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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 July 2024 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.107 4

G. Entitlement Children under 19 receive 12 months of continuous eligibility unless they reach age 19; are no longer Virginia residents; the child or child’s representative requests eligibility be closed; the agency determines that eligibility was incorrectly approved because of agency error or fraud, abuse, or perjury attributed to the child or the child's representative; or the child is deceased. 1. IV-E Foster Care Child Entitlement to Medicaid as a IV-E Foster Care child begins the first day of the month of commitment or entrustment if a Medicaid application is filed within 4 months of commitment or entrustment. Retroactive entitlement prior to the month of commitment or entrustment is not allowed.

If the Medicaid application is filed more than 4 months after entrustment or commitment, entitlement may be retroactive up to 3 months prior to application if the child met all Medicaid eligibility requirements in the retroactive months. However, Medicaid entitlement cannot go back to the month of entrustment or commitment when the application is filed more than 4 months after entrustment or commitment.

2. IV-E Adoption Assistance Child Entitlement to Medicaid as a IV-E Adoption Assistance child begins the first day of the application month if all eligibility factors are met in that month. Retroactive entitlement, up to three months prior to application, is applicable if all Medicaid eligibility criteria were met during the retroactive period. H. Enrollment The aid category (AC) for IV-E foster care children is “076.” The AC for IV- E Adoption Assistance children is “072”.

M0330.107 INDIVIDUALS UNDER AGE 21

A. Policy 42 CFR 435.222 – The federal Medicaid law allows the State Plan to cover reasonable classifications of individuals under age 21 years who do not receive cash assistance but who meet the income requirements of the state’s July 16, 1996 AFDC State Plan. Children under age 19 should be evaluated in the FAMIS Plus covered group if not eligible as individuals under age 21. Individuals ages 19 and 20 should be evaluated in the Individuals Under Age 21 covered group when they are not eligible for Medicaid in any other full- benefit covered group. The reasonable classifications of individuals under age 21 are: • IV-E eligible foster care children who do NOT receive a IV-E maintenance payment, • Non-IV-E foster care children, • Department of Juvenile Justice (DJJ) children, • Non-IV-E Adoption Assistance children, • Children in intermediate care nursing facilities (ICF), and • Children in intermediate care facilities for the intellectually disabled (ICF-ID). B. Nonfinancial Eligibility Requirements The individual must be under age 21 and meet the nonfinancial requirements in chapter M02. C. Reasonable Classifications The individual under age 21 must meet one of the following classifications: