Appendix C: Sample Letters

(Local CCYA Letterhead)

Dear ______(Parent's Name)____:

While in foster care, your child, ____(Child's Name)_____, will receive medical benefits under a program known as EPSDT, which is Early and Periodic Screening, Diagnosis, and Treatment. Under EPSDT, your child is entitled to receive regular medical examinations, including eye and ear examinations, and any professional medical services or treatment that the doctor or other professional decides are medically necessary. As a parent, you may be included in services such as family therapy or counseling with your child if the doctor or other professional decides it is medically necessary for you to participate.

Making sure that _____(Child’s Name)____ gets the health care he/she needs is another reason why you should make a point of staying in touch with me. I will keep you informed, by telephone call or letter, about any medical appointments that are scheduled. If a doctor prescribes treatment or a service that includes you, I will send you another letter.

Enclosed is a brochure that describes the EPSDT Program.

Sincerely,

_____________________

(Child's Case Manager)

(Local CCYA Letterhead)

Dear ______(Parent's Name)____:

This is to inform you that your child _____(Child’s Name)____ has received a medical examination under the Early and Periodic Screening, Diagnosis and Treatment Program ("E.P.S.D.T.") on ___(Date of Examination)____.

As a result of this screening, the doctor recommended that you participate in the following services or treatment with your child:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

This service or treatment may require prior authorization by the Department of Human Services ("DHS") before you can receive service(s). If prior authorization is required, we will let you know promptly when DHS authorizes or denies the service(s) or treatment.

Because this service is important to the well-being of your child, I am sure that you will want to participate as recommended by the doctor. I will contact you in the near future to determine your availability for participation in treatment. Based on your availability, an appointment time(s) will be set.

If you are receiving medical assistance and need help in arranging for transportation to attend these appointments, you should contact your county assistance office. Transportation or reimbursement of transportation costs may be available to you. Information about applying, in writing or otherwise, for this transportation is available through your county assistance office.

You have the right to a fair hearing if DHS denies, delays, reduces, suspends or ends the services or treatment(s) listed above. You will get a notice about how to exercise your right to a hearing if DHS does not authorize the services or treatment.

If you have any questions regarding this letter or need assistance in requesting a hearing, please contact me. Information about free legal services that might be available for assistance with a fair hearing may be obtained by calling the Pennsylvania Legal Services Center at 1-800-322-7572 or your local county assistance office.

Sincerely,

_____________________

(Child's Case Manager)

cc: File

(Local CCYA Letterhead)

Dear ______(Parent's Name)____:

This letter is to inform you that the Department of Human Services ("DHS") has APPROVED_____ DENIED_____ the following services or treatment which the doctor had recommended for your child, with your participation:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

A copy of the notice received from DHS is enclosed.

If DHS has authorized treatment, I will contact you in the near future to determine when you are available for appointment(s).

If DHS denied the recommended treatment, you have the right to appeal that decision. You have thirty days to ask for a fair hearing, if you disagree with the decision. If DHS approved the recommended treatment now, but decides to reduce, or suspend, services/treatment in the future you also have the right to appeal that decision. If you ask for a fair hearing within ten days of the decision to reduce, suspend, or end, the service(s) will continue until the appeal is decided.

If you wish to exercise your right to a hearing, you should send a letter to the address listed on the enclosed decision notice statement. Information about free legal services that might be available to you may be obtained by calling Pennsylvania Legal Services Center at 1-800-322-7572 or your local county assistance office. The procedure for filing an appeal is also described on the notice statement.

If you have any questions about this letter or need assistance in requesting a hearing, please contact me.

Sincerely,

_____________________

(Child's Case Manager)

cc: File

(Local CCYA Letterhead)

Parent Name: _______________________

Address: _____________________________

Social Security #: ______________________

Dear ______(Parent's Name)____:

This letter is to inform you that ___________(Name of Agency)__________ will recommend that your child ___________(Name of Child)______________ be discharged from foster care and returned to your custody. I anticipate that the return will occur on ________(Date)__________. The discharge must be approved by the Juvenile Court.

If you want medical benefits to continue for your child after he or she returns to your custody, you must complete the enclosed Application Form and submit it to:

Name: __(CAO where the parent resides)___

Address: _____________________________

Phone: _______________________________

This form will have to be returned to __________(Name of CAO)______________ by _________________(Insert Date 10 days prior to Scheduled Discharge Date)_______.

In order to continue receiving Medical Assistance benefits for your child while your application is being processed, you must notify the County Assistance Office ("CAO") as soon as your child returns to your care. When you do so, an interim Medical Assistance Identification ("MAID") card for your child will be issued to you. If you do not notify the CAO that your child is living with you, there might be a delay in issuing the MAID card to you.

Congratulations on the pending reunification of your family. If you have any questions or require any help regarding the medical assistance process, you should feel free to contact me.

Sincerely,

_____________________

(Child's Case Manager)

cc: CAO whose address is given in the body of the letter.

cc: CAO located in Foster Care placement county if parents' county of residence is different.