Page 1 of 7

CODES/ REFERENCES

N/A

REQUIREMENTS

The Division of Family and Children Services (DFCS) shall utilize the funds provided by the Medicaid program to pay the costs associated with providing medical services to Medicaid eligible recipients. These funds must be utilized in order to conserve state funds for those children who have been determined Medicaid ineligible. DFCS shall submit a childs Medicaid application to the DFCS Revenue Maximization Unit (Rev Max) via Georgia SHINES, the Statewide Automated Child Welfare Information System, within 24 hours of a child entering DFCS custody. DFCS shall screen each child entering foster care in the Georgia Medicaid Management Information System (GAMMIS) within one business day of a child entering foster care. DFCS shall notify Amerigroup, Rev Max, and the Georgia Department of Community Health (DCH) within 24 hours of a child entering or exiting foster care using the Amerigroup GA Families 360 DFCS Referral Form. The Social Services Case Manager (SSCM) shall complete a PeachCare for Kids application for any child entering care who does not meet Medicaid eligibility requirements. DFCS shall inform and refer individuals who age out of foster care, or Chafee Medicaid to apply for Former Foster Care Medicaid with the Right From the Start Medicaid (RSM) Outreach Project or at any local DFCS office.

PROCEDURES

When a child enters DFCS custody, the SSCM will: 1. Gather as much medical history on the child as possible and enter it into Georgia

SHINES. 2. Ensure each child has been screened in GAMMIS within the required timeframe. 3. Check all available resources including SUCCESS to determine if there is any historical

or current information about the family. 4. Complete and submit the Medicaid Application for Foster Care in Georgia SHINES

including all information on the Person Detail Page, Citizenship and Identity Page,

GEORGIA DIVISION OF FAMILY AND CHILDREN SERVICES

CHILD WELFARE POLICY MANUAL

Chapter: (9) Eligibility Effective

Date: August 2014 Policy

Title:

Applying for Medical Services at Initial Entry and Exit

Policy

Number: 9.2

Previous

Policy #:

1003.1 1003.2

Page 2 of 7

Custody Page, Income and Expenditures Documentation Checklist and Application and Background page.

a. The Medicaid application is sent via Georgia SHINES to Rev Max where it is assigned to a Revenue Maximization Specialist (RMS).

b. The Medicaid Application for Foster Care must be completed regardless of the childs potential eligibility for Medicaid. Some of the information on these pages will also be used to process the IV-E application;

5. Assign the designated RMS as a secondary worker to each case as soon as the Foster Care Child (FCC) stage is created in Georgia SHINES.

6. Complete and submit the Amerigroup GA Families 360 DFCS Referral Form to notify Amerigroup that a child has entered foster care within 24 hours of the date of removal.

a. Follow all directions at the top of the E-Form regarding submission to Amerigroup, Rev Max, and the Georgia Department of Community Health (DCH).

b. Submit the E-Form for case actions including: i Removal of a child ii Changes in Placement iii Child leaves DFCS custody iv Updates v Changes in DFCS Case Manager

c. Document all submissions of the E-Form in the narrative of the Contact Detail page in Georgia SHINES within 72 hours of submission.

d. Use the E-Form to provide Amerigroup the name and contact information for the provider selected to complete the Comprehensive Child and Family Assessment (CCFA). Provide the CCFA provider with contact information for Amerigroup.

7. Document the Amerigroup contact in the Narrative of the Contact Detail in SHINES within 72 hours of the contact and include the Amerigroup staff members name, telephone number and date and time of initial contact;

8. Verify that the Amerigroup Care Coordination Team (CCT) has scheduled each childs initial Health Check and trauma assessment; (See policy 10.11 Foster Care: Medical, Dental and Developmental Needs)

9. Complete a PeachCare for Kids application online at https://www.peachcare.org for any child not eligible for Medicaid

10. Report any issues/concerns with Amerigroup to the DFCS System of Care Unit including the Amerigroup staff member who was contacted, their telephone number, and the date and time of the contact.

