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

Revised: June 20, 2023

This page includes questions and answers about Medical Assistance for children in foster care (MA-FC) and Medical Assistance for children who receive Northstar Kinship Assistance (MA-NKA). Regardless of Title IV-E eligibility, a health care application is not required and financial eligibility requirements (i.e. income or asset limit) are not applicable for MA-FC and MA-NKA.

For more information, see:

Minnesota Health Care Programs Eligibility Policy Manual (EPM), section 2.5.6 for specific eligibility policy for MA-FC and MA-NKA.
Procedures for health care eligibility workers to determine MA eligibility for children in foster care and children who receive NKA can be found in ONEsource. Note: ONEsource is the Minnesota Department of Human Services (DHS) health care resource for workers who determine eligibility for Minnesota Healthcare Programs (MHCP). ONEsource is a password protected site.
Training for county and tribal case managers and eligibility workers is also being updated to clarify these new policies and procedures. Please contact your regional Title IV-E Eligibility Determination Trainer (EDT) with questions related to children in foster care.
Submit Northstar Kinship Assistance policy and eligibility questions to: northstar.benefits@state.mn.us.

During the COVID-19 public health emergency, continuous coverage requirements apply. For the duration of the continuous coverage requirements, children in foster care and children who receive NKA are eligible for MA even if they leave foster care or NKA ends.

Updates and Changes

November 21, 2022
New Questions and Answers added for MA for Children in Foster Care to elaborate on 72-hour hold guidance in regards to backdated MA (item #4).

June 20, 2023
Minor update for clarification purposes to item #17 under MA for Children in Foster Care.

Frequently Asked Questions (FAQ)

MA for Children in Foster Care

	Question	Answer
1	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.
2	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.
3	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 (i.e. 72-hour hold)?	A child removed under the authority of a 72-hour 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 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 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.
4	If a child was previously removed by the authority of a 72-hour 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 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 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 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.
5	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.
6	Does a noncitizen child placed in foster care who does not have a valid immigration status qualify for MA-FC eligibility?	No, with few exceptions people without a valid immigration status are not eligible for MA, including children in foster care. However, many undocumented children in foster care qualify for a path to obtain lawful permanent residence (i.e. green card) through Special Immigrant Juvenile (SIJ) classification. Case managers should assist undocumented children in foster care with obtaining an immigration attorney who can advise them on potentially applying for SIJ classification. Once an application for SIJ has been accepted by 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, the process for applying for SIJ classification is lengthy and can take several months. DHS will be issuing a bulletin regarding the SIJ classification process for undocumented youth in foster care soon. Undocumented children in foster care continue to qualify for Emergency Medical Assistance (EMA) if they have a medical emergency. Counties and tribes may also explore other resources to cover medical expenses not covered by EMA that are incurred by an undocumented child in foster care, until the child obtains a lawfully present immigration status.
7	When children are removed under the authority of a delinquency court petition, are they eligible for MA-FC?	Children who are removed under the authority of a delinquency court petition are 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.
8	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.
9	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.
10	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.
11	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.
12	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.
13	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.
14	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.
15	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.
16	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.
17	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.

MA for Children Receiving Northstar Kinship Assistance (NKA)

	Question	Answer
1	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?	The child should remain on their own MA case because a child who receives NKA benefits is eligible for MA-NKA without an application or financial eligibility requirements (until age 18 or up to age 21 with an extension). This ensures the child has MA until they age out of NKA.
2	What happens if a child’s foster care placement ends before NKA benefits are approved?	The child remains eligible for MA-FC under the foster care basis while eligibility is determined under other MA bases, including MA-NKA. In this situation, the agency cannot complete the redetermination until NKA benefits have been approved. The eligibility worker should keep MA open and track the case until the NKA payment commencement notice is received. If the NKA commencement notice is not received from DHS Permanency Support within 30 days of foster care ending, the eligibility worker should contact the child’s foster care case manager to find out the status of the NKA benefits. If NKA benefits are denied, the child must be redetermined for MA under all other MA bases or insurance assistance programs, before MA-FC eligibility is closed.
3	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?	Since the child began receiving non-IV-E NKA benefits prior to January 1, 2021, but was never enrolled in MA, the child’s MA eligibility should be backdated to January 1, 2021, without requiring an application. Note: Health care eligibility workers should submit a HealthQuest for children who were receiving NKA but did not have MA open, and had unpaid medical bills prior to January 1, 2021.
4	Will I need to calculate a parental fee for a child who receives MA-NKA and is on a HCBS waiver?	Parental fees may be assessed when a child who receives MA-NKA is also on a HCBS waiver. See ONEsource for instructions for sending a parental fee referral in this circumstance.
5	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?	To qualify for MA-NKA without an application or financial eligibility requirements, the child must receive NKA benefits which usually end when the child turns 18. NKA benefits can be extended beyond age 18 but unlike extended foster care, when an extension is granted for NKA, it is typically granted for a shorter duration (for example, until the youth graduates high school). In some situations, an extension may be granted until the child’s 21st birthday, but cannot go beyond that. As a result, the child’s MA-NKA eligibility will always end by age 21, or sooner, if Northstar Kinship Assistance ends sooner.
6	Are children in who receive MA-NKA required to enroll in managed care?	Yes, children in who receive MA-NKA are required to enroll in managed care, unless the child has a specific managed care exclusion.

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