Frequently Asked Questions

Yes.

Supplemental Links:

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

FAQ ID:91781

Title IV-E foster care stops either when the individual attains age 21 or attains age 20, 19, or 18, as specified in the state's IV-E state plan.

Supplemental Links:

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

FAQ ID:91791

According to federal regulations at 45 CFR 1355.20, "Foster care means 24-hour substitute care for children placed away from their parents or guardians and for whom the [state or tribal] agency has placement and care responsibility. This includes but is not limited to, placements in foster family homes, foster homes or relatives, group homes, emergency shelters, residential facilities, child care institutions, and preadoptive homes. A child is in foster care in accordance with this definition regardless of whether the foster care facility is licensed and payments are made by the State, Tribal or local agency for the care of the child, whether adoption subsidy payments are being made prior to the finalization of an adoption, or whether there is Federal matching of any payments that are made."

Receipt of foster care maintenance payments is not required for a child to be considered "in foster care" under this definition/ Thus, children placed with a relative or in another non-licensed out-of-home placement, with respect to whom foster care maintenance payments are not being provided, may be considered to be "in foster care" according to this definition if they are also under the placement and care of the state or tribal agency.

This definition of "foster care" is contained in regulations implementing titles IV-B and IV-E of the Social Security Act. However, because the federal regulations implementing titles IV-B and IV-E require state and tribal title IV-E agencies to agree to certain program requirements for all children in foster care, this definition applies to all foster care provided in a state or tribe, even that which is provided without federal participation.

Supplemental Links:

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

FAQ ID:91796

No. Federal guardianship assistance payments provided under section 473(d) of title IV-E of the Act are not considered federal foster care maintenance payments. Because the title IV-E agency no longer has placement and care responsibility for youth receiving such payments, these youth are not considered to be in foster care and therefore would not be eligible for coverage 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:91806

There is no income test for eligibility under this new mandatory group for former foster care children. Therefore, MAGI-based methodologies are not relevant and states do not need to consider the parents' (or even the individual's own) income for purposes of Medicaid eligibility.

Supplemental Links:

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

FAQ ID:91816

No. States may not impose an asset test for eligibility 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:91821

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.

Supplemental Links:

• 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