We noted in a previous FAQ released on May 22, 2012 (available at: http://www.medicaid.gov/sites/default/files/state-resource-center/FAQ-medicaid-and-chip-affordable-care-act-implementation/downloads/Eligibility-Policy-FAQs.pdf (PDF, 81.8 KB)), states are not required to track the pregnancy
Section 1903(v)(2) of the Social Security Act limits the availability of federal Medicaid matching funds for states' expenditures for medical assistance for certain individuals to expenditures for services furnished to treat an emergency medical condition. If such individuals meet the eligibility criteria for the Medicaid new adult group in the state to be considered "newly eligible" under the state's FMAP methodology for the new adult group, state expenditures consistent with section 1903(v) are matched at the newly eligible FMAP described in section 1905(y).
Section 2004 of the Affordable Care Act added a new mandatory group for former foster care children at section 1902(a)(10)(A)(i)(IX) of the Social Security Act (the Act). Proposed 42 CFR 435.150 of the January 22, 2013 proposed rule, available at http://www.gpo.gov/fdsys/pkg/FR2013-01-22/pdf/2013-00659.pdf, would codify the provisions of section 1902(a)(10)(A)(i)(IX).
States cannot cover individuals who left foster care before aging out under the former foster care children group. Section 1902(a)(10)(i)(IX) of the Act only provides Medicaid eligibility for individuals who were in foster care when they turned 18 or such higher age when the state's foster care assistance ends. Individuals who left foster care before age 18, or who were not in foster care and Medicaid either upon turning 18 or upon "aging out" of foster care at the higher age elected by the state, are not eligible for coverage under this group.
Yes, we will approve state plan amendments to cover individuals who were in foster care and receiving Medicaid when they turned age 18 or "aged out" of foster care in another state. This option is provided in the state plan amendment (SPA) page (S33) for this group. Because this provision has not yet been finalized, if section 435.150 is later finalized in such a way that conflicts with the state's approved state plan amendment, a subsequent amendment to the state plan may be necessary (see 42 CFR section 430.12(c)(1)(i)).
Yes. Effective as of January 1, 2014, coverage is available to individuals under age 26 who meet the eligibility requirements described above. For example, an applicant who is 23 years old in January 2014 and who was in foster care and receiving Medicaid at the time he or she turned 18 (back in 2009) will be eligible for coverage under the former foster care group.
Yes.
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.
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.
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.
