FCASPL 72 (Medicaid and Children No Longer Title IV-E Eligible)
Family, Children and Adult Services Procedure Letter No. 72
August 22, 2003
TO: Directors, County Departments of Job and Family Services All Family, Children and Adult Services Manual Holders
FROM: Thomas J. Hayes, Director
SUBJECT: Continuing Medicaid Eligibility Review for Children no longer eligible for Title IV-E Foster Care Maintenance Payments or Title IV-E Adoption Assistance

Medicaid Information Letter: 03-011

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 severed the categorical link between the Medicaid and former ADC programs. As a result, some individuals who are no longer eligible for cash assistance, whether through receipt of OWF, Title IV-E foster care maintenance or Title IV-E Adoption Assistance, may continue to remain eligible for Medicaid coverage under other categories of Medicaid. To assure uninterrupted Medicaid coverage whenever possible, the federal government and OAC rule 5101:1-38-01.1 require that a pre-termination review (PTR) of continuing Medicaid coverage be completed before stopping an individual's Medicaid benefits.

Children eligible for Title IV-E foster care maintenance payments or adoption assistance are automatically eligible for Medicaid. For these children, a PTR must be completed by the CDJFS prior to the termination of the Medicaid coverage whenever a child's foster care maintenance payments or adoption assistance eligibility is ending. Although the Title IV-E Medicaid case is maintained in FACSIS rather than CRIS-E, it is still the state's responsibility to ensure that Medicaid coverage is not interrupted before the CDJFS has had an opportunity to complete a PTR for the child. This letter establishes the procedure for coordination between the PCSA and CDJFS to ensure the timely completion of the PTR for Title IV-E eligible children.

In order to assure a smooth implementation of this process, each CDJFS must identify a Title IV-E Medicaid coordinator to function as the single point of contact between the PCSA and CDJFS. Please e-mail identifying information about your coordinator (county, name, telephone number and e-mail address) to wellsl@odjfs.state.oh.us by September 15, 2003. This information will be made available to all CDJFSs and PCSAs after it is compiled.

This information is also available on the Internet and may be accessed: at either:

http://dynaweb.odjfs.state.oh.us:6336/dynaweb/ohpeligibility/MEM or http://dynaweb.odjfs.state.oh.us:6336/dynaweb/family.

Attachment: JFS 01958 "Referral for Continuing Medicaid Eligibility Review"

PCSA Responsibilities for Pre-termination review of Title IV-E cases

Prior to terminating a child's Title IV-E foster care maintenance or adoption assistance Medicaid, the PCSA must complete a JFS 01958 "Referral for Medicaid Continued Eligibility Review" form and fax or hand deliver it to the appropriate CDJFS' Title IV-E Medicaid coordinator. This referral should be completed as soon as the PCSA becomes aware that the child's foster care maintenance (FCM) eligibility or reimbursibility is ending or that the adoption assistance (AA) case is being terminated. The PCSA must provide notice to the CDJFS at least 8 working days prior to the termination of the Title IV-E Medicaid.

1)For changes in FCM eligibility or reimbursibility the JFS 01958 referral should be sent to the appropriate CDJFS as follows:

(a)When the child is leaving the custody of the PCSA the referral is sent to the CDJFS in the Ohio county where the child will be residing after his removal from placement.

(b)When the child is remaining in the custody of the PCSA or other IV-E agency the referral is sent to the CDJFS in the same county as the PCSA.

(c)When the child will be residing out of state after removal from placement no referral is necessary.

2)For changes in AA eligibility the JFS 01958 referral should be sent to the appropriate CDJFS as follows:

(a)To the CDJFS in the Ohio county where the child will be residing after the termination of the AA agreement.

(b)No referral is necessary when the child will be residing out of state after termination of the AA agreement.

For questions about this procedure, the PCSA should contact the OCF Helpdesk at helpdeskocf@odjfs.state.oh.us

Instructions for FCSAM users:

Insert the following into the Family, Children, and Adult Services Manual (FCASM):

LOCATIONREMOVE AND FILE AS OBSOLETEINSERT/REPLACEMENT
Transmittals/Procedure Letters FCASPL No. 72
Forms JFS 01958

CDJFS Responsibilities for Pre-termination review of Title IV-E cases

1)Immediately upon receipt of the JFS 01958 referral, the CDJFS must authorize either Healthy Start or Medicaid for children under 21 (MA-T) based on the information contained in the referral.

2)The CDJFS must then begin a continuing eligibility review in accordance with the provisions in rule 5101:1-38-01.1 and notify the assistance group of the CDJFS's decision.

For questions about this procedure the CDJFS should contact the CFCTA staff at CFCTA@odjfs.state.oh.us