The CCYA/JPO has several placement options when a child is taken into custody. For example, the child may be placed in a shelter or juvenile detention center until final disposition and then later placed in a foster home, group home or residential placement.
The CCYA placing the child will contact the CAO in the county where the CCYA is located no later than the end of the next work day after the placement date. The contact may be by phone, FAX, or e-mail.
The CCYA will give the CAO the following information about the child:
The child’s full name (last, first, middle initial)
Date of birth
Sex
Race
The CCYA will also give the CAO the following information:
Name of the reporting CCYA staff person
Address and telephone number of the reporting CCYA
CCYA or JPO case number
Type of placement, using placement/facility code
Where the child is placed, using county/district code
The CAO will authorize MA benefits for the child after the telephone, FAX or e-mail contact with the CCYA as follows:
STEP 1: Do a file clearance to find out if the child is currently receiving benefits.
If the child is not currently receiving MA, the CAO will authorize MA benefits no later than the end of the next work day after the telephone, FAX or e-mail contact.
NOTE: In a medical emergency, once MA is authorized, the CAO will immediately give the CCYA the child's recipient number, card issue number and managed care information, if appropriate.
If the child is currently receiving MA, SSI or cash assistance, the contact by telephone, FAX or e-mail notifies the CCYA that the child is no longer in the home. The CAO worker in the county where the CCYA is located must:
Immediately enter the appropriate placement/facility code and county/district code.
Notify the CAO worker responsible for the child's active benefits. The worker will send a Notice to confirm the child’s removal from the family's benefits effective the first date possible.
Authorize MA for the child in the Foster Care case within five working days of the telephone, FAX or e-mail contact with the CCYA. The child must be closed in the family’s case record and re-opened in the CCYA case record within the same calendar month to meet managed care requirements for continuity of care. The CCYA has access to the Eligibility Verification System (EVS) to verify MA eligibility.
If the child is currently receiving SSI, the CAO will immediately notify the CCYA. The CCYA will notify the Social Security Administration of the child's address change. The SSI MA budget stays open until SSA notifies the CAO that SSI benefits are discontinued.
STEP 2: Enter the appropriate information into the Client Information System (CIS) Application Processing. If the child is or was getting MA and the CIS information differs from the CCYA information, authorize MA using the CIS information until the CCYA verifies that their information is correct.
STEP 3: Authorize MA in the appropriate category.
For the budget open date, use the placement date.
For the payment name, use the child’s name in care of the CCYA at the CCYA address.
STEP 4: Enter a Y in the EPSDT field and the name of the child's doctor, if known. The CCYA will notify the parents that their child is enrolled in EPSDT. (See Appendix C, Sample Letter 1) All children in placement are enrolled in EPSDT.
STEP 5: Enter the correct county/district code and placement/facility code into CIS. This ensures the correct MA services program (managed care or fee-for-service).
The CCYA/JPO will determine the placement/facility code and county code.
Contact the CCYA/JPO for the code if it is not provided.
It is important to use the correct code. The code directly affects the child’s ability to get medical services.
STEP 6: Set a case alert for 60 days from the budget open date to review the case record.
STEP 7: Contact the CCYA if the CY 61 has not arrived.
The CCYA will mail or FAX the CY 60 to the CAO within five working days of the telephone, FAX or e-mail contact.
The CAO will then mail or FAX the completed CY 60 to the CCYA within five working days.
The completed CY 60 tells the CCYA that MA has been authorized and the child enrolled in EPSDT.
The completed CY 60 also tells the CCYA whether the child receives SSI or is from a household that receives cash assistance, MA and/or the Supplemental Nutrition Assistance Program (SNAP).
If the CCYA has custody of a baby born to a mother who is in CCYA placement, the newborn has the same MA status as the mother. The newborn is automatically eligible for the same type of MA coverage, with the same program status code, as the mother.
A newborn not in CCYA custody is automatically eligible, but not in CCYA MA category.
The CCYA will send a CY 842 when a child is born to a mother in placement. The form can be sent with a CY 61 or later as a supplement.
When the CAO receives a Newborn Eligibility Form (MA 112) or CY 842, MA is authorized immediately for the child based on the information on the form.
The CAO will issue a notice of MA eligibility for the newborn shown on the form. CIS will automatically issue an ACCESS card when the newborn is authorized.
A child born to a mother who receives placement maintenance may not receive TANF. The newborn is eligible for placement maintenance benefits.
