The legal basis for Medical Assistance for Children in Care (MACC) is in 42 CFR 435.222. Although MACC is a separate type of assistance, the instructions are being included in the Family Healthcare manual as general procedures and policies apply (i.e., TPL, reinvestigations, hearings, rights and responsibilities, etc.).
Specific children for whom the Department of Mental Health (DMH), Division of Youth Services (DYS), or a Juvenile Court have full or partial financial responsibility, may be eligible for Medicaid benefits excluding vendor coverage, if they are living in an eligible living arrangement and meet all other eligibility factors as outlined below. If they are in a vendor situation, their eligibility will be determined under procedures outlined under ICF Under 18 and ICF/MR in Chapter VI, Pages 27A-29.
Use “K” as the type of assistance designation for Medical Assistance for Children in Care.
Children in the custody of the Children's Division also may qualify for Medicaid under the provisions of this program. Eligibility for these children will be determined by Children's Division staff and benefits provided through their system.
At the time of application, screen each case in the system to determine if a Children's Division case is currently open. If the Children's Division case is open, contact the Children's Division worker to determine if the Children's Division has custody. If the Children's Division has custody, Children's Division will determine eligibility and provide Medicaid benefits. If DYS or a Juvenile Court has custody or financial responsibility, Eligibility Specialists (ES) working for the Children's Division will determine eligibility for MACC.
If DMH has custody or financial responsibility, the Income Maintenance caseworker will determine eligibility for MACC. When DMH has custody or financial responsibility, there is no advantage to determining the child's eligibility under MACC rather than MAF or MC+ for children. Any DMH child who would be eligible for MACC should be eligible under the MC+ for children program as non-CHIP. This is because if DMH only has financial responsibility and the parents retain legal custody, the parents' needs and income must be included to determine MACC eligibility.
HB 564 enacted changes effective January 1, 1994, which expanded MACC to provide state only funded medical assistance to children (ineligible for Federally matched Medicaid) placed in a non-profit residential facility by the Juvenile Court.
Claimants must meet the eligibility factors listed below:
Eligible living arrangements for MACC include publicly operated community residences, private institutions, and foster homes.
Medicaid is not available to individuals living in public institutions. This is defined as an institution that is the responsibility of a governmental unit or an institution over which a governmental unit exercises administrative control.
However, an institution that otherwise meets the public institution definition is considered an eligible institution for MACC if it is a publicly operated community residence which serves no more than sixteen (16) residents and is not:
A publicly operated community residence is further defined as one which:
If the child is in a public residence, the facility must meet the definition of a publicly operated community residence.
DMH/DYS children are in eligible living arrangements for MACC in the licensed or approved PRIVATE settings listed below which are NOT restricted to sixteen (16) or less residents:
If a child is living in one of the eligible living arrangements, as designated above, (s)he may be eligible for the Medical Assistance for Children in Care (MACC) program.
Use the Medical Assistance for Families (MAF) need criteria to determine eligibility for MACC. For children who are under age 19 with income above the MAF limit, their eligibility on the basis of need will be made by comparing the family's income to the appropriate poverty level, rather than the MAF limits.
Note: For children placed in a non-profit residential facility by the Juvenile Court, with income above the appropriate poverty level there is no income limit. Approve these children for state only funded medical assistance (level of care “M”).
- If the child is in the legal custody of DMH, DYS or a juvenile court, use MAF budgeting procedures based on the income and expenses of the child.
- If the child is in the legal custody of the parents, use MAF budgeting procedures based on the family's income and expenses.
- Include SSI received by the child as income. If the SSI income causes ineligibility for MACC, the claimant does not have the option of electing to receive MACC instead of SSI. Also, include all the Social Security benefits a child is eligible for, even if the benefits are being sent to a representative payee.
DMH, DYS, or a juvenile court must assume full or partial financial responsibility for the child to be eligible for MACC.
If the child is in a DYS publicly operated community residence such as the DYS group homes, consider that DYS is providing support and maintenance for the child.
If the child is in a DYS foster home, obtain a copy of the foster home contract or other verification of DYS support and maintenance from the Regional Administrator.
If the child is placed in a facility or foster home by DMH, obtain a copy of the contract DMH has with the facility or foster home. Use the contract for verification of whether DMH is providing support and maintenance.
Effective October 1, 1998 the resource eligibility factor was eliminated for the MAF program. Therefore resources are no longer an eligibility factor for MACC children eligible for under MAF criteria.
The resource eligibility factor was eliminated for children eligible under the poverty level income guidelines effective July 1, 1990.
The requirement is the same as for MAF. Refer to Section 0905.010.25.
0955.005.30 CITIZENSHIP AND ALIEN STATUS (MACC)
The requirement is the same as for MAF. Refer to Section 0905.010.30.
The requirement is the same as for MAF. Refer to Section 0905.010.05.
Individuals are eligible for MACC up to age 21. However, DYS and the juvenile courts usually do not maintain custody past age 18 and DMH children usually qualify for MA at age 18.
Beginning July 1, 1990, any child below the age of (6) six is covered under this program at 133% of the federal poverty income level.
