The following procedures apply when the adoption assistance eligibility specialist receives a request for ICAMA services for a child from another state who is placed in or being moved to Texas and who is eligible for Title IV-E or state-paid adoption assistance.

The eligibility specialist does the following:

• Contacts the adoptive family to get the information needed to create an adoption assistance case as Medical Assistance Only (MAO) in IMPACT. This task includes creating a foster and adoptive home development (FAD) home, making a case-related special request (CRSR), and entering necessary information to record the placement. The eligibility specialist contacts the family within five working days after receipt of the request.
• Determines when the child last had Medicaid coverage from another state, to make sure that Medicaid coverage from Texas does not overlap or lapse. This information is usually on the ICAMA 7.1 form, which the sending state completes in the Blue Iron system and emails to the regional adoption assistance eligibility specialist. Texas Medicaid coverage can begin the day after coverage in the other state ends. The other state’s coverage ends as stated in the adoption assistance agreement or when the family moves out of that state.
• Authorizes the appropriate MAO coverage in IMPACT, to begin on the first day the child was eligible and was not covered by another state’s Medicaid. If the child receives Title IV-E adoption assistance, Title IV-E Medicaid Only (ICAMA) is authorized in IMPACT. If the child is not eligible for Title IV-E, State Adoption Assistance Medicaid Only (ICAMA) is entered.
• Completes Form 1039 Medical Insurance Input to report any medical resources that the child has, other than Medicaid, and submits the form to the Texas Department of State Health Services (DSHS), Third-Party Resources, 1100 West 49th Street, Austin, TX 78756-3171.
• Completes and sends Form 7.5 Report of Change in Child/Family Status in the Blue Iron system, to notify the sending state of the effective date of Texas Medicaid coverage.