A child in placement will be enrolled and remain in the MA Program without interruption of coverage unless the child's income is above the MA eligibility limits.
If the child’s income is over the limits, the CAO will contact the CCYA to explore spend-down eligibility. The CAO must make sure MA benefits continue for these children while spend-down eligibility is being determined.
The CCYA in the county placing the child will send the CY 61 to the CAO within sixty days of the child's placement. The CAO will not require an application or interview. The CAO will use the CY 61 to determine MA for the child based on spend-down eligibility.
Based only on the information on the CY 61 from the CCYA, the CAO will determine eligibility and:
If the child is eligible, continue MA in category J or PC/program status code 33 until the CCYA notifies the CAO that the child is IV-E eligible.
If the child is not eligible for MA, close category PC with program status code 33 effective the day before the first day of the next benefit eligibility period for which the deadline can be met. The CAO will refer the child to the Children’s Health Insurance Program (CHIP) using the CY 61.
The CAO must notify the CCYA of the eligibility determination within 10 working days by sending the appropriate notice and the original copy of the CY 61 with the appropriate sections completed.
The CCYA will send a letter to the parents if a doctor or other professional has found it medically necessary for the parents to participate in medical services or treatment with their child. (See Appendix C, Sample Letter 2) The CCYA will mail a copy of this letter to the CAO in the parents' county of residence.
The letter will verify the need for transportation or transportation cost reimbursement for the parents as if they have been determined eligible for MA benefits. The CCYA will notify the parents if prior authorization is required for their child’s medical services or treatment. (See Appendix C, Sample Letter 3)
If a child is returned to the parents' home or placed in an ineligible facility (one that does not meet the standards in 45 CFR 1355.20) before the CY 61 process is completed, the CCYA will notify the CAO that the child may no longer be eligible for MA. The CCYA may call or FAX the CY 60 to the CAO.
The CCYA must confirm telephone notification in writing within five working days by completing the CY 60 and sending it to the CAO. The CAO will send the appropriate notice to the CCYA notifying them that MA benefits for the child will end. See Section 850.27, Discharge from Placement for closing the Foster Care record.
When a child is discharged from placement, the CAO continues MA benefits until eligibility is determined.
The CCYA/JPO will:
1. Send a letter to the parents at least thirty days before a child’s discharge from placement giving them the discharge date. (See Appendix C, Sample Letter 4)
2. Mail an application form stamped with the letters “CCYA” to the child's parents with the letter.
3. Mail a copy of the letter to the CAO in the parents' county of residence.
4. Mail a copy of the letter to the CAO in the placement county if the parents live in a different county.
To ensure that MA coverage and appeal rights are uninterrupted, the CAO will:
1. Begin case action timely based on receipt of the earliest available information
2. Change the case record payment name and address to the name and address of the parents or person to whom the child is released
3. End date the placement/facility code
4. Issue a replacement ACCESS card if necessary
NOTE: When a child leaves placement, the CCYA will return the ACCESS card to the parents or person to whom the child will be released. The card belongs to the child and stays with the child. If the card is not available, the CCYA will call the CAO to say that a replacement card is needed. The CAO can only issue a seven-day interim card if the child has immediate medical needs.
5. Give the parents the notice that explains their right to appeal.
6. Form a plan with the parents to determine eligibility, noting that no adverse action can be taken before the end of the 10-day appeal period on the Advance Notice.
7. Make a referral to the Disability Advocacy Program (DAP) according to Chapter 820, Disability Advocacy Program if the CCYA or the parents indicate the child may have a disability.
When the CAO receives the copy of the letter based on Sample Letter 4, the CAO will:
1. Do a file clearance.
2. Set a control to contact the CCYA three work days after the Juvenile Court date shown in the letter to verify that the child has returned to the parents' home. Verify the child’s return by the telephone contact, FAX from the CCYA or by receipt of the CY 60.
3. For cash assistance, an application form is required to add a mandatory budget group member to an existing budget group. (See Cash Assistance Handbook Section 104.15, Adding Persons to a Budget Group.) MA benefits must remain open in the Foster Care case until eligibility is determined.
4. If the child is eligible for MA, close the Foster Care case and open MA for the child in the case record of the parents or person to whom the child is released.
