STATE OF WISCONSIN
Department of Health and Family Services
Division of Children and Family Services

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.