When a child enters DFCS custody, the RMS will: 1. Review the submitted Medicaid application for a child entering foster care. 2. Contact the SSCM or designated staff by telephone or email if there are any questions

with the application. 3. Request the SSCM, as the childs authorized representative, to sign the Health Insurance

Questionnaire (Form DMA-285), regarding third party resources available to the child. 4. Screen for the CRS number to prevent duplication of existing cases and/or merge

duplicate identification (ID) numbers. 5. Verify whether there is an existing case for Temporary Assistance for Needy Families

(TANF), Supplemental Nutrition Assistance Program (SNAP), and/or Medicaid that includes each applicant child as a member.

6. Determine each childs eligibility for Medicaid, change living arrangement codes, and

Page 3 of 7

remove each child from existing active/pending SUCCESS cases within one business day of application.

7. For children active on SUCCESS, close the child/case for the ongoing month and register a new Medicaid case coding the childs living arrangement.

8. For children not active on SUCCESS: a. Make the appropriate Medicaid Class of Assistance (COA) determination; b. Complete the Medicaid Application via SUCCESS and Georgia SHINES.

9. Complete the funding determination through Georgia SHINES when all required criteria have been met; (See policy 9.3 Eligibility: Applying for Initial Funding)

10. Communicate the initial decision for Medicaid and IV-E via the Eligibility Summary page in Georgia SHINES.

When a child enters DFCS custody, Amerigroup will: 1. Receive the Amerigroup GA Families 360 DFCS Referral Form from DFCS 2. Ensure the child is enrolled on their roster as a member. 3. Access each childs Virtual Health Record (If available) to begin care coordination

planning and developing each childs individualized care plan. 4. Assign each child to a CCT. 5. Assign each child a primary care physician (PCP) and primary care dentist (PCD). 6. Contact the primary care provider assigned to the child to obtain the most recent

information available and required historical data; 7. Provide ID cards to members via a secure portal on the Amerigroup website. 8. Coordinate medical assessments and development of an individualized care plan for

each child.

When a child exits DFCS custody, the SSCM will: 1. Notify Amerigroup, Rev Max, and DCH of the child exiting DFCS custody via the

Amerigroup GA Families 360 DFCS Referral Form within 24 hours. a. Upon receipt of the Amerigroup GA Families 360 DFCS Referral Form, the CCT

prepares for the child to transition out of foster care. b. Rev Max updates the residential and mailing address, determines if a family has

tried to add the child to TANF Medicaid, and updates the class of assistance. i Rev Max will complete a Continuing Medicaid Determination (CMD) on

each child exiting Foster Care. ii Rev Max will CMD a child exiting care to a child only Medicaid case in

Georgia One. This will allow the child to remain on Medicaid without any coverage gaps once exiting care. The child may also remain with Amerigroup via the GA Families program (not the GA Families 360 program) for continuity of care.

iii Rev Max will CMD a youth aging out of care to Chafee Medicaid. iv Rev Max will CMD a youth aging out of Chafee to Former Foster Care

Medicaid.

NOTE: The childs Medicaid case should not be closed. 2. Update the childs placement in Georgia SHINES including an ending date and discharge

reason immediately but no later than three business days of the childs exit. If a child is in a post Foster Care (PFC) stage and DFCS is paying a subsidy, enter the new placement in the PFC stage.

3. Update the Legal Status page in Georgia SHINES.

Page 4 of 7

4. Inform the youth they may apply for Former Foster Care Medicaid with the RSM Outreach Project or at any local DFCS office and document the discussion in the case narrative in Georgia SHINES.