5. Send a Confirming Notice to the parents explaining that the child remains eligible for MA.
6. Send a copy of the Confirming Notice to the CCYA.
NOTE: A new MA application is not necessary to add a child who is moving back into the household if the child is under 21, not emancipated, and under the care and control of a parent or legal guardian. MA may be authorized while waiting for proof of citizenship and identity. Check for any income changes.
7. If the child is not eligible for MA, close the Foster Care case by sending an Advance Notice to the parents (or person to whom the child is released) and a copy to the CCYA. The Advance Notice must show that MA is ending because the child is no longer in placement and does not meet eligibility requirements.
8. Send an Advance Notice to the parents if the CCYA contact or the CY 60 verifies that the child has returned home and the parents (or person to whom the child is released) did not notify the CAO. The Advance Notice must show that MA is ending because the child is no longer in placement.
9. Determine eligibility so MA can continue for the returning child. The Advance Notice must show that the parents (or person to whom the child is released) need to apply in order for the child’s MA benefits to continue. If the application form is returned or the parents contact the CAO before the effective closing date, the Foster Care case stays open while MA eligibility is determined.
10. Close the Foster Care case if there is no response to the letter based on Sample Letter 4 or to the Advance Notice and the parents (or person to whom the child is released) do not contact the CAO or return the application form. Indicate the closing on the Advance Notice.
11. If the parents ask for an application after the Foster Care case is closed, process the application according to Medical Assistance Eligibility Handbook Chapter 304, Application.
12. If the parents do not live in the same county as the CAO with the active Foster Care case, the CAO in the parents’ county of residence will set a control to contact the CAO worker in the county with the active Foster Care case no later than three work days after the Juvenile Court date in the letter based on Sample Letter 4 to verify that the child has returned to the home.
13. Mail a copy of the letter based on Sample Letter 4 to the CAO in the parents' county of residence and to the CAO with the active Foster Care case. The CAO worker in the county with the active Foster Care case who has contacted the CCYA or received the CY 60 may provide information on the child's return.
14. When notified that the child has returned home, the CAO worker in the parents' county of residence will contact the CAO worker in the county with the active Foster Care case. The CAO worker will change the payment name and address to the name and address of the parents or person to whom the child is released. The worker will send another application form if a completed application does not arrive within 30 days of the child’s placement discharge date.
15. The CAO worker in the parents' county of residence and the CAO worker in the county with the active Foster Care record must communicate and cooperate to get the information needed so MA benefits continue for the returning child while eligibility is decided.
16. The CAO worker in the parents' county of residence will tell the CAO worker in the county with the active Foster Care case that a completed application form has been received or that another application has been mailed. The Foster Care case remains open until MA eligibility is determined.
If the child is eligible:
Authorize continued MA for the child in the parents' case record.
Send a notice to the parents telling them that the child is eligible for MA.
When notified that the child is eligible, the CAO worker in the county with the active Foster Care case will close the Foster Care case, issue a Confirming Notice to the parents, and give a copy of the Confirming Notice to the CCYA.
If the child is not eligible:
The CAO worker will send the appropriate notice telling the parents the decision and the reason for ineligibility.
The notice must show that MA for the child is ending because the child is no longer in placement and, based on the parents' MA application, the child is not eligible for continued MA.
The worker will also notify the CAO in the county with the active Foster Care case of the rejection. The CAO worker in that county will close the Foster Care case on the effective date shown on the Advance Notice and send a copy of the Advance Notice to the CCYA.
If the parents have not contacted the CAO for continued MA benefits for the child:
Mail the Advance Notice to the parents.
The Advance Notice must show that an eligibility determination is necessary to continue MA for the child and that the parents must apply to the CAO in their county of residence.
If the parents do not respond to the Advance Notice, the Foster Care case closes with the date shown on the Advance Notice.
If the parents contact the CAO before the end of the ten-day appeal period on the Advance Notice, but the eligibility determination cannot be completed before the closing date, the CAO worker in the parents' county of residence must notify the CAO worker in the county with the active Foster Care case. The Foster Care case will remain open until eligibility is determined.
The Foster Care case closes as of the date on the Advance Notice if:
There is no response to the letter based on Sample Letter 4
There is no response to the Advance Notice
The parents do not contact the CAO
The parents do not return the application form
If the parents request an application after the Foster Care case is closed, process the application using Medical Assistance Eligibility Handbook Chapter 304, Application.
Citations:
55 Pa .Code § 3140.111
55 Pa. Code § 3140.112
Reviewed July 30, 2013