FAQ: MA for Children in Foster Care and Receiving Northstar Kinship Assistance

Who receives MA notices for children in foster care?

All MA notices for children in foster care are sent to the case manager at the county or Tribal social service agency with legal responsibility for the child. Copies of notices will also be sent to the child directly at the foster home address and to the child’s authorized representative, if applicable. Note: Eligibility workers, see ONEsource for more information.

Can youth in extended foster care over the age of 18 apply for health care on their own?

Youth ages 18-20 who are in extended foster care do not need to apply for health care on their own. Youth in extended foster care are eligible for MA-FC without an application or financial eligibility requirements. If a youth in extended foster care discovers they do not have MA coverage, they should contact their case manager for assistance.

On what date is a child who has been removed from their home eligible for MA? Does this include a child placed on a 72-hour law enforcement emergency protective hold?

A child removed under the authority of a 72-hour law enforcement emergency protective hold is eligible for MA the first day of the month in which the foster care placement begins. The foster care placement begins the date a child is removed from their home by the authority of a 72-hour law enforcement emergency protective hold, court order, or voluntary placement agreement (VPA). An application is not required to request MA for the child.

Example: A child is removed from their home on September 30, 2022, by the authority of a 72-hour law enforcement emergency protective hold. A court order transferring care and placement responsibility to the county agency is not issued until October 2, 2022. The child is eligible for MA, without an application or financial eligibility requirements, effective September 1, 2022.

MA eligibility can be approved before the issuance of the court order. In the rare circumstance a court order is not eventually issued, MA eligibility under the foster care basis ends. The child should be redetermined under other bases of eligibility before closing with 10-day advance notice.

Note: Unlike MA, Title IV-E eligibility does not start until the date a court order is issued granting placement and care responsibility to the county or Tribal agency or a VPA is signed. It can take several weeks after the child enters foster care for the removal home or case manager to provide the Title IV–E Foster Care Application and necessary documentation to the eligibility worker to complete the Title IV-E eligibility determination. The child is eligible for MA while this process takes place.

If a child was previously removed by the authority of a 72-hour law enforcement emergency protective hold in a month before a court order or VPA was issued, and policy was correctly applied with the direction at the time (before the 72-hour law enforcement emergency protective hold clarification was announced) so MA-FC did not begin until the month in which the court order or VPA was issued, can MA coverage be backdated in accordance with this new direction?

If a child in an active foster care placement was removed by the authority of a 72-hour law enforcement emergency protective hold in a month before the court order or VPA was issued, and does not have coverage for the month in which the 72-hour law enforcement emergency protective hold occurred due to the policy guidance at the time, the case manager can request backdated MA coverage if there are also outstanding medical bills for this time period.

If a non-IV-E foster child entered care prior to January 1, 2021, but never received MA, would the child be eligible for MA without an application now? When does MA-FC eligibility begin in this situation?

MA-FC eligibility for non-IV-E foster children went into effect on January 1, 2021. Since this child entered foster care prior to January 1, 2021, but was never enrolled in MA, the child’s MA eligibility should be backdated to January 1, 2021.

Note: Health care eligibility workers should submit a HealthQuest for children in foster care who did not have MA open, and had unpaid medical bills prior to January 1, 2021.

Does an undocumented child placed in foster care qualify for MA-FC eligibility without an application?

No. A noncitizen who is under age 21 must meet the definition of “lawfully present” to be eligible for MA-FC. See EPM 2.1.2.2.2 MA Immigration Status. “Lawfully present” is defined at EPM Appendix H Lawfully Present Noncitizens. A foster child who does not meet the lawfully present definition at Appendix H is considered undocumented for the purpose of MA eligibility and not eligible for MA-FC. See #7 below for programs the child may still qualify for.

Does an undocumented child placed in foster care qualify for other Minnesota Health Care Programs?

Possibly. There are several programs that a child who is not lawfully present may qualify for, depending on their circumstances.

• MinnesotaCare: Children in foster care who are not eligible for MA because they are not lawfully present may qualify for MinnesotaCare if they meet MinnesotaCare program eligibility requirements and are under age 18. See Bulletins #24-21-10 and #25-21-05. Also see MinnesotaCare Expansion for Undocumented Individuals FAQ.
• CHIP-funded MA: Children in foster care who are pregnant and are not eligible for MA because they are not lawfully present may qualify for CHIP-funded MA for Pregnant People. EPM 2.1.2.2.2 MA Immigration Status and 2.2.2.1.2 Pregnant Person Basis of Eligibility
• EMA: Emergency Medical Assistance (EMA) could cover emergency services for a noncitizen foster child who meets the financial and non-financial eligibility requirements for Medical Assistance (MA) but is not eligible for MA due to their immigration status. A child who is eligible for MinnesotaCare and EMA may have ongoing overlapping coverage for both programs. EPM 2.5.3 Emergency Medical Assistance.
• MA-CVT: People receiving services at the Center for Victims of Torture (CVT), who are not otherwise eligible for MA, may be eligible for MA-CVT regardless of citizenship or immigration status, including undocumented people. See EPM 2.5.2 MA-CVT.

