aaicama700faaicama 700 form new work...

Company LOGOLOGO

AAICAMA 700 FAAICAMA 700 FormNew Work Flow

Association of Administrators of the Interstate Compact in Adoption and Medical AssistanceAAICAMA

Benefits of the AAICAMA worksite:::Company LOGO

―Using the electronic approach to administering h ICAMA b fi ff

LOGO

the ICAMA benefits staffRequest to open Medicaid in a new Residence State (RS) (outgoing)State (RS) (outgoing)

• No faxing or emailing required• All exchange of information between AS and RS done in secure

environment rather by secure email• Form holds information for up to12 children• Form has required fields and cannot be submitted without completion• Auto-load FROM information based on User Profile• Auto Load certification information based on User Profile• Auto-Load certification information based on User Profile• Agreement attached to form without the need to

print out• Agreements always available without need for physical

AAICAMA | https://aaicama.blueironnetwork.net/workflow

or e-storage in county

Benefits of the AAICAMA worksite:::Company LOGO

―Using the electronic approach to administering h ICAMA b fi ff

LOGO

the ICAMA benefits staffRequest to open Medi-Cal from an Agreement State (AS) (incoming)State (AS) (incoming)

• Form and agreement are ever-stored in the AAICAMA database• Form is standardized and includes all required information • Notification of new case received through secure CA email from Health g

Services• Comprehensive list maintained in real time of children

coming to CA• Simple one-step process for response to AS that theSimple one-step process for response to AS that the

Medi-Cal has been opened - includes update of case lists

• Capture of all ICAMA actions in one place


Benefits of the AAICAMA worksite:::Net Results

Company LOGO Net Results

―Less county staff time required to complete f

LOGO

forms―Increased capacity to monitor all ICAMA

cases CA as the AS and the RScases…CA as the AS and the RS―Real time data available on the number of

ICAMA cases in specific time periods―Real time data on the numbers of children

turning 18 both for CA as the AS and RS―More effective compliance with―More effective compliance with

state law


Basics of the ICAMA 700 Form:::System RequirementsSystem Requirements

―Browsers: Mozilla Firefox, Chrome, and Safari k llwork well

Internet Explorer (IE) 8 continues to work well butbut IE 11 is a less robust browser* and cannot run the AAICAMA worksite/database.

*Microsoft has moved to the Edge browser and is no longer supporting Internet Explorer


Basics of the ICAMA 700 Form:::System RequirementsSystem Requirements

— FirewallCounty users may need to work with their IT

staff to allow access to the AAICAMA worksite/database on Blue Iron’s network.worksite/database on Blue Iron s network.

Blue Iron staff will work with IT Departments when necessarynecessary.Please let AAICAMA know if you need additional help gaining access.


Basics of the ICAMA 700 Form:::California ProcessCalifornia Process

California as the Agreement State (AS) (outgoing)

• County Liaison completes the ‘Request to Open Medicaid’

• Submits to the new Residence State (RS)Submits to the new Residence State (RS)• [Copy automatically sent to Central]• County Liaison (or other staff as designated) ensures

that the MediCal is case is closed. (NB: County policy directs the date of closing, but ICAMA

liaisons should be sure that there is no gap in coverage)



California as the Residence State (RS) (incoming)

• AS completes the ‘Request to Open Medicaid’• Submits to California (new Residence State (RS))• N tifi ti t H lth (DHCS) d t Child• Notification goes to Health (DHCS) and to Child

Welfare (CDSS)• DHCS will determine if Medi-Cal should be opened• If the case should be opened DHCS will forward

ICAMA 700 form (using the AAICAMA worksite/database) to correct county ) ydirecting that Medi-Cal be opened

• County will submit response to AS that Medi-Cal has been opened


AS that Medi Cal has been opened


California as the RS/AS :: Other ICAMA Actions

AS actionsClose Medicaid

RS actionsMedicaid Opened

Extend Medicaid past age 18Medicaid ClosedApprove Medicaid Extension past age 18Child enters Foster Care

