Interstate Compact on Adoption and Medical Assistance (ICAMA)

The Interstate Compact on Adoption and Medical Assistance (ICAMA), Sections 453.500-453.503 RSMo requires states to provide Medicaid coverage to eligible adoption subsidy children when families move across state lines. A child who is eligible for Title IV-E benefits is automatically eligible to receive Medicaid in the receiving state. However, a child who receives state-funded adoption assistance does not automatically qualify for Medicaid in the receiving state unless the sending state has a reciprocal agreement with the receiving state to provide state health care services. MO HealthNet services will be opened on all children who move from any state with an adoption subsidy agreement (full reciprocity for IV-E and state only adoption subsidy which meet eligibility requirements). 

The Compact Administrator (Division Director) and Deputy Compact Administrator (Interstate Unit Program Manager) are designated in each member state and approved by the national ICAMA Office. ICAMA Coordinators work together with Coordinators in other states to process the required paperwork so Medicaid eligibility can be established in the adoptive family’s current residence state.

All states except Wyoming are members of ICAMA. The territories of Puerto Rico and the Virgin Islands are also non-members.

In 2015, AAICAMA developed an electronic submission process to be used by all member states to transmit ICAMA referrals across the country. This system is referred to as “blueiron”. In MO, all adoption subsidy workers are responsible for entering ICAMA referrals as necessary on their subsidy cases.

Missouri as the Sending State

When a child/adoptive family has moved from Missouri to another state, the adoption subsidy worker will:

• Update the Alternative Care (AC) Client Information Screen/Placement Information to show new address of adoptive family and the county as “999”. This code identifies the child as being placed out of state.
• The subsidy worker will then log into blueiron (on line ICAMA database) and enter a new referral and upload the subsidy paperwork for each child. A step by step guide is located on the Children’s Division Intranet, under Interstate Compact.

NOTE: There is a check box labeled “ICAMA Indicator” on the AC Client Information Screen. DO NOT mark this box. This box is for Central Office Use only.

Missouri as the Receiving State

MO ICAMA Coordinator will process incoming referrals as they are received through the blueiron network.

• Open a vendor license in PROD for the adoptive parents and assign a DCN to the child/ren if they are not already in the PROD/FACES systems;
  • Open the AC Client Information Function in FACES or update if the child(ren) is already in the system to show that ICAMA Medicaid is opened for the child(ren)
• Request a MO HealthNet card for the child/ren to be sent to the new Missouri residence. The case will be opened for MO HealthNet services only and will display the assigned ICAMA Coordinator as the case manager.

The child/ren’s adoption subsidy state (where the adoption subsidy contract originated) will remain responsible for maintenance and other special expenses under the terms of the adoption subsidy agreement.

Compact Termination/Closure

Compact termination or closure can occur under one of the following circumstances:

• The child reaches the age of majority (18 years) and the adoption subsidy is not extended by the subsidy originator state
• The family moves back to the sending state or
• The child becomes self-supporting.

Upon one of these circumstances occurring, the adoption subsidy worker is to enter in blueiron a change of status and forward to the receiving state’s ICAMA office to notify them of case closure in their state.

Interstate Compact on Juveniles

The Interstate Compact on Juveniles (ICJ), Section 210.570-210.590 RSMo, pertains to children who have been declared delinquent. The ICJ is administered in Missouri by the Division of Youth Services (DYS).

The Children’s Division must honor this compact for any child in its custody or when providing any services to a child who comes under the jurisdiction of the court for delinquent behavior.

Interstate Compact on Mental Health

The Interstate Compact on Mental Health (ICMH), Sections 630.810-630.835, RSMo, pertains to persons who have been declared mentally ill or deficient. The ICMH is administered by the Department of Mental Health (DMH).

Placements of children are made only from DMH administered state institutions or other medical facilities to a similar facility in another state.

Interstate Compact on Educational Opportunity for Military Children

The Interstate Compact on Educational Opportunity for Military Children, Section 160.2000, RSMo., makes provisions for children of families serving in the military by allowing greater opportunities for military children to meet Missouri’s educational requirements. The Compact commissioner responsible for the administration and management of the state’s participation in the Compact shall be appointed by the Governor.

Some of the Compact’s 18 Articles which could impact Children’s Division case management are listed below:

ARTICLE III

• The provisions of the Compact shall apply only to local education agencies and to the children of active duty military members or veterans (including the National Guard or Reserve) who are severely injured, medically discharged, retired from service, or died on active duty or as a result of injuries sustained on active duty, for a period of one (1) year after discharge, retirement or death.

ARTICLE IV

• Unofficial or “hand-carried” education records—In the event that official education records cannot be released to the parents for the purpose of transfer, the custodian of the records in the sending state shall prepare and furnish to the parent a complete set of unofficial educational records. The school in the receiving state shall enroll and appropriately place the student based on the information provided in the unofficial records pending validation by the official records, as quickly as possible.
•  
• Official records/transcripts—Simultaneous with the enrollment and conditional placement of the student, the school in the receiving state shall request the student’s official education record from the school in the sending state. The sending state will process and furnish the official records within ten days or within such time as is reasonably determined under the Compact.
• Immunizations—Compacting states shall give thirty (30) days from the date of enrollment or within such time as is reasonably determined to obtain any immunization(s) required by the receiving state.
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• Kindergarten/First grade entrance age—Students shall be allowed to continue their enrollment at grade level in the receiving state commensurate with their grade level (including kindergarten) from a local education agency in the sending state at the time of transition, regardless of age. A student that has satisfactorily completed the prerequisite grade level in the local education agency in the sending state, shall be eligible for enrollment in the next highest grade level in the receiving state, regardless of age.

ARTICLE V

• Absences as related to deployment activities—Students whose parent or legal guardian is an active duty member of the uniformed services and has been called to duty for, is on leave from, or immediately returned from deployment to a combat zone or combat support posting, shall be granted additional excused absences at the discretion of the local education agency superintendent to visit with his or her parent or legal guardian relative to such leave or deployment of the parent or guardian.

ARTICLE VI

• A local education agency shall be prohibited from charging local tuition to a transitioning military child in the care of a noncustodial parent or other person standing in loco parentis who lives in a jurisdiction other than that of the custodial parent.
• The transitioning military child, placed in the care of a non-custodial parent or other person standing in loco parentis who lives in another jurisdiction other than that of the custodial parent, may continue to attend the school in which he/she was enrolled while residing with the custodial parent.
• ARTICLE XVIII
• All member states’ laws conflicting with this Compact are superseded to the extent of the conflict.

Related Practice Alerts and Memos:

1-16-20 – CD20-07 – Interstate Compact Policy and Procedure Changes