A health care application must be submitted for the child to receive an eligibility determination for MHCPs when they are not eligible for MA-FC. Applications are submitted and processed following standard policy and procedure. The social services agency legally responsible for the child should facilitate the submission of a DHS-6696 (or online application at mnsure.org) on behalf of the child. Anyone who qualifies as an application filer according to EPM 1.2.2 may submit the application. As per EPM 1.3.1.2, social workers or other representatives of the agency that has legal custody and control of the child may be authorized representatives for the foster child. If someone from the social services agency applies on behalf of the child, they must still include anyone in the child’s household composition and family size on the application. See EPM 3.3.1 and EPM 2.2.3.2 for information on household composition and family size.

Can a child placed in foster care who is undocumented and enrolled in another MHCP move to MA under the Foster Care basis (MA-FC) if their immigration status changes?

Yes. If the child’s immigration situation changes while in foster care, so that they now meet the definition of lawfully present at EPM Appendix H, open MA-FC for the child in MAXIS following standard procedures. See the ONEsource page titled Medical Assistance for Children in Foster Care (FC) or Receiving Northstar Kinship Assistance (NKA).

As a note, many undocumented children in foster care qualify for a path to obtain lawful permanent residence (i.e. a green card) through a Special Immigrant Juvenile (SIJ) petition. Case managers should assist all foreign-born children in foster care who are not yet U.S. citizens with obtaining an immigration attorney to assess their potential options under U.S. immigration and citizenship laws. For undocumented children this could potentially include advising them on filing an SIJ petition. Once a petition for SIJ is submitted and pending with the United States Citizenship and Immigration Services (USCIS), an undocumented child in foster care is considered lawfully present and qualifies for MA-FC eligibility. Note, early identification of children potentially eligible for SIJ and prompt referral to an immigration attorney is critical, as the process to prepare an SIJ petition is lengthy and it is important to not miss the child’s window of potential eligibility for SIJ. For more information about SIJ, see Special Immigrant Juvenile Status for children involved with child welfare services (DHS-8501A).

When a child’s removal is initiated by a delinquency court petition, are they eligible for MA-FC?

A child whose removal is initiated by a delinquency court petition is NOT eligible for MA-FC, without an application or financial eligibility requirements, unless one of the following conditions applies:

• the county or Tribal social service agency was given placement responsibility through a court action or by the signing of a Voluntary Placement Agreement,
• the county/community corrections department has placement responsibility and there is a Title IV-E Agreement in place between the social service agency and corrections department making them a designee of the social service agency, or
• the social service agency and corrections department are considered an umbrella agency (Umbrella Counties are Dakota, Nobles and Olmsted County).

If the child has a case manager, they should assist children who are not eligible for MA-FC with completing an application to apply for MA under another basis of eligibility.

If a child in foster care is involuntarily placed in a secure, public institution through operation of law enforcement authorities, such as in a jail or secure juvenile detention facility, are they still eligible for MA-FC?

Yes. A child who is still under the care and placement responsibility of the county or Tribal social service agency remains eligible for MA-FC even if they are placed in a secure setting, such as a jail or juvenile detention facility. However, as per standard MA policy for incarcerated individuals, their MA coverage is suspended except for payment of inpatient hospital services. See EPM 2.5.5 MA Hospitalized Incarcerated People for more information about this policy. See the ONEsource page titled Update MMIS for Incarcerated MA Enrollees for instructions on how to update MMIS if an enrollee becomes incarcerated.

Please note that not all secure placements meet the definition of incarceration. If you need assistance determining what type of placement the child is in, contact the child’s social services case manager.

Does a child in foster care who is approved for MA-FC, without an application or financial eligibility requirements, qualify for retroactive MA prior to the month of placement?

No, retroactive coverage under the foster care basis of eligibility is not available. A request for MA for a month prior to the child’s foster care placement would follow MA rules under another basis, typically a child or disabled/blind basis of eligibility. The child’s social services case manager would need to work with the removal home to gather the information needed to complete a health care application to request health care in months prior to foster care placement.

If I receive a child’s foster care placement begin date and end at the same time, do I need to open MA-FC eligibility? Is there a minimum time that the child needs to be in foster care to be eligible for MA-FC?

Yes, approve MA-FC eligibility for the child effective the first day of the month of placement, even if the foster care placement has already ended. There is no minimum time requirement for a child to be in foster care in order to receive MA-FC eligibility. A child who is in foster care for as little as one day will qualify for at least one full month of MA-FC eligibility.

Example:
The eligibility worker is notified on March 18 that a child entered foster care March 13 and left foster care on March 18. The worker approves MA-FC eligibility for the child in MAXIS effective March 1. The worker closes MA-FC for the child on March 31, sends a 10-day notice, and redetermines MA for the child under another basis. The actions to approve and close MA-FC may all happen on the same day in this situation.