AS/ RS tiAS/ RS actionsContact Information ChangeChange in Case status

Done by County ICAMA Liaisons


Basics of the ICAMA 700 Form:::LinksLinks

―2 links for using the worksite/databaseWorksite/databasehttps://aaicama.blueironnetwork.net/workflow

Password Maintenance:http://aaicama.blueironnetwork.net:8080/pwm

See the User Guide:• Passwords• Passwords Forgotteng• User Profile

http://icama700form.aaicama.org.instapage.com/


Basics of the ICAMA 700 Form:::User Information Does Not Auto LoadUser Information Does Not Auto-LoadThe User Profile (at the Password Maintenance site) must be

completed for the user information to auto loadcompleted for the user information to auto load (And the Forgot Password will not work if the User Profile does not contain a valid e-mail address)

Password Maintenance:https://aaicama.blueironnetwork.net:8080/pwm

See the User Guide:• User Profile

http://icama700form aaicama org instapage com/http://icama700form.aaicama.org.instapage.com/


Basics of the ICAMA 700 Form:::AnswersAnswers⁞ Who do you contact if you forgot your password?Use the Forgot Password feature at:Use the Forgot Password feature at:https://aaicama.blueironnetwork.net:8080/pwm

⁞ Who do you contact if you get an error message?⁞ Who do you contact if you get an error [email protected] ICAMA 700 Form Administrator

⁞ Who can you contact if you have a [email protected] ICAMA 700 Form AdministratorAAICAMA Executive Committee membersAAICAMA Executive Committee members


Basics of the ICAMA 700 Form:::Multiple Children Original FormMultiple Children- Original FormA form created with more than one child can be saved as a

e file and/or hard copy when it is initially created ande-file and/or hard copy when it is initially created and approved.

This is the only time a copy of the initial form will be presented to the userpresented to the user.

All subsequent child look-ups will be by SSN and so the form di l d ill b f th t hild ldisplayed will be for that child only.


Basics of the ICAMA 700 Form:::Adding DOB/SSNs of Parent(s)Adding DOB/SSNs of Parent(s)― Can AAICAMA add the Date of Birth (DOB) for the

parent(s)?parent(s)?― Can AAICAMA add the SSNs for the parent(s)?NO.Under the ICAMA (state law in all signatory states) the only personal information that can be required is that of the child(ren) protected by the ICAMA.AAICAMA has considered adding this data many times since

1986, but have been told each state would have to amend it’s legislation enabling the ICAMA f AAICAMA t i lfor AAICAMA to require personal information on the parent(s).


Basics of the ICAMA 700 Form:::Guardianship AgreementsGuardianship Agreements

If the guardianship is not Federal, should we initiate through the AAICAMA worksite/database?the AAICAMA worksite/database?

NO.ICAMA forms are designed to provide a new Residence State

ith th i f ti th d t M di id fwith the information they need to open a Medicaid case for categorically eligible children.

In the case of a state-funded guardianship agreement the hild i NOT t i ll li ibl f M di idchild is NOT categorically (automatically) eligible for Medicaid

in the new Residence State. To receive Medicaid services in the new Residence State an application must be made by the family in that statemust be made by the family in that state. The child may or may not be determined eligible under that state’s programs.



If the guardianship is Federal, should we initiate through the AAICAMA worksite/database?AAICAMA worksite/database?

YES.The title IV-E KINGAP cases were added, with member

l t th ICAMA f ft th tapproval, to the ICAMA forms after that program was established.

Though the program was established by the federal t f idi i f tigovernment no means of providing case information

interstate was mentioned.Because the information needed to open a

M di id f KINGAP hild iMedicaid case for a KINGAP child in a new state is the same as that used in a title IV-E adoption assistance case, AAICAMA added this eligibility group to their forms


AAICAMA added this eligibility group to their forms.


Are all states using the AAICAMA worksite/database to process Federal guardianship Agreements?process Federal guardianship Agreements?

