312.8 Deciding on Eligibility

 

The CAO must decide who is eligible for MAGI-related MA as follows:

 

  1. Decide who is in the MAGI household. (See Section 312.1 and Section 312.2.)

 

  1. Base household composition on how the household files taxes. (See Section 312.2.) Step-parents and parents are treated the same.  A household can include an OOTH individual who has a tax-relation to an applicant and does not live in the household.

 

  1. Determine the countable household income of every individual included in the individual’s household.  Financial eligibility is based on current monthly income. (See Section 312.5.)

 

  1. Calculate each applicant’s net monthly income by applying the allowable deductions. (See Section 312.6.)

 

  1. Disregard 5 percent of the 100 percent FPIG for the applicable family size, only if the disregard is necessary.

 

  1. Compare the total net monthly income for all applicants with the MAGI income limits applicable for each individual.

 

312.81  Medical Assistance for Former Foster Care Recipients

Individuals who were in foster care and enrolled in MA at any time on or after their 18th birthday may qualify for MA in a special category.  The category/program status code PC 40 is assigned to the individuals in this group.

 

The individuals eligible for MA coverage under the Former Foster Care category are those who:

 


Exception:  General Assistance (GA) MA, NMP spend down, Medically Needy Only (MNO) MA and MNO spend down should not be authorized for former foster care recipients. PC40 must be authorized if the individual is not eligible for MAGI MA or SSI-related NMP.


Example: Bill (age 23, single, former foster care recipient) applies for Medical Assistance. He indicates on the application that he has a medical condition. Among other verifications, the caseworker requests a form PA 1663 to be completed by his doctor. Bill returns PA 1663 to the CAO which indicates that he has a temporary disability. Because Bill does not meet the criteria for MAGI or SSI-related MA, the caseworker must authorize PC40 regardless of the fact that Bill may qualify for GA-related MA.


Note: If the individual fails to provide verification necessary for his or her eligibility determination for MAGI or SSI-related MA, the CAO must still authorize PC40, if all other conditions of eligibility for the Former Foster Care category are met.


Note: The federal definition of foster care does not include placement in a detention facility, secure treatment facilities, psychiatric facilities, hospitals and forestry camps. Children placed with facility codes 55, 56, 73 and 74 upon release from placement between the ages of 18-21 are not eligible for this category.

 

 

NOTE: This group is for Former Foster Care recipients only. Individuals who received Adoption Assistance and Permanent Legal Custodians (PLC) are not eligible for MA in this group.

For those who are eligible under the Former Foster Care category (PC 40), there is no income or resource determination.

 

Foster Care Age Out information is accessible through the “CQMAIN transaction” in CIS.

 

When an individual receiving MA in a federal or state-funded foster care category, (PC 31 or PC 33) leaves foster care on or after their 18th birthday, the CY-60 completed by the County Children and Youth Agency notifying the CAO of the child’s discharge will serve as the application.

 

Individuals under age 26 who left foster care with MA on or after their 18th birthday prior to January 1, 2014 will need to submit an application to be reviewed for eligibility under the Former Foster Care category. The CAO must verify receipt of foster care and MA in CIS. Individuals who moved to Pennsylvania from another state must submit an application and provide verification of receipt of foster care and MA from the other state. The CAO will assist the individual, if necessary, to obtain verification of receipt of foster care and MA from the other state.

 

These individuals are subject to an annual renewal to review for eligibility in other categories. The Former Foster Care budget may not be closed for failure to furnish verification. The budget is to be processed through reapplication mode and the PC 40 is to remain open. 

 

NOTE: If a caseworker receives verified information indicating that an individual is not eligible for MA for a reason such as incarceration, moved out of state, or death, the caseworker must close the case.

 

When an individual loses eligibility under Former Foster Care upon attaining age 26, the CAO must determine if the individual is eligible for any other category before terminating MA coverage.

 

Issued September 19, 2014