DCFS INFO MEMO 2006 - 03

           February 8, 2006


Department of Health and Family Services
Division of Children and Family Services

To: Area Administrators/Assistant Area Administrators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Section Chiefs
Tribal Chairpersons/Human Services Facilitators
From: Burnie Bridge
Re: Medicaid Re-determinations for Children Leaving Out of Home Care


This memo reiterates the existing Wisconsin Medicaid (MA) policy for ensuring that children leaving Out of Home Care have Medicaid benefits continued until such time that a Medicaid re-determination is completed by the county economic support agency (ESA). Initial guidance for this policy was provided in Bureau of Workforce Programs (BWP) Operations Memo 01-67, released 10/15/01.

Federal and State Regulations specify that no child should have their Foster Care Related Medicaid benefits terminated prior to the child welfare agency assisting the child in attempting to obtain health care benefits under a different Medicaid eligibility category.

Current State Medicaid policy as found in the Wisconsin Department of Health and Family Services Medicaid Eligibility Handbook, section 5.3.4 states:

Whenever a child loses Foster Care Medicaid eligibility, complete a separate MA eligibility re-determination before Foster Care MA is terminated, unless the child dies or leaves Wisconsin.

ESA should be notified of children leaving the Foster Care system, with eligibility information. Until the MA eligibility re-determination, the Child Welfare agency will extend MA eligibility using the Foster Care medical status code.

If there is insufficient information to re-determine MA eligibility, request needed information from the individual or family, who have a responsibility to cooperate. If they do not comply within 30 days, MA can be terminated with an adverse action notice.

County child welfare agencies are encouraged to work with county economic support agencies to develop an effective process to ensure that all children are afforded the opportunity to become eligible for additional Medicaid programs (e.g. Healthy Start, AFDC-MA, AFDC-Related MA, or BadgerCare) as part of its reunification plans. Each county child welfare agency has the flexibility to work with their ESA partner to develop the most efficient process for completing MA re-determinations for children leaving out-of-home care. Applications for MA re-determinations can be completed by any of the following methods:

  • Face to Face Interview

  • Mail-In Application (see attached application - HCF-10129)

  • Telephone Interview

Once the child welfare agency has assisted the child in applying for Medicaid services with the county ESA it is the responsibility of the child and/or family to cooperate with the Medicaid re-determination process. If the child and/or family fail to cooperate with the requests of the ESA, Foster Care Medicaid benefits can be terminated after 30 days with an adverse action notice to the child and/or family, which completes the Medicaid re-determination. Unless the child dies or leaves the state Foster Care Medicaid eligibility should not be terminated prior to the child having a Medicaid re-determination completed by the local ESA.

All actions taken by the child welfare agency to assist the child and/or family in obtaining additional types of Medicaid benefits should be documented in eWiSACWIS.

It should be noted that for Medicaid purposes there are no distinctions made concerning the reason why a child is in out of home care. Therefore the requirement to assist a child in obtaining Medicaid coverage upon his or her exiting the care includes children placed in out-of-home care under Chapters 48 and 938 as well as children who have aged out of the system.

Example #1
Chad is a 13-year old male who is being reunified with his parents. Chad is currently receiving AFDC-FC (Foster Care) Medicaid benefits due to his out-of-home placement. Chad will be returning home on December 15, 2005. As part of the re-unification process Chad's case worker calls the local economic support agency and sets up an appointment for Chad and his family to apply for additional types of Medicaid. The first available appointment date for Chad's Medicaid appointment is January 6, 2006.

Chad and his family attend the January 6, 2006 appointment and the ESA determines that they are eligible for BadgerCare benefits effective January 1, 2006. Once Chad is found eligible for BadgerCare the economic support specialist (ESS) calls the case worker to inform him or her that AFDC-FC Medicaid may be ended in eWiSACWIS.


Example #2

Emily is a 16-year old female who is being reunified with her parents. Emily is currently receiving AFDC-FC Medicaid benefits due to her out-of-home placement. Emily will be returning home on January 4, 2006. Prior to Emily returning to her parent's home the case worker contacts the ESA to inform them that Emily will be returning home. This county requires that all children leaving Foster Care will receive face-to-face Medicaid appointments with the ESA. The county ESA schedules Emily and her parents for a face-to-face appointment on January 6, 2006.

At this point the case worker has ensured that Emily will have the opportunity to obtain another type of Medicaid and should note such actions in eWiSACWIS as a case note. The responsibility for making the Medicaid eligibility re-determination now rests with the county ESA.

On February 7, 2006, the county economic support specialist calls the case worker to inform him or her that Emily's family never showed up for their Medicaid appointment (did not meet the 30 day application requirement) and that notice of Emily's Medicaid termination was sent to the family. Emily's AFDC-FC Medicaid may now be ended in eWiSACWIS since she was afforded the opportunity to obtain additional types of Medicaid.

Since special rules exist concerning when Medicaid eligibility can be terminated the case worker should never end AFDC-FC Medicaid until they are notified by the economic support specialist that termination of Medicaid benefits is appropriate.


REGIONAL CONTACT: Area Administrator
Office of Policy Evaluation and Planning
1 W. Wilson, Street, Room 550
Madison, WI 53708
Phone: (608) 261-8895
Email: timmedj@dhfs.state.wi.us


cc: Jim Jones, Director
Medicaid Eligibility Bureau, DHCF

The Department of Children and Families, protecting children, strengthening families, building communities.