YES.Since all ICAMA states agreed to add this eligibility group to

th f t t h b i ICAMA f t idthe forms, states have been using ICAMA forms to provide eligibility information in cases of title IV-E GAP Agreements to Residence states.



Is this true even for states who have not elected to provide title IV E GAP eligibility for their own state residents?title IV-E GAP eligibility for their own state residents?

YES.Example:

State A has not elected the GAP ProgramState A has not elected the GAP ProgramState B has elected the GAP ProgramState A can not send a title IV-E GAP Agreements to other

t tstates State B can send a title IV-E GAP Agreement to

State A.State A must provide Medicaid for the child

from State B.

(See: ACYF-CB-PI-10-01, page 4, Medicaid Eligibility )


(See: ACYF CB PI 10 01, page 4, Medicaid Eligibility )


States (32) that have elected title IV-E KinGAP:

AlabamaAlaskaArkansasCalifornia

MissouriMontanaNebraskaNew JerseyCalifornia

ColoradoConnecticutDistrict of ColumbiaHawaiiId h

New YorkOklahomaOregonPennsylvaniaRhode IslandIdaho

IllinoisIndianaLouisianaMaine

Rhode IslandSouth DakotaTennesseeTexasVermont

MarylandMassachusettsMichigan

WashingtonWest Virginia Wisconsin


Basics of the ICAMA 700 Form:::Guardianship Agreements CaliforniaGuardianship Agreements - California

Link to California information on title IV-E KinGAP:

http://www.childsworld.ca.gov/pg1354.htm


Basics of the ICAMA 700 Form:::Guardianship Agreements CaliforniaGuardianship Agreements - California

The basic eligibility requirements of Kin-GAP in California are: ― The relative guardian has been assessed/approved as meeting licensing

standards. ― Efforts to return the youth/non-minor to the parents have failed and the

dependent/delinquent youth/non-minor cannot return home. p q y― The relative is unwilling/unable to adopt for personal, familial, cultural or

financial reasons. ― The dependent/delinquent youth/non-minor has been in placement with the

relative at least 12 months (six months under the new federally-compliantrelative at least 12 months (six months under the new federally-compliant program) and has a stable, ongoing, well-functioning family relationship.

― The family, relative and youth/non-minor have no need for ongoing supervision or supportive services from the public agency.

― The relative is appointed guardian of the youth/non-minor and court jurisdiction is terminated.

― The agency has entered into a written, bindingagreement with the relative caregiver.


Basics of the ICAMA 700 Form:::Scanning AgreementsScanning Agreements

Should we scan the agreements?GENERALLY YESGENERALLY, YES.The agreements must have the signature of the parent(s) and

the agency representative to be valid under the ICAMA.For most states this requires that the agreement be scanned.

The AAICAMA worksite/database requires an electronic qdocument.

So any type of e-document is the system’s only requirement. States are free to use any q ytype of e-document, provided both signatures are on it.


Basics of the ICAMA 700 Form:::All Agreements in one documentAll Agreements in one document

Can all the agreements, in the case where the ‘open Medicaid’ request is being completed for more than oneMedicaid request is being completed for more than one child, be combined into one document?

NO.Th f thi i th t h hild l k i t d itThe reason for this is that when a child lookup is requested, it

is requested by SSN. If the agreements were all in one document the computer wouldn’t be able to access the specific child’s agreementspecific child s agreement.


Basics of the ICAMA 700 Form:::Signing the FormSigning the Form

Is signing the form a requirement?YESYES.The signature on the certification part of the ‘request to open

Medicaid’ makes the form a legal document and attests to th R id St t th t th A t St t hthe Residence State that the Agreement State has followed all applicable federal guidelines for the determination of eligibility.


Basics of the ICAMA 700 Form:::Signing the FormSigning the Form

What does signing the form entail?Cli k ‘Si ’ ft th tifi tiClick ‘Sign’ after the certification.Click ‘Accept’ after clicking ‘Sign’

This locks in the information on the form and provides the Residence state with a justification (in CMS audits) for opening the Medicaid case.

