12 Colo. Code Regs. § 2509-5-7.402

Current through Register Vol. 47, No. 11, June 10, 2024

Section 12 CCR 2509-5-7.402 - MEDICAL RESOURCES

7.402.1PROVISION OF SERVICES

Subject to certain income and resource limitations, medical assistance through the Colorado Medicaid program must be provided to certain children and youth receiving child welfare services as follows:

A. Children and youth for whom the county department is assuming full or partial financial responsibility.

1. Children and youth in foster care, including those who are in supervised independent living placement situations subsequent to being in foster care;

2. Youth committed to the Department of Human Services, Division of Youth Services, who are placed in a non-secure community based residential facility or in supervised independent living placement situations;

3. Children and youth who have a current, signed subsidized adoption agreement;

4. Children and youth receiving Core services who otherwise would be in foster care;

5. Children and youth in subsidized adoption, including adoption placements out of state, who are IV-E eligible or where the state option is in effect until the receiving state can provide Medicaid;

6. Children and youth from Colorado placed in an out of state out-of-home placement by a Colorado county. IV-E eligible children receive Colorado Medicaid until the receiving state can provide Medicaid;

7. Children and youth eligible for Supplemental Security Income, even if they are not receiving cash benefits, who are placed in an out of state foster care setting until the receiving state can provide Medicaid.

8. Children and youth who are eligible for the Relative Guardianship Assistance Program, including relative guardianship assistance placements out of state who are Title IV-E eligible, until the receiving state can provide Medicaid.

B. Certain children and youth from other states who are placed in Colorado by that state.

1. Children and youth eligible for adoption assistance placed in Colorado by another state;

2. Children and youth placed in an out-of-home placement in Colorado by another state;

3. Children and youth who are eligible for Supplemental Security Income placed in an out-of-home placement in Colorado by another state.

4. Children and youth who are eligible for Relative Guardianship Assistance placed in Colorado by another state and who are Title IV-E eligible.

C. Children and youth who are receiving child welfare services, living in their own home or the home of a designated relative, and the county department is not assuming full or partial financial responsibility for their care, may be eligible for coverage under other Colorado Medicaid programs for families and children.

D. Adoption assistance youth who emancipated from foster care or adoption assistance at age eighteen (18) or after and are under age twenty-one (21), and for whom the state made foster care or adoption assistance payments in the month the youth turned eighteen (18) years of age.

E. A child who has an acceptable non-citizen status as defined in 10 CCR 2505-10 Section 8.100.3.G and is in the custody of DHS is eligible for Colorado Medicaid and no longer need to meet the five-year waiting period to be eligible for Medicaid.

F. Beginning January 1, 2014, former Colorado foster care youth, who were under the State's or Tribe's responsibility, when they emancipated from foster care at age eighteen (18) or after, and who were enrolled in Medicaid (IV-E or non-IV-E) under Colorado's Medicaid State Plan at the time of their emancipation, and are under age twenty-six (26); are eligible for Colorado's Former Foster Care Medicaid. Eligible placement types include the following:

* Kinship family foster care

* Non certified kinship care

* Foster home care

* Group home and group center care

* Children's Habilitation Residential Program (CHRP)

* Residential Child Care Facilities

* Supervised Independent Living Placement programs

* Youth committed to the Division of Youth Services, living in one of the above, non-secure placements.

G. Youth for whom the county had placement authority or custody on or after the youth's 18th birthday.

7.402.2COUNTY DEPARTMENT RESPONSIBILITY [Eff. 02/01/2009]

The county department shall be responsible for determining eligibility for Colorado Medicaid. For children for whom the county department is assuming full or partial financial responsibility through an out-of-home placement or Core services, the county department shall:

A. Determine Medicaid eligibility at the time the child enters out-of-home placement or begins receiving Core services.

B. Determine if a child entering out-of-home care is covered by medical insurance and notify the Department of Health Care Policy and Financing of such coverage in the manner prescribed by the Division of Third Party Resources.

C. Determine eligibility in the manner prescribed by the state Department of Human Services.

D. For children in out-of-home placement, consider income and resource limitations as set forth in Section 8.101 through 8.104 of the Department of Health Care Policy and Financing's Medical Assistance manual (10 CCR 2505-10), considering the child as a household of one.

E. For children receiving Core services and residing with the custodial parent(s), consider income and resource limitations as set forth in Section 8.101 through 8.104 of the Department of Health Care Policy and Financing's Medical Assistance manual (10 CCR 2505-10), considering income and resources of the family unit. Medicaid eligibility determination for children receiving Core services is required only if it appears the household income or resources will not preclude eligibility.

F. Enroll the child using the appropriate data system no later than 90 calendar days after assuming full or partial responsibility for the child.

For children voluntarily placed in out-of-home care who were Medicaid eligible prior to placement, the caseworker shall coordinate Medicaid coverage with the eligibility technician. If it appears that the out-of-home placement will last longer than 90 calendar days, the child shall be enrolled in child welfare Medicaid.

G. Re-determine eligibility for Medicaid at such time as may be required.

H. For children receiving adoption assistance from a Colorado county when the child is being placed into another county in Colorado, the county of residence where the child is placed shall be responsible for opening the Medicaid case.

