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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 May 2015 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.804 36

M0330.804 INDIVIDUALS UNDER AGE 21

A. Policy 42 CFR 435.308(b) - A state may choose to provide medically needy coverage to reasonable classifications of individuals under 21 years of age who are not eligible for coverage as categorically needy but who meet the medically needy resource and income requirements. Virginia has chosen to cover the following reasonable classifications of individuals under age 21: • 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 an ICF-ID. NOTE: the ICF- ID services are not covered for medically needy individuals, but other Medicaid covered services such as prescription drugs, physicians, inpatient and outpatient hospital services are covered for medically needy patients in ICF- IDs. B. Nonfinancial Eligibility The individual must be under age 21 and meet the nonfinancial requirements in chapter M02. The child meets the age requirement until the end of the month in which the child turns age 21. C. Reasonable Classifications The individual under age 21 must meet one of the following classifications: 1. Non IV-E Foster Care Children who meet the foster care definition in M0310.115 but do not receive a IV-E maintenance payment are “individuals in foster homes, private institutions or independent living arrangements for whom a public or private nonprofit child-placing agency is assuming full or partial financial responsibility.” This group also includes DJJ children. c. Children Living In Public Institutions Non-IV-E foster care children meet the Medicaid institutional status requirements when they live in a public child care institution if the facility has less than 25 beds, or if they live in a publicly operated community residence that has no more than 16 beds. See section M0280.100 for definitions of public institutions. When these children are placed in public residential institutions, the facility must not have capacity for more than 16 children (see M0280).