Medical planning for children in out-of-home care is a necessary service to ensure that children receive the medical care they need. The following includes several medical service alternatives for which planning will be necessary.
Routine Medical/Dental Care
Routine medical/dental care including services available through the Healthy Children and Youth (HCY) Program, also known as Early Periodic Screening, Diagnosis and Treatment (EPSDT):
- Children entering out-of-home care need initial medical examinations, as well as regular medical examinations throughout their out-of-home care placement.
- Resource parents should seek medical providers who are enrolled with MO HealthNet (MH) or MO HealthNet/Managed Care (MH/MHMC).
- Plan with out-of-home care providers and other appropriate team members to ensure that all children in out-of-home care shall receive education on sexual development, appropriate to their age, life experiences, and living conditions. This information should include information on sexuality and venereal diseases.
- Children in out-of-home care are eligible for MM/DSP (MO HealthNet, Title XIX). As a result, they are also eligible for HCY services.
- When a resource parent receives an invoice for medical or mental health services for a foster placement in their home, the invoice must be submitted to the foster youth’s case manager immediately.
Human Immunodeficiency Virus (HIV) Screening
HIV Screening (ELISA test) is available for children entering out-of-home care who are displaying symptoms of Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or at increased risk of AIDS. The Children’s Services Worker may arrange for the ELISA test through the local Health Department or a private physician. The ELISA test is covered by MM/DSP.
Emergency and Extraordinary Medical/Dental Care
When children are in CD custody their birth parents still have certain rights. One of these rights is to give permission for extraordinary medical/dental care. Whenever possible, the worker should seek parental permission for these medical/dental services. If this is not possible, the Children’s Services Worker shall seek approval for the medical/dental services from the juvenile court. Then the Children’s Service Worker shall seek approval through their Area Office.
Children’s Treatment Services
Children in Out-of-home care are eligible for a variety of children’s treatment services, medical and psychiatric services covered by a contract with CD. If a child in out-of-home care is in need of these services, the worker should consult the listing of CD approved contractual treatment providers who offer the service and make the appropriate referral. Payment will be made at MO HealthNet or state contracted rates.
NOTE: For medical examinations, the HCY referral should be done first. CTS would be used if an HCY physician is not available.
Missouri Medical/Dental Services Program (MM/DSP) (Also known as Title XIX or MO HealthNet)
Children in out-of-home care are eligible for MM/DSP if they are in the custody of CD. Guidelines established by the MO HealthNet Division (MHD) determine which medical services are eligible for payment and at what rate. Staff should use this program whenever possible to provide a child with medical care. HCY services are available through this program.
Section 6036 of the Deficit Reduction Act of 2005 section 1903 of the Social Security Act requires that states obtain satisfactory documentation of citizenship in order to receive MO HealthNet benefits. States must obtain documents establishing identity and citizenship for new applicants and recipients for all categories of MO HealthNet.
For all children coming into Division custody after July 1, 2006, and for all eligibility re-determinations, the Children’s Service Workers will provide the Eligibility Specialist with a copy of the court order and if available documentation of identity and citizenship, preferably a copy of the child’s birth certificate. (Original birth certificates will remain in the child’s file.)
If documentation is not available the Children’s Service Worker will begin the process of collecting the appropriate documentation immediately and when obtained forward copies to the Eligibility Specialist. The Children’s Service worker will presume all children coming into care as eligible for MO HealthNet, however if the worker is not able to collect the proper documentation, it will be the responsibility of the Eligibility Specialist to make that determination and put the proper coding on the SS-61. The Eligibility Specialist may request the Children’s Service Worker to collect particular documentation during the certification or re-certification process.
The citizenship and identification verification process is also applicable for children eligible for MO HealthNet who were referred to the Division for adoption subsidy by outside adoption agencies.
Documents Used to Verify both U.S. Citizenship and Identity:
- U.S. Passport. The passport does not have to be currently valid to be accepted as long as it was originally issued without limitation;
- Certificate of Naturalization (N-550 or N-570); or
- Certificate of Citizenship (N-560 or N-561).