Effective July 1, 1991, any child, age 6 or over, born after September 30, 1983, up to age (19) nineteen, is provided Medicaid coverage if family income is below 100% of the federal poverty income level.
Effective January 1, 1994, the “born after September 30, 1983” provision was eliminated. This allows Medicaid coverage for children age six (6) up to age (19) nineteen, if family income is below 100% of the federal poverty income level.
Effective January 1, 1994, any child below the age of (1) one is covered under this program at 185% of the federal poverty income level.
EXCEPTION: If the child is an inpatient in a hospital at the time (s)he would become ineligible due to age, then the child's eligibility will continue until the end of his or her inpatient stay if all other eligibility is met.The caseworker will be notified of children turning (6) six years of age two months prior to their birthdate on the “Caseload Management Worksheet”. The caption on the Caseload Management Worksheet will read “Poverty-Turning 6.” The caseworker must do a budget at 100% of the federal poverty level to determine eligibility. If the case is ineligible, send an IM-80 to close the case.
For these children, eligibility on the basis of need will be made by comparing the family's income to the MAF standards.
Use MAF criteria to determine relationship if the child remains in the custody of the parents.
This requirement was eliminated as an eligibility factor for children eligible under the poverty level income guidelines effective January 1, 1994.
Section 208.151 of the revised Statutes of Missouri, 1982 sets forth the legal basis for Title XIX coverage.
The claimant's eligibility for Medicaid coverage begins with the first day of the month of application, provided the claimant is subsequently found eligible, and was not obviously ineligible for the entire month of application and any subsequent month prior to approval. If the claimant was obviously ineligible for the entire month of application and any subsequent months prior to approval, the Medicaid eligibility date begins with the first day of the month in which eligibility was met.
Eligibility determination for prior quarter Medicaid coverage is separate from the eligibility determination of current coverage. A child DOES NOT have to be currently eligible for Medicaid coverage to be eligible for prior quarter coverage and vice versa. The effective dates of prior quarter coverage are no earlier than the first day of the third month prior to the month of application and can extend to but not include the first day of the month of application.
To be considered eligible for prior quarter Medicaid coverage, the claimant must, during the prior quarter meet all eligibility factors. If the claimant becomes eligible for assistance sometime during the prior quarter, eligibility for Medicaid begins on the first day of the month in which the claimant became eligible for assistance.
MACC recipients under the age of 21 are eligible for Healthy Children and Youth (HCY) services. These services were formerly known as Early Periodic Screening, Diagnosis and Treatment (EPSDST) services. Refer questions about these services the Division of Medical Services Recipient Services unit.
Enter the application in the name of the child for “K” type of assistance. Eligibility Specialists in Children's Services take applications for children in the custody of DYS or a Juvenile Court. Income Maintenance caseworkers only take applications for children for whom DMH has custody or financial responsibility (these children would also be eligible for MC+ for children non-CHIP) . Accept applications from:
A parent if the parents retain custody and can be located (If the parents cannot be located the custodial agency may apply for the child); or
The DYS Regional Administrator if the child is in the custody of DYS and currently residing in DYS foster care; or
The DYS Unit Manager if the child is in the custody of DYS and currently residing in eligible DYS living arrangements other than foster care; or
The appropriate representative of the Juvenile Office if the child is in the custody of a Juvenile Court; or
The DMH Resource Investigator if the child is in the custody of DMH and residing in an eligible living arrangement.
A list of the DYS/DMH contact persons is included in Appendix D.
The parent or appropriate contact person may complete and sign all necessary forms for the child. Normal verification procedures apply when the parent applies. If the contact person applies for the child and claims knowledge of the financial situation of the child, accept their statement as verification. If the contact person states they do not have complete information about the financial situation of the child, the caseworker and the contact person will work together to obtain necessary information.
If the parents make application, use their address and send the Medicaid card to them. If the DYS/DMH/Juvenile Court contact person makes application for the child, use the address of the facility or foster home where the child resides.
If DYS/DMH/Juvenile Court has custody or the parents cannot be located, the DYS/DMH/Juvenile Court contact person will:
NOTE: File a copy of any applicable guardianship/legal custody order in the case record.
Process applications for MACC as soon as possible; the time frame is not to exceed 45 days. When pending applications for MACC become delinquent, workers will receive a notice through the S020 print subsystem. Workers must follow the instructions in Section 0105.045.05 for entering delay codes in Field 11 of IMU5.
If a claimant enters an eligible living arrangement and makes application for MACC, the worker will:
When a child enters an eligible MACC living arrangement through DMH/DYS/Juvenile Court placement and is already in active Medicaid status, the caseworker will:
When a claimant's living arrangement/address is changed, a complete re-evaluation of the claimant's needs must be completed to determine continued eligibility.
The action taken will depend upon the new living arrangements and the age of the child. Explore all available options for the child (i.e., MAF, MC+ for children, MA, JCAHO, NF, IMR, etc.).
Follow the procedures outlined for the applicable program providing the specific Title XIX coverage needed. (i.e., placement into a certified IMR facility, a certified nursing facility, and/or JCAHO inpatient psychiatric treatment.)