I. Discontinue Medicaid eligibility on the date the child is removed from the out-of-home placement and the county department is no longer assuming full or partial financial responsibility for the child.

J. Discontinue Medicaid when an adoption is finalized, unless the child is receiving adoption assistance and/or otherwise entitled to continued Medicaid coverage.

K. Develop another plan to meet the child's medical needs when a child for whom the county department is assuming full or partial financial responsibility through an out-of-home placement is ineligible for Medicaid. If the child is ineligible because of personal income, that income shall first be applied to the provision of medical care, either by the direct purchase of medical care or by the purchase of medical insurance.

L. Determine Medicaid eligibility for foster care or adoption assistance youth who emancipated from foster care or adoption assistance at age eighteen (18) or after and are under age twenty-one (21), and for whom the state made foster care payments or adoption assistance payments in the month the youth turned age eighteen. Enter the determination into the state automated system within ninety (90) days of the determination.

7.402.3MEDICAID FOR CHILDREN COVERED BY THE INTERSTATE COMPACT ON THE PLACEMENT OF CHILDREN [Rev. eff. 4/1/12]

A. Children moving to Colorado:

1. The county department shall establish eligibility for Medicaid for IV-E eligible children moving from another state into Colorado for out-of-home care when the state or origin provides verification of IV-E eligibility. The letter of verification shall contain the date of discontinuation of medical assistance from the state of origin.

2. If the child is placed with a parent, it is the responsibility of the parent to provide financial support and medical coverage or to apply for medical assistance in the county where he/she resides regardless of the child being determined Title IV-E eligible or not Title IV-E eligible by the state of origin.

3. Medicaid eligibility in Colorado shall begin the month following the discontinuation of medical assistance by the state of origin.

4. Medical assistance for children who are not IV-E eligible and who are moving to Colorado for out-of-home care is the responsibility of the state of origin.

B. Children moving from Colorado:

1. The county department shall establish eligibility for Medicaid for IV-E eligible children moving to another state from Colorado for out-of-home care. The county department shall provide the receiving state verification of IV-E eligibility and notification of the last date of Medicaid coverage under Colorado Medicaid.

2. Children from Colorado who are not IV-E eligible and who move to another state for out-of-home placement must have a plan for medical assistance in place prior to placement out of state.

3. If the child is placed with a parent, it is the responsibility of the parent to provide financial support and medical coverage or to apply for medical assistance in the new state where he/she resides regardless of the child being determined Title IV-E eligible or not Title IV-E eligible by the county department of human/social services.

4. The county department shall provide the Interstate Compact on Adoption and Medical Assistance (ICAMA) forms and a copy of the adoption assistance agreement to the receiving state within the same month when the change from foster care to adoption occurs.

7.402.4MEDICAID FOR CHILDREN AND YOUTH COVERED BY THE INTERSTATE COMPACT ON ADOPTIONS AND MEDICAL ASSISTANCE (ICAMA) [Rev. eff. 12/1/12]

A. Children and youth moving to Colorado

1. The county department shall establish eligibility for Medicaid for children and youth moving from another state into Colorado who have a current adoption assistance agreement or a Title IV-E Guardianship Assistance Agreement in effect from the state of origin. The state of origin shall provide completed Interstate Compact on Adoptions and Medical Assistance forms and a copy of the current adoption assistance agreement or the Guardianship Assistance Agreement. The letter of verification shall contain the date of discontinuation of medical assistance from the state of origin.

2. Medicaid eligibility in Colorado shall begin the month following the discontinuation of medical assistance by the state of origin

B. Children and youth moving from Colorado

1. IV-E Adoption Assistance

For children and youth who have a current adoption assistance agreement who are moving out of state, the county department shall provide the state adoptions program staff with duplicate copies of the completed ICAMA forms and a copy of the current adoption assistance agreement.

2. For children and youth who have a current Relative Guardianship Assistance Agreement who are moving out of state, the county department shall provide the state adoptions program staff with duplicate copies of the completed ICAMA forms and a copy of the current assistance agreement.

3. Non-Title IV-E Adoption Assistance

a. For children and youth who are moving to a reciprocal state and have a current adoption assistance agreement, the county department shall provide the State adoptions program staff with duplicate copies of the completed ICAMA forms and a copy of the current adoption assistance agreement.

b. For children and youth who are moving to a state that is not reciprocal with Colorado's non-Title IV-E Medicaid, the county shall provide medical insurance for the child or youth. This arrangement shall be negotiated with the family as to how the insurance will be provided.

12 CCR 2509-5-7.402

38 CR 23, December 10, 2015, effective 1/1/2016

40 CR 17, September 10, 2017, effective 10/1/2017

40 CR 21, November 10, 2017, effective 12/1/2017

41 CR 21, November 10, 2018, effective 12/1/2018

42 CR 17, September 10, 2019, effective 10/1/2019

42 CR 23, December 10, 2019, effective 1/1/2020

43 CR 21, November 10, 2020, effective 12/1/2020

44 CR 21, November 10, 2021, effective 11/1/2021

44 CR 23, December 10, 2021, effective 12/30/2021

46 CR 09, May 10, 2023, effective 6/1/2023