Documents Verifying Citizenship Only:
- U.S. Birth Certificate or IBTH.
- IBTH is available for individuals born in the State of Missouri.
- IBTH will display birth records for those born in Missouri back to 1920.
- IBTH can be viewed to verify citizenship. When using this information, document in the case record the date viewed and the information verified. Do not print and file the IBTH in the case record.
- A Certification of Report of Birth (DS-1350).
- Consular Report of Birth Abroad (FS-240).
- Certificate of Birth Abroad (FS-545).
- U.S. Citizen ID card (I-197 or I-179).
- American Indian Card (I-872).
- Northern Mariana Identification Card (I-873).
- Final adoption decree which shows a U.S. place of birth.
- Official Military Record of Service which shows a U.S. place of birth.
- Hospital record that meets the following criteria:
- Created on hospital letterhead;
- Established at the time of the person’s birth;
- Created at least five years before the initial application date; and
- Indicates a U.S. place of birth.
NOTE: For children under 5 years of age, the document must have been created near the time of birth.
- Life or health insurance record, created at least five years before the initial application date, showing a U.S. place of birth.
- U.S. State Vital Statistics official notification of birth registration.
- Statement signed by the physician or midwife who was in attendance at time of birth.
- Institutional admission papers from a nursing home, skilled nursing care facility, or other institution that were created at least five years prior to the initial application date and indicates a U.S. place of birth.
- Medical (clinic, doctor, or hospital) record that was created at least five years before the initial application date and indicates a U.S. place of birth. An immunization record is not considered a medical record for purposes of establishing citizenship.
- For children under 5 years of age, the document must have been created near the time of birth.
NOTE: When using a document from the above to verify citizenship, a second document must be obtained from the following list to verify identity.
When documents verifying both citizenship and identity are not available, a document may be used to verify citizenship accompanied by a second document that verifies identity. Sources of documentation of identity for children under age 16 are as follows:
- School record that shows the date and place of birth and parent(s) name. School records may include nursery or child care records.
- Clinic, doctor, or hospital record showing date of birth.
- Court orders identifying individual.
- Identity may be verified through our database if child received coverage as a Newborn.
- If none of the above documents are available, an affidavit by the parent or guardian may be used.
Verification of Citizenship and Identity for Newborns
Citizenship and identity are not required to be verified to add children as newborns as these children are deemed to have applied for and been found eligible to receive MO HealthNet benefits as a result of their mothers being active recipients at the time of birth.
Obtaining Records from the Bureau of Vital Records
The Bureau of Vital Records, within the Missouri Department of Health and Senior Services, has certificates of Missouri births, deaths and fetal death reports. BVR screens frequently utilized by staff include IBTH and IDTH. In Missouri these records are not open to the public and each screen includes the wording: “Information on this screen is confidential and shall be used for official state purposes only”. This information is for inquiry only and should not be printed, faxed or copied.
Certified copies of Missouri vital records of birth and death on behalf of children in out-of-home care can be obtained by submitting form CD-127 to Central Office as directed on the form.
Amendments to a Missouri vital record on behalf of a child in out-of-home care should be requested through Central Office. The CD-127, as well as a certified court order – with raised seal – clearly describing what changes need to be made to the record should be mailed to Central Office. Central Office will review, log, and send to Vital Records for processing.
Requests for out-of-state birth or death certificates must be made to the holding state’s vital records office. Staff should complete that State’s vital records application form via an on-line search. The application, any other documents (court order, photo id, cover letter, etc) required by that state, and a SAMII Payment Request Form should be forwarded to the DFAS Payments/Accounts Payable Unit. DFAS will process payment for the vital record and send the payment and application to the holding state.
