CODES/REFERENCES

Foster Care Independence Act of 1999, P.L. 106-169 as incorporated in the Social Security Act, 42 U.S.C. § 677 and amended in 45 C.F.R. 1356

Affordable Care Act of 2010

 REQUIREMENTS

The Division of Family and Children Services (DFCS) shall:

1. Determine if youth 18 years of age and older are eligible for Child Welfare Foster Care (CWFC), Chafee Independence Program Medicaid, or Former Foster Care Medicaid.
2. Extend Medicaid coverage to individuals who age out of foster care or age out of Chafee Independence Program Medicaid, through the last day of the month in which the individuals reach 26 years of age. Applicants may not be determined ineligible based on a diagnosis or pre-existing condition.
3. Use the following basic eligibility criteria for Chafee Independence Program Medicaid or Former Foster Care Medicaid:
   1. Age:
      1. Must have been in foster care (in Georgia or any other state) on their 18th birthday;
      2. Must be under the age of 21 for Chafee Independence Program Medicaid;
      3. Must be under the age of 26 for Former Foster Care Medicaid.
   2. Enumeration: Must have a Social Security Number or an application for a Social Security Number
   3. Residency: Must be a resident of the state of Georgia
   4. Citizenship/Immigration Status/Identity: Individuals who were in foster care under Title IV-B or Title IV-E of the Social Security Act are exempt from providing additional documentary evidence of citizenship/immigration status/identity as long as they were in foster care in Georgia
   5. There are no income or resource limits for either Chafee or Former Foster Care Medicaid.
4. Educate youth about the importance of designating another individual to make health care related decisions on his or her behalf if the youth is unable to participate in such decisions; and, assist the youth in completing and executing the Georgia Advance Directive for Health Care (GADHC) if they choose this option upon reaching age 18 or older.

 PROCEDURES

When youth in foster care reach 17 years of age, the Social Services Case Manager (SSCM) and Independent Living Specialist (ILS) will:

1. Discuss with youth the advantages of receiving Extended Youth Support Services (EYSS) at age 18 and older.
2. Inform youth both verbally and in writing of their possible eligibility to receive Chafee Independence Program Medicaid or Former Foster Care Medicaid if they choose to opt out of Foster Care and EYSS at age 18 or older. This may occur at any time, including the following:
   1. During the initial transition planning meeting;
   2. During regular monthly contacts;
   3. During the Foster Care exit meeting.
3. Discuss with youth the importance of designating another individual to make health care related decisions on his/her behalf should the youth become unable to participate in such decision making.
   1. Provide youth with the Georgia Advance Directive for Health Care if the youth elects to designate such an individual.
   2. If necessary, assist youth with completing and executing the Georgia Advance Directive for Health Care.
   3. Advise youth to maintain the document in a secure location with other important documents.
   4. The SSCM or ILS will maintain a copy of the form in External Documents in Georgia SHINES, the Statewide Automated Child Welfare Information System.

If a youth receives EYSS at age 18, the SSCM will:

1. Notify Rev Max when the youth reaches 18 years of age with a Notification of Change via Georgia SHINES.
   1. At age 18, youth are no longer Title IV-E eligible.
   2. Rev Max will determine the class of assistance for the 18 year old (i.e. Child Welfare Foster Care).
2. Document in the Case Narrative in Georgia SHINES the Medicaid Class of Assistance (COA) determined by Rev Max.
3. Update all changes in the youth’s physical placement (e.g. youth resides in a college dorm, transitional housing, etc.)

If a youth opts out of foster care at age 18 or older, the SSCM or ILS will:

1. Send Rev Max the youth’s new residential address and legal status.
   1. Rev Max will complete the transition to another Medicaid COA. This keeps youth from having to complete a new application online at a DFCS office, or at a Right From the Start (RSM) Outreach Project office.
   2. At the beginning of the month following the youth’s exit from foster care, the new Medicaid COA will automatically take effect and a Medicaid card will be sent out.
   3. Annual renewal will entail verification of continued Georgia residency.
   4. After Rev Max changes the COA, a youth may then apply for SNAP with the Medicaid linked in SUCCESS to the Food Stamp case.
2. Provide or assist the youth with obtaining his/her identification information
   1. Georgia Identification Card;
   2. b. Social Security Card; and
   3. Birth Certificate

PRACTICE GUIDANCE 

Regular preventive health care is important for all people and medical bills can be financially disastrous even for those who are generally healthy. Many children enter foster care suffering from poor health and chronic physical and emotional illnesses. As they reach age 18 and older, these young people need continuous health care to successfully transition to adulthood. Medicaid coverage serves as the primary safety net for this population, even if they opt out of foster care at age 18 or older.

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. Consequently, the Medicaid Class of Assistance (COA) for which these youth may qualify must be determined. Each COA has resource limits and certain deductibles. Most children in foster care are eligible for Medicaid.

Child Welfare Foster Care (CWFC)

CWFC Medicaid provides medical coverage to youth 18 to 21 years of age receiving EYSS or participating in the ILP after opting out of foster care. Eligibility continues through the month in which the youth reaches age 21 provided that eligibility requirements are met after the youth turns 18. The youth must meet citizenship/alien/age requirements. Youth 18-21 years of age receiving EYSS may continue to receive CWFC.

John H. Chafee Foster Care Independence Program Medicaid Coverage

Effective July 1, 2008, the Foster Care Independence Act allowed Medicaid coverage to be extended to age 21 for youth who opted out of foster care at age 18. The youth’s Medicaid eligibility is allowed to continue unless one of the following occurs:

1. The youth dies;
2. The youth moves out of state;
3. The youth requests closure of their Medicaid case;
4. DFCS determines another Medicaid program would be more beneficial;
5. The youth is incarcerated; or
6. The youth fails to cooperate with their eligibility redetermination or case review.

Chafee Medicaid is also available to youth who were in foster care during the month of their 18th birthday, but choose to exit. For example, if a youth decides to exit EYSS/ILP at age 20, the youth is still eligible for Chafee Medicaid until age 21 if the youth was in foster care during the month in which the youth reached the age of 18.

Former Foster Care Medicaid

This type of Medicaid became effective 01/01/ 2014 in accordance with the Affordable Care Act (ACA). The ACA allows Medicaid coverage to be extended for individuals who opt out of

foster care, or out of Chafee, until the last day of the month in which 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 youth’s 18th birthday, the month following the closure of Chafee Medicaid, or until the youth reaches the age 26 (as long as the youth was in foster care during the month of their 18th birthday).

Georgia Families 360˚

On March 03, 2014, the Georgia Department of Community Health (DCH) 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 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.

Advance Directive for Health Care

Effective October 1, 2010 the Foster Care Independence Act required that adolescents participating in the Chafee program be provided with education about the importance of designating another individual to make health care treatment decisions on their behalf if the youth becomes unable to participate in such decisions. Youth should be educated about the importance of this designation, and must understand how to execute a health care proxy or health care power of attorney. Youth should understand that if they become unable to participate in their own health care decisions, and do not have a relative authorized under State Law to make such decisions on their behalf, there are options available to designate an individual to make health care decisions on their behalf and in line with their wishes.

FORMS AND TOOLS 

Georgia Advanced Directive for Health Care