PRACTICE GUIDANCE

Eligibility Determinations All funding, reimbursability and Medicaid eligibility determinations for foster or adoption assistance children are the responsibility of Revenue Maximization Specialists (RMS) based on information submitted by a DFCS SSCM via Georgia SHINES. Coordination between SSCMs

and the RMS is critical to the funding determination and Medicaid coverage for children in out-

of-home placement. If a child in DFCS custody is covered by health insurance other than Medicaid, the name of the insurance company, policy number, group number and named of insured are important in processing the application for Medicaid. At the time that a claim is filed, such coverage will be primary with Medicaid being the secondary insurance provider. Children who are in an out-of-home placement may be eligible for Medicaid coverage under several Classes of Assistance (COA). These include the following:

1. IV-E Foster Care (FC) or IV-E Adoption Assistance; 2. SSI; 3. Child Welfare Foster Care, RSM, or State Adoption Assistance; 4. Medically Needy; 5. Emergency Medical Assistance (EMA).

The RMS processes the Medicaid determination in SUCCESS. The Medicaid Class of Assistance (COA) aligns with the funding determination. See policy 2100 Medicaid: Classes of Assistance for the eligibility requirements of each type of Medicaid.

Medicaid The Medicaid program is a joint federal/state program that is authorized under the Social Security Act. Funds are available to states for providing medical services to eligible recipients and for reimbursing activities that support the administration of the Medicaid program. DFCS accesses Medicaid funds through the Department of Community Health (DCH) and the Division of Medical Assistance (DMA) for case management and services for children in out-of-home care. Children who are IV-E eligible and/or SSI eligible are eligible for Medicaid. However, children whose foster care is paid by state funds may not be eligible for Medicaid. Consequently, the Medicaid COA for which these children qualify must be determined. Each COA has resource limits and certain deductibles. Most children in foster care are eligible for Medicaid.

IV-E Foster Care Medicaid (IV-E FC) Title IV-E eligibility is determined for each child who enters care via court order or voluntary placement agreement (VPA) regardless of the length of stay in care. In order for a child to be IV-E eligible, certain criteria must be met including certain judicial determinations (See policy 9.4 Eligibility: Removal from the Home and policy 9.6 Eligibility: Aid to Families with Dependent Children (AFDC) relatedness Criteria).

Page 5 of 7

Supplemental Security Income (SSI): SSI is a federal payment program for disabled individuals administered by the Social Security Administration. If a child in DFCS custody receives SSI, the Social Security Administration processes the childs monthly Medicaid card.

Child Welfare Foster Care (CWFC) or IV-B Medicaid: CWFC Medicaid provides medical coverage to children who have been determined ineligible for IV-E FC. The child must be placed in an approved foster home or licensed child placing agency (CPA) or child caring institution (CCI). Eligibility continues through the month in which the CWFC child reaches age 21 (assuming the CWFC per diem payment continues to be made and all other requirements are met after the child turns 18). The child must meet citizenship/alienage requirements. Only children in DFCS custody may receive this type of Medicaid. (Youth committed to the Department of Juvenile Justice (DJJ) may be eligible for Right from the Start Medicaid (RSM). Youth ages 19-21 may continue to receive CWFC if there is a signed voluntary agreement to remain in care (Consent to Receive Extended Youth Services) and the youth is in a placement receiving a per diem for his/her care at least one day per month.

Right from the Start Medicaid (RSM) RSM provides medical coverage to children in foster care who have been determined ineligible for IV-E Foster Care. The resource and income limits are considerably higher for RSM; therefore, more children qualify. RSM provides Medicaid to eligible children through the month in which the child turns 19 years of age. Youth, who are adjudicated delinquent and are placed in an out-of-home facility, may be eligible for RSM and/or IV-E foster care payments. The application process involves the submission of a RSM request from the DJJ Juvenile Probation/Parole Specialist (JPPS) to the Rev Max DJJ Eligibility worker.

Medically Needy (MN) Medicaid MN Medicaid has no income limits. The child must meet citizenship/alienage requirements. Eligibility continues through the month in which the child reaches age 18.

Emergency Medical Assistance (EMA) If the child does not meet the citizenship/alienage requirements, EMA may be an option when there is an emergency medical need. The immediacy of treatment must be verified by a doctor and subsequently, the claim approved by the Department of Medical Assistance (DMA). Routine, non-emergency health care may require using state funds. Eligibility for this Medicaid is determined on a monthly basis.

