Medicaid Policy
Medicaid Policy
Effective Date: November 1, 2023
Foster Care Medicaid provides medical coverage to children who:
o Have been removed from their home AND
o Are in the custody of the state or tribe AND
o Are in an out-of-home placement AND
o A Foster Care maintenance payment is being made.
Children may be placed in the custody of the Division of Child and Family Services (DCFS), the Department of Health and Human Services (DHHS), the Division of Juvenile Justice Services (DJJS) or a tribe.
1. When the state takes a child into custody, DHHS makes an eligibility determination for IV-E foster care based on the child's parents' income, assets and home circumstances. If the family the child is removed from meets IV-E eligibility criteria, DHHS receives additional Federal funding for the care of the child. A IV-E eligible child is automatically eligible for Medicaid coverage.
2. A child who does not meet the IV-E eligibility criteria may qualify for Medicaid under one of the other Medicaid coverage groups for children. We refer to them as non-IV-E eligible foster children.
3. Catholic Community Services is the designated agency to provide foster care to unaccompanied refugee minors. These children may apply with DWS to receive regular Medicaid coverage. These children are considered to be under the responsibility of the state.
4. DHHS considers multiple criteria to make an appropriate placement for each child. DHHS first tries to place the child with a relative, and second, with a licensed non-relative. The different types of placements are described below.
When a member becomes ineligible for any foster care program, always review the member for eligibility under other medical programs (827).
A. Title IV-E Foster ChildTitle IV-E children may be placed with, a relative, a non-relative or in a Kinship Guardianship placement, and are issued benefits as listed below:
1. Placement with a Relative:
a. DHHS issues a IV-E Foster Care payment and authorizes IV-E Medicaid for a child when they:
o are determined to be IV-E eligible;
o are in state custody;
o Lives with a relative who is a state licensed foster care provider; or
o Lives with a parent who is receiving in-patient substance abuse treatment.
b. A "Preliminary Placement" is when DHHS makes no Foster Care payment to the relative. Instead, the relative may apply to DWS for a Specified Relative financial payment and Child Medicaid for a child because:
o The child is in state custody, but
o The relative with whom the child lives is not a licensed foster care provider. This may change if the relative later becomes a licensed provider.
c. DHHS authorizes a Kinship Guardianship payment and Kinship Guardianship Medicaid for a child when he:
o Is determined to be IV-E eligible,
o Is between the ages of 14 – 18,
o Is living with a relative, has been there for a minimum of six months and the relative signs a guardianship agreement to permanently care for the child,
o Is no longer in state custody, and
o Neither reunification with the parents nor adoption is a viable option.
2. Placement with a Non-Relative:
a. DHHS issues a IV-E Foster Care payment and authorizes IV-E Medicaid for a child when he:
o Is determined to be IV-E eligible,
o Is in state custody, and
o Lives with a non-Relative who is a state licensed foster care provider.
b. DHHS can issue a State Guardianship financial payment and DWS would determine Medicaid eligibility for a child when he:
o Is determined to be IV-E eligible,
o Is not in state custody, and
o Lives with a non-relative.
3. When another state places a Title IV-E foster child in Utah, Utah is responsible to provide Medicaid for the member. DHHS determines the Medicaid eligibility for the child.
B. Non-Title IV-E Foster Child
1. Placement with a Relative:
a. DHHS issues a Foster Care payment and authorizes Non-IV-E Medicaid for a child when he:
o Does not meet the IV-E Foster Care criteria,
o Is in State Custody, and
· Lives with a relative who is a state licensed foster care provider.
· Lives with a parent who is receiving in-patient substance abuse treatment, does not meet the IV-E AFDC criteria and is receiving a IV-E Foster Care payment.
b. A "Preliminary Placement" is when DHHS does not make a Foster Care payment to the relative. Instead, the relative may apply to DWS for a Specified Relative financial payment and Child Medicaid for a child when he:
o Does not meet the IV-E Foster Care criteria,
o Is in State Custody, and
o The relative with whom the child lives is not a licensed foster care provider. This may change if the relative later becomes a licensed provider.
c. DHHS issues no Foster Care payment and DWS would issue a Specified Relative payment and Child Medicaid for a child when he,
o Does not meet the IV-E Foster Care criteria,
o Is not in State Custody, and
o Lives with a relative.
2. Placement with a Non-Relative:
a. DHHS issues a Foster Care payment and authorizes Non-IV-E Medicaid for a child when he:
o Does not meet the IV-E Foster Care criteria,
o Is in State Custody, and
o Lives with a non-relative who is a state licensed foster care provider,
b. DHHS makes State Guardian financial payment and DWS determines Medicaid eligibility for a child when he:
o Does not meet the IV-E Foster Care criteria,
o Is no longer in State Custody, and
o Lives with a non-relative.
3. When another state places a non-Title IV-E foster child in Utah, the state making the placement is responsible to provide Medicaid for the child.
C. Guardianship Program
The Division of Child and Family Services has a program called the Guardianship Program. The Guardianship Program provides financial assistance to children who do not wish to be adopted, but still need to be placed in a home other than their parents or specified relative.
o The services associated with this program are similar to the Foster Care Program.
o Children in the Guardianship program are not in the custody of the State.
o In certain counties, mental health services are provided under a capitated mental health plan. Unlike the Foster Care program, the Guardianship program does not allow a member to obtain mental health services on a fee-for-service basis when the member resides in a county that is under the capitated plan. The member must receive services under the capitated mental health plan or Medicaid will not pay for the services.
o A child receiving Guardianship assistance should not be opened for Foster Care Medicaid.
o Instead, a program such as Child Age 0-5, Child Age 6-18, Disability or Blind Medicaid, or Medically Needy Child should be opened.
o Complete Duty of Support papers against the legal parents, not the guardian.
o Count only the income and assets available to the child. Do not count the income or assets of the guardian.
o All other Medicaid policy applies.
D. Title IV-E Kinship Guardianship Medicaid
DHHS has created a Kinship Guardianship program for youth aged 14-18 who live with a relative to provide the child a permanent, safe living arrangement. The relative will receive a Federal Title IV-E subsidy, which usually ends when the member ages out at 18 years old. The following requirements must be met.
o The member cannot safely return home.
o The member does not want to be adopted and,
o The member has developed a significant bond with the relative.
The Title IV-E Kinship Guardianship Medicaid is the accompanying Medicaid category for those youth. DHHS is the agency which approves the Medicaid eligibility (354-5).
DHHS may place a sibling who is under age 14 in the same relative's home when the older sibling is under a Kinship Guardianship agreement. In this case, DHHS will authorize Title IV-E Kinship Guardianship Medicaid for the younger sibling.
E. Former Foster Care Children
Beginning January 1, 2014, persons aged 18-26 who have been in foster care in the past may qualify for Medicaid. The Former Foster Care program is for persons aged 18-26 who were in foster care under state custody on or after their 18th birthday. They had to be receiving Medicaid at some point during the foster care period in which they turned age 18. They can receive this coverage until they reach age 26. See Sections 354-3.
F. Foster Care Independent Living
The Foster Care Independent Living program is for persons who were in foster care under state custody on or after their 18th birthday. They did not have to be eligible for Medicaid while in state custody. They can receive this coverage until they reach age 21. This includes members who were in foster care in any state or tribe. See section 354-4.