Do I approve MA-FC for a child in foster care on their own case if the child is already receiving MA on their parent’s case and is a tax dependent of that parent?

Yes, approve MA-FC for a child in foster care on their own case (MAXIS) beginning the first day of the month of foster care placement. MA-FC for the child should be closed on the parents (METS) case the first month after foster care placement. Children in foster care who are expected to be claimed as tax dependents by their parent(s) remain listed as household members on their parents (METS) case while in foster care.

Do I need to get income verification from the parent to complete the application for health care for a child in foster care?

No, verification of income is not required to determine MA-FC eligibility for a child in foster care.

Note: An application and income/asset verification is required to determine Title IV-E eligibility for the child. Eligibility workers should not delay MA-FC approval while waiting for information for the IV-E determination.

Will I need to calculate a parental fee for a child in foster care who receives a home and community based services (HCBS) waiver?

Parental fees may be assessed when a child in foster care is on a HCBS waiver. See ONEsource for instructions for sending a parental fee referral in this circumstance.

Is there an age limit for MA-FC eligibility for children in foster care? Do 18-20 year olds in extended foster care qualify for MA-FC?

Yes, youth in extended foster care qualify for MA-FC eligibility, without an application or financial eligibility requirements. Extended foster care ends when a child turns age 21 so the MA-FC eligibility will end the month the child turns age 21, or sooner, if foster care ends sooner.

Does a child in foster care who goes home for a trial home visit qualify for MA-FC eligibility?

Yes, a child on a trial home visit is considered to be in foster care and is eligible for MA-FC. For additional questions regarding the child’s status and eligibility, contact your regional Title IV-E Eligibility Determination Trainer (EDT). You can also contact foster care policy using dhs.csp.fostercare@state.mn.us.

Bulletin #21-21-01 says that eligibility workers should use the foster care placement data from the SSIS-MAXIS interface to approve MA-FC. Can I use an initial report from the social worker instead of waiting on the interface data when approving MA?

The SSIS-MAXIS interface data, which includes the foster care placement date, will usually be received more quickly and be more accurate. In the rare circumstance that an SSIS-MAXIS interface cannot be completed, a verbal/written communication from the case manager or case aide can be used to report the placement date.

Since I don’t receive the child’s foster home address from the SSIS to MAXIS interface, what residence address do I enter in the system when approving MA eligibility?

Eligibility workers can request the foster home address from the case manager following your agency’s internal procedures. However, if the foster home address is not immediately available workers should enter the county or Tribal social services address that has care and placement responsibility for the child (the legally responsible county or tribe) in the residence address field in MAXIS. Do not delay MA approval for this reason.

If the child is placed in a foster home in a different county than the legally responsible county or tribe, the managed care plans offered may not be available in the county or tribe where the child lives. If this occurs, the case manager or eligibility worker should contact the designated managed care advocate in their county or tribe for assistance. The managed care advocate can submit an HPEN ticket in SIR to DHS to review the case, if needed.

Are children in foster care (MA-FC) required to enroll in managed care?

Yes, children eligible for and enrolled in MA-FC are required to enroll in managed care, unless a child has a specific managed care exclusion. The child’s case manager will receive the managed care enrollment packet within 30 days of MA approval from the eligibility worker and must work with the foster family to select the best plan for the child.

Is a child who is placed in Minnesota by another state, who is not eligible for Title IV-E, eligible for MA-FC without an application?

No. Children who are placed in foster care in Minnesota by another state, and who are not eligible for Title IV-E, are not eligible for MA-FC. However, these children may be eligible for MA under another basis, or for another MHCP such as MinnesotaCare, if they are placed in Minnesota with a relative or important friend. See Bulletin #24-21-12.

A health care application must be submitted for the child to receive an eligibility determination for MHCPs when they are not eligible for MA-FC. Applications are submitted and processed following standard policy and procedure. The social services agency legally responsible for the child should facilitate the submission of a DHS-6696 (or online application at mnsure.org) on behalf of the child. Anyone who qualifies as an application filer according to EPM 1.2.2 may submit the application. As per EPM 1.3.1.2, social workers or other representatives of the agency that has legal custody and control of the child may be authorized representatives for the foster child. If someone from the social services agency applies on behalf of the child, they must still include anyone in the child’s household composition and family size on the application. See EPM 3.3.1 and EPM 2.2.3.2 for information on household composition and family size.

When a child in foster care is approved for Northstar Kinship Assistance (NKA) benefits, should the child remain on their own MA case or should they be added to the relative caretaker’s case?

What happens if a child’s foster care placement ends before NKA benefits are approved?

If a child who received non-IV-E NKA benefits prior to January 1, 2021, never received MA, would they be eligible for MA without an application now? When does MA-NKA eligibility begin in this situation?

Will I need to calculate a parental fee for a child who receives MA-NKA and is on a HCBS waiver?

Is there an age limit for MA for children who receive NKA? Does this cover the 18-20 year olds who receive extended Northstar Kinship Assistance?

Are children in who receive MA-NKA required to enroll in managed care?