Bureau for Children with Special Health Care Needs (BCSHCN)
This bureau provides some medical services not covered by MO HealthNet. To make a referral for a child, the Children’s Service Worker should make sure that the needed medical services are not covered by MO HealthNet. When it has been determined that the needed medical services are not covered by MO HealthNet, the Children’s Services Worker may make a referral to the appropriate regional bureau office.
Department of Mental Health
The Department of Mental Health (DMH) provides prevention, evaluation, and treatment services to eligible adults and children in out-of-home care who are in need of DMH services may be referred to the appropriate DMH division to meet the needs of the child.
Division of Behavioral Health (DBH): Provides, among others, outpatient community-based services, targeted case management, day treatment, treatment family home programs, and community psychiatric rehabilitation (CPRP). DBH also assures the availability of substance use prevention, treatment, and recovery support services.
Division of Developmental Disabilities (DD): Supportive services for individuals with developmental disabilities such as intellectual disabilities, cerebral palsy, head injuries, autism spectrum disorder, epilepsy, and certain learning disabilities. Such conditions must have occurred before age 22 and be considered lifelong in duration.
More information about DD, including referrals, must be made directly to DMH/DD. For more information on services and referral procedures for DBH, contact the appropriate Community Mental Health Center servicing the county of interest. These DMH affiliates are responsible for determining eligibility and providing the services. Contact information for regional Community Behavioral Health Centers can be found on the DMH website.
Private Psychiatric Hospital Placement
Children in Out-of-home care who are eligible for private psychiatric hospital care. These facilities provide services including medical treatment, psychiatric/psychological counseling and testing, nursing care, educational services, social work services, recreation services and occupational therapy. The Children’s Services Worker should contact the hospital directly to arrange for the child’s admission. Cost for the child’s care is paid by MO HealthNet for a number of days as prescribed by the Professional Activity Study (PAS).
Payment for days beyond the PAS days may be paid with Area Office approval. The psychiatric facility should request prior approval of the extension through the MO HealthNet Division (MHD) for extended MO HealthNet payment of the service. If MHD denies, the psychiatric facility should submit the request for payment to the County Office. Such a request is forwarded through normal supervisory channels to the Program Development System Unit (PDSU). The worker should consult the listing of CD contracted services and use these facilities, if treatment is anticipated to exceed the number of PAS days.
Medical Foster Care
Children in Out-of-home care who require special care directly attributable to a medical/physical/developmental disability may be eligible to receive medical foster care. If a child is in need of such special care, refer the child through local procedure.
Medical Services Authorization Information Letter
The Children’s Division (CD) participates in the development and implementation of coordinated social and health services which includes preventive, maintenance, and long-term medical and mental health care for children placed in the legal custody of the Children’s Division.
Services for foster youth medical and mental health needs should be provided by service providers who are enrolled in the state Medicaid plan, MO HealthNet. If a provider who is not enrolled with MO HealthNet is used for a foster youth, the resource provider may have to pay for the services out-of-pocket and not be reimbursed. If the resource parent is reimbursed, it will be at the Medicaid rate. Any reimbursement to the resource provider will be from Children’s Treatment Services (CTS) funds.
In the event that a resource parent uses a medical or mental health provider who is not enrolled with MO HealthNet or a MO HealthNet Managed Care Plan the CD-27 must be presented prior to the foster youth receiving services.
When a resource parent pays for a medical or mental health service out-of-pocket, the receipt for services must be submitted to the foster youth’s case manager immediately.
When a resource parent receives an invoice for medical or mental health services for a foster placement in their home, the invoice must be submitted to the foster youth’s case manager immediately.
Related Practice Points and Memos:
7-9-19 – PP19 CM-01 – Timely Informed Consent – Inpatient Hospitalizations and Medication Management Checkups
7-26-19 – CD19-47 – Informed Consent for Psychotropic Medication (Form CD-275)
4-9-20 – PP20-CM-03 – Mandatory Psychotropic Medication Reviews
7-23-20 CD20-34 –Introduction to Child Welfare Manual policy updates to align with best practices and comply with Joint Settlement Agreement requirements.
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