Frequently Asked Questions

While there is significant overlap in eligibility under the two groups, the mandatory group for former foster care children does not completely subsume or replace coverage under the optional group, and states that currently cover the optional group for independent foster care adolescents must continue to do so until the maintenance of effort for individuals under age 21 has expired in accordance with section 1902(gg) of the Act.

The coverage of former foster care individuals ages 18-25, set forth at proposed section 435.150, covers individuals who were either receiving IV-E or non-IV-E foster care and were enrolled in Medicaid either when they turned age 18 or aged out of foster care. As noted in an earlier question, states have the option, but are not required, to cover individuals who were in foster care and enrolled in Medicaid in another state when they turned 18 or aged out of foster care.

The optional coverage for independent foster care adolescents, set forth at proposed section 435.226, covers individuals age 18-20 who were in IV-E or, at state option, non-IV-E foster care when they turned age 18. Eligibility under the optional group does not require the individual to have been enrolled in Medicaid when they turned 18, nor are they required to have been in foster care in the same state in which they are seeking coverage under this group. Unless the state has elected to eliminate the income test for this group (by disregarding all income under section 1902(r)(2) of the Act), eligibility for this optional group is subject to the MAGI-based methods described at section 435.603.

As noted, the mandatory group will largely subsume the optional group, but there are some differences:

• The mandatory group at section 435.150 must be applied to individuals who were in state-only funded or IV-E foster care. The optional group at section 435.226 applies to individuals who were receiving IV-E foster care and, at state option, individuals who were in state foster care.
• The mandatory group requires that the individual have been enrolled in Medicaid while in foster care when s/he turned 18 or aged out of foster care; the optional group only requires that the individual have been in foster care when they turned 18.
• Eligibility for the mandatory group goes up to age 26; the optional group goes up to age 19, 20, or 21 (state option).
• There is no income test for the mandatory group. There is an income test for the optional group. Currently, the income standard for the optional group is based on the AFDC payment standard, although most states that cover this group apply a block of income disregard under section 1902(r)(2) of the Act to raise the effective income standard, and in some cases to eliminate it. This standard will be converted to a MAGI-equivalent standard effective in 2014, and additional disregards will no longer be permitted. States that have effectively eliminated any income test for this optional group may continue that policy in 2014

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91826

Individuals under age 21 who are eligible under the group for former foster care children are covered for EPSDT services. Individuals ages 21 - 25 who are eligible under this group are not covered for EPSDT services.

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• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91836

States have broad flexibility under the final regulations at section 435.956 regarding verification of non-financial eligibility requirements, other than citizenship and immigration status. States may, for example, accept self-attestation of the former foster care status and enrollment in Medicaid required for eligibility under this group.

In addition, section 435.952(c)(2)(ii) provides that the state may not require paper documentation unless electronic data to verify the individual's status as a former foster care individual is not available and establishing such a data match would not be effective. States that do not currently have an electronic data base that could be used for verifying an applicant's former status as a foster care child receiving Medicaid should consider the effectiveness of developing such capability in accordance with the regulations. The 90/10 federal match for systems development would be available for this purpose through Dec. 2015, as outlined in 42 CFR Part 433, available at http://www.gpo.gov/fdsys/pkg/FR-2011-04-19/pdf/2011-9340.pdf.

We note that, over time, verification of former foster care status may become less important at the point of application because, in accordance with sections 471(a)(16) and 475(1)(D) and (5)(H) of the Act, Title IV-E/B agencies are required to assist and support a foster youth in developing a transition plan during the 90-day period before the youth attains age 18, or, if applicable, before the later age elected by the state or tribe, that addresses specific options for the youth, including health insurance coverage. We encourage child welfare agencies and state Medicaid agencies to begin incorporating coverage under this group in the transition planning for foster care youth as soon as practicable. More information about transition planning requirements for youth in foster care can be found in Section C of ACYF-CB-PI-10-11, available at https://www.acf.hhs.gov/cb/policy-guidance/pi-10-11.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91841

No. In accordance with section 1902(a)(10)(G) of the Social Security Act, eligibility under the group for former foster care children takes precedence over eligibility under the new adult group. Thus, individuals who meet the requirements for both of these groups must be enrolled under the group for former foster care children.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91846

No. Under the law, the state's regular federal matching rate applies for individuals eligible under the former foster care group.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91851

Section 2101(a) of the Affordable Care Act amended section 2104(a) of the Social Security Act to extend title XXI funding for states' CHIP fiscal year allotments through September 30, 2015, the end of federal fiscal year (FY) 2015. The new law also amended section 2105(b) of the Social Security Act to increase the enhanced Federal Medical Assistance Percentage (Enhanced FMAP) rate by 23 percent applicable for certain expenditures for the period FY 2016 through FY 2019, but in no case will the enhanced FMAP exceed 100 percent. In the absence of additional legislation, the FY 2015 allotments would continue to be available through September 30, 2016. The Secretary also has the authority to redistribute prior unexpended allotments to states experiencing shortfalls.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91861

Yes. States have a limited opportunity to expand CHIP eligibility without a section 1115 demonstration (through the use of a block of income disregard) that will then get incorporated into a MAGI converted eligibility level. Any state interested in expanding CHIP eligibility above 200 percent of the FPL must submit a state plan amendment (SPA) before Dec. 31, 2013. After such time, states could expand eligibility through a demonstration. (Of course, if a state has not already expanded eligibility to 50 percent points above the MAGI-converted Medicaid income level that was in effect in 1997, that option for expansion without demonstration authority will remain available after Dec. 31, 2013.)

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91866

Yes. The CHIP enhanced FMAP will continue to be available for the expenditures for children shifted from CHIP to Medicaid, as long as their income is greater than the state's March 31, 1997 Medicaid income standard for children. In other words, if CHIP funding was available for this group of children when they were covered in a separate CHIP, it will continue to be available when the children are covered under Medicaid. The CHIP enhanced FMAP is available for uninsured children whose income exceeds that income standard, whether the children previously qualified for or were enrolled in a separate CHIP program or not.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91871

Yes, consistent with Medicaid coverage rules. States must cover children ages 6-18 in the new mandatory Medicaid group and Medicaid is the secondary payer to other insurance. All children must be covered without regard to their insurance status but title XIX funds must be used to cover such children who have creditable health insurance.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91876

Yes. As with children who move from a separate CHIP to Medicaid because of the change in Medicaid eligibility to 133 percent FPL, children moving from CHIP to Medicaid because of the application of the 5 percent disregard may also be funded through title XXI.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91881