NB: This isn’t an electronic signature as used in other instances, it’s simply the Agreement state’s verification that the information is correctthat the information is correct.


Basics of the ICAMA 700 Form:::Editing the DatabaseEditing the Database

Can the information on the form be edited once it’s saved to the database?the database?

YES.The ICAMA 700 Form Administrator will have access to the

d t b d ill b bl t h i f ti th t hdatabase and will be able to change information that has been incorrectly entered. (Misspelled name, incorrect address, phone etc.)

The ICAMA 700 Form Administrator will also be able toThe ICAMA 700 Form Administrator will also be able to change an SSN if this has been entered incorrectly or if the child’s SSN is changed.

There is an audit trail of changes made including who madeThere is an audit trail of changes made including who made the change and when it was made.


Basics of the ICAMA 700 Form:::Move to Second Residence StateMove to Second Residence State

Case:CA A t St tCA Agreement StateChild moves to MAChild then moves to PAHow is this managed on the worksite/database?See the attached flow chart documentBut basically, if the request to open Medicaid in MA was made with an

ICAMA 6 01 ( li f ) h h di i l hICAMA 6.01 (or earlier paper form) then the direction to close that case should also be made with a paper form (the ICAMA 7.5).

if the request to open Medicaid in MA was made with the worksite/database then use the worksite/database to direct that the case be closed in MA.

REMEMBER:Paper :: PaperEl t i El t i


Electronic :: Electronic

Basics of the ICAMA 700 Form:::Print the agreementPrint the agreement

How do I print the agreement?

When you do a child lookup, the child’s current form will appear. After each child’s information you will see: ‘Extract Agreement’

ClickThe agreement will load and you can print the

agreement as a hard copy and/or an electronic file.


Basics of the ICAMA 700 Form:::Print the formPrint the form

How do I print form?

—When you do a child lookup the child’s current form will appear. At the bottom of the form is a ‘Print’ buttonClickYou can print the form as a hard copy and/or an electronic file.

—When the ‘request to open Medicaid’ is initially completedThe ‘Print’ button appears at the bottom of the form after the certification.ClickYou can print the form as a hard copy and/or an electronic file both before


and/or an electronic file both before and after the signing

Basics of the ICAMA 700 Form:::Attaching the AgreementAttaching the Agreement

Page has all the directions at the top.


Basics of the ICAMA 700 Form:::Attaching the AgreementAttaching the Agreement

.Comes after the form is signed

.Comes after the form is double checked by the user and approved

Table lists each SSN entered on the ICAMA 700Table lists each SSN entered on the ICAMA 700 Form

One agreement for each childgEach agreement must be attached separately

using the SUBMIT iconU FINISH i h llUse FINISH icon when all

agreements are attached


Use of the ICAMA 700 Form

―Who must use the ICAMA worksite?All states except Wyoming

―Who is using the ICAMA worksite?49 t t49 states


Case Lists by State

―Cases sent by your state as the A SAgreement State

Use this report to see if a Medicaid case has been popened in the Residence State

Date the case was opened in the Residence State

Most recent first

All cases will remain on list

Use this report to review a case

Use this report to see the Agreement


Case Lists by State:::California as the Residence StateCalifornia as the Residence State

―Cases sent to your state as the R id SResidence State

Use this report to see if a new ICAMA action has

Most recent first

pbeen sent to your state

All cases will remain on list

Use this report to review a case

Date the case was opened in the your State

Use this report to see the Agreement


Case Lists by State :::California as the Agreement StateCalifornia as the Agreement State

―The ACTIVE Date is the date the Medicaid i d i h R id Scase is opened in the Residence State.

