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:
Are under age 26.
Are not currently eligible or enrolled in MAGI-related MA budget (except for MG90 and MG91) or SSI-related Non-Money Payment (NMP) MA
Exception: 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. 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.
Example: Bill (age 23, single, former foster care recipient) and his son Todd (age 2) apply for Medical Assistance. Bill indicates on the application that he is working part-time at McDonald's. The CAO is unable to verify his income via electronic data sources and requests paper verification. Bill does not return the requested verification. Bill did not verify information necessary for a MAGI determination, but he must be authorized PC40. Todd should be rejected for MA for failing to provide income information.
Note: If the individual fails to provide verification necessary for his or her eligibility determination for MAGI or SSI-related MA (including verification of disability), 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 73 and 74 upon release from placement between the ages of 18-21 are not eligible for this category.
Meet the U.S. citizen or non-citizen requirements to be eligible. (See Chapter 322, Citizen/Noncitizen.)
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.
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.
Updated May 25, 2016, Issued September 19, 2014