of youth unless the Court explicitly limits those rights – in which case the Court must appoint an advocate Priority on school stability and the “best interest of the child.” Youth must be immediately enrolled in school – even if all typically required documents are unavailable. Each Local Educational Agency must designate a staff person as a foster care education liaison. Partial credits must be awarded.

73. Special Education Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794, 34 C.F.R. §§ 104 et seq. Individuals with Disabilities Education Act (IDEA), 20 U.S.C. §§ 1400 et seq., 34 C.F.R. Part 300 Titles II and III of the Americans with Disabilities Act (ADA) 42 U.S.C. §§ 12131-12134; 12181- 12189. California Education Code §§ 56000 et seq., California Code of Regulations, Title V, §§ 3000 et seq. Various Sections of the California Government Code and California Welfare & Institutions Code

74. Special Education Eligible disability Need special education to benefit from their education Free and appropriate public education (FAPE) Individualized education plan (IEP)

75. IEP & Related Services Speech and language therapy Transportation Mental health therapy (AB 3632) Occupational therapy Physical therapy Behavioral intervention plan * Transition Plans *

76. Special Education Resources Disability Rights California http://www.disabilityrightsca.org/issues/specialeducation_pubs.html DREDF: Disability Rights and Education Fund http://www.dredf.org/special_education/dueprocess.pdf

77. Special Education Issues Screen youth for eligibility Participation of parents or education decision maker Must provide services in juvenile hall, ranch or camp Must implement current IEP

78. Advocacy Don’t take no for an answer This is complicated: staff can (do) make mistakes Joinder Administrative appeal: fair hearings, due process Legal Services advocates

79. Further Information Angie Schwartz The Alliance for Children’s Rights 500 Washington Street San Francisco, CA 94111 (415) 568-9803 a.schwartz@kids-alliance.org Alice Bussiere Youth Law Center 200 Pine Street, Suite 300 San Francisco, CA 94104 415-543-3379 x 3903 abussiere@ylc.org Brian Blalock Bay Area Legal Aid 1735 Telegraph Ave. Oakland, CA 94612 (510) 250-5201 bblalock@baylegal.org