Former Foster Care Medicaid This Medicaid became effective 01/01/ 2014 in accordance with the Affordable Care Act (ACA). The ACA allows Medicaid coverage to be extended to individuals who age out of foster care, or out of Chafee, to the last day of the month they reach 26 years of age. Applicants may not be determined ineligible based on a diagnosis or pre-existing condition. The eligibility month is the month following the youths 18

th birthday or the month following the closure of Chafee Medicaid.

PeachCare for Kids PeachCare for Kids (PCK) provides comprehensive health care for children who do not qualify for Medicaid and do not have any other form of insurance. The child must meet

Page 6 of 7

citizenship/alienage requirements. PeachCare for Kids (PCK) is available to children from birth

through the last day of the month of a childs 19th birthday. PeachCare for Kids will waive the

monthly premium for children in DFCS custody.

GAMMIS GAMMIS consolidates all required functions for Medicaid, PeachCare for Kids

TM (PCK) and the

public employee health benefits into a single computer system. The state agency which has oversight of these functions is the Department of Community Health (DCH). When screening in GAMMIS, assistance from the appropriate Office of Financial Independence (OFI) supervisor or case manager will be required.

Georgia Families 360 On March 03, 2014, DFCS transitioned from a standard fee-for-service Medicaid program to a statewide Medicaid Care Management Organization (CMO) through Amerigroup Georgia Managed Care Company. The transition impacted children in DFCS custody and children receiving AA as they became members of a new program called Georgia Families 360 which is separate from Georgia Families, the general Medicaid program administered by the Georgia Department of Community Health (DCH). Georgia Families 360 is designed to provide coordinated care across multiple services and focus on the physical, dental, and behavioral needs of member children. The program is designed to ensure each member has a medical and dental home, access to preventive care screenings, and timely assessments. It also seeks to ensure medical providers adhere to clinical practice guidelines and evidence-based medicine.

Amerigroup Care Coordination Teams (CCT) and Care Managers Each Georgia Families 360 member is assigned to a regional Care Coordination Team with a specified Care Manager. The CCT members are Masters level staff, the majority of whom hold a professional license to practice in their respective field. The CCT completes a Health Risk Screening (HRS) on youth in care to identify medical and/or behavioral needs. The CCT is responsible for coordinating the health components of the Comprehensive Child and Family Assessment (CCFA), including the initial physical assessment, dental screening, and trauma assessment. Care Managers are the primary partner for identifying and making referrals for needed services. They ensure each youth has an individualized care plan that addresses both physical and behavioral health needs. They work with community agencies to ensure appropriate services are provided.

Amerigroup Notification Form (E-Form) DFCS communicates with Amerigroup, Rev Max, and DCH utilizing an electronic notification form (E-Form). It is the primary means for communicating information about a member in Amerigroup. The E-Form must be completed and sent to Amerigroup, Rev Max, and DCH within 24 hours of a youth entering foster care. It should be completed thoroughly to include demographic information, medical information, placement information, the identified CCFA provider and other referrals (e.g., Babies Cant Wait). The E-Form is also used to report updates such as placement changes, a youth exiting care, etc. If there is information not available at the time of the initial referral to Amerigroup, submit an E-Form (update) as soon as the information is obtained. Accurate and timely communication with Amerigroup and Rev Max is vital to the Medicaid eligibility determination and the assignment of an Amerigroup Care Coordination Teams and service providers. Important decisions regarding the assignment of primary care providers and referrals are made based upon the information submitted on the E-Form.

Page 7 of 7

FORMS AND TOOLS

Amerigroup GA Families 360 DFCS Referral Form PeachCare for Kids, https://www.peachcare.org Policy 2100 Medicaid: Classes of Assistance Policy 2194 Medicaid: PeachCare for Kids Back to Table of Contents

FormerFCMedicaidGAMMISGeorgiaFamilies360CCTEform