Page 9

COMAR 10.09.24.03

308 State of Maryland Medical Assistance Manual Revised July 2012 The Centers for Medicare and Medicaid Services (CMS) approved changes in MA eligibility requirements for E-track children in out-of-home placements. Income and resources are no longer a factor of MA eligibility for foster care or subsidized adoption children in the E-track. Therefore, the only reason for a foster care child to be MA eligible in the State-only coverage group of E03 is if the child fails a technical factor of MA eligibility, such as citizenship or Social Security number (SSN). Non-IV-E eligible children in State subsidized adoptions are eligible in the federal category of E02 if they meet MA technical eligibility requirements and have special needs for medical, mental health, or rehabilitative care. E01 is for IV-E or SSI eligible foster care or subsidized adoption children. E02 is for non-IV-E foster care children or special needs subsidized adoption children who are not IV-E or SSI eligible, but meet the MA technical eligibility requirements. The State-only category of E04 is for all other children in State subsidized adoptions.

When the state places a child in foster care or subsidized adoption, it is imperative that the MA certification process is timely so that the child has immediate access to health care coverage. If there are unpaid medical bills for the child, retroactive eligibility should be determined for the three months prior to the date of MA E-track application. Good communication between the OHP service worker, FIA MA case manager, and IV-E specialist (who determines IV-E eligibility) at the LDSS is necessary to ensure prompt and correct MA coverage. This information provides uniform procedures to be followed by all local offices when processing E-track MA applications filed on behalf of a child in Out of Home Placement (OHP) (IV-E or State foster care and subsidized adoptions) when: The child is filing an initial MA-application and is not already active or pending in CARES for MA and/or other eligibility; or The child applicant is already a recipient in an active or pending Assistance Unit (AU), such as TCA, Food Stamps (FS), SSI, MA, or the Maryland MCHP. Eligibility for OHP is established by the DHR regulations found in COMAR 07.02.11. Federal funding of OHP services is governed by Title IV-E of the Social Security Act (SSA).

The E-track is only for foster care children committed by the courts to the custody of the DHR and for children receiving subsidized adoption services from DHR. The MA application for a foster care child must clearly indicate if parental rights have been terminated, because this triggers a child support referral. The procedures in this section are not applicable to children placed in foster care or adoption by private agencies or individuals, who should have their eligibility determined under the appropriate MA or MCHP coverage group other than the E- track. They are not eligible in the E-track. However, the E-track may include children who are dually committed to the custody of DHR and the Department of Juvenile Services (DJS), so long as the child is receiving foster care or subsidized services from DHR.

As long as children in the Kinship Care Subsidized Guardianship Waiver Program remain under the State‟s custody, they stay MA eligible in their E-track coverage group. Once guardianship is granted and the service case is closed, children in the Kinship Care Subsidized Guardianship Waiver Program must have their eligibility determined in the appropriate MA or MCHP coverage group other than the E-track. They are no longer eligible in the E-track. FIA Action