(or the date the case was sent to the Medicaid agency for processing)

Date the case d iwas opened in

the your State


Residence State Date the case was opened in the your State

―Practice issue with ICAMA 600 series…Many states not advising the AS that the Medicaid case was openHas always been a requirement since first statesHas always been a requirement since first states formed the AAICAMA in 1986Using the worksite/database makes this easyg yBut it is still a requirement

―And very good practice


Residence StateIndicate the Medicaid Case is Open


Indicate the Medicaid Case is Open

If I am the Residence (county) State, how do I i di I h d h ?indicate I have opened the case?

Click:ICAMAResidence State (enter child’s SSN)Medicaid Case Opened

Complete:Complete:Date case openedProjected closure date (defaults to child’s 18th birthday)Medicaid case number (if known)

ReviewSubmit


Residence StateMedicaid Case Should Be Closed


Medicaid Case Should Be Closed

If I am the Assistance (county) State how do IIf I am the Assistance (county) State, how do I indicate a Medicaid case should be closed?

Click:ICAMAICAMAAgreement StateClose Medicaid Case (enter child’s SSN)

Complete:Date case to be closedMove to a new state?St t NState Name

ReviewSubmit


Submit


―Is the open date for a Medicaid case always the fi f h h?first of the month?NO.Some states do open (and close) on a specificSome states do open (and close) on a specific date of the month, but using a specific date is not a requirement of the ICAMA and therefore not of the database.

(See AAICAMA’s May 2015 Practice Bulletin for a(See AAICAMA s May 2015 Practice Bulletin for a discussion of this issue.)



―What if I don’t know when the MediCal case is d?opened?

Good question!Good question!

Use the date you sent the request to yourUse the date you sent the request to your MediCal agency/office


Landing Page/User Guide

―http://icama700form.aaicama.org.instapage.com/

All the news on the ICAMA 700 Form

Something missing?Something incorrect?Something confusing?Something confusing?

Let me know:b k @ [email protected]

(I love hearing from the states and counties)


Landing Page/User Guide :::Is Puerto Rico an ICAMA member?Is Puerto Rico an ICAMA member?NO

Traditionally states have used ICAMA forms to work with ICAMA cases coming from and going to Puerto Rico.

The AAICAMA Executive Committee felt that maintaining a paper form to use with Puerto Rico was an efficient and effective way to convey information to them.


Security :::PasswordsPasswordsDo we need to change our Password periodically?

NOT YET.AAICAMA is in the process of developing protocols for regular change of passwords.Recommendations form the states as well as current security protocols will be used to determine the policy.The policy will be sent to all ICAMA 700 Form Administrators for review prior to finalization.


Security :::PasswordsPasswordsIs security robust?

YES.Security is FISMA and HIPAA compliant.For a comprehensive statement of security levels please email Robyn Bockweg ([email protected])


Other Issues :::Advice from the StatesAdvice from the States―Is there a way to indicate the County of the state where the family lives?family lives?

This has been part of our next generation discussions.We hope to work with the states on where and at what point this information is most important, if it is needed in all cases, and the best way to implement this feature.


Other Issues :::Advice from the StatesAdvice from the States―Which state is to initiate MA prior to an adoption or guardianship?guardianship?

Essentially ICAMA implies that an Adoption Assistance A t (AAA) h b i d d i i ff t If thi iAgreement (AAA) has been signed and is in effect. If this is the case then the Agreement State always directs the Residence State in the provision of Medicaid.( d l th t d li ibilit )(open and close the case, extend eligibility)

If an AAA has NOT been signed then the i d b th l ticase is governed by the regulations

of the ICPC.


CaliforniaICAMA Liaison Contacts:::ICAMA Liaison Contacts:::

S t Child W lfSacramento Child Welfare:Lisa Witchey - [email protected] Jackson - Marjana Jackson@dss ca govMarjana Jackson [email protected] Sloan - [email protected]

Medi-Cal:Amrit Singh – [email protected] Barajas - [email protected] Hightower - [email protected]

AAICAMA Secretariat:Robyn Bockweg - rbockweg@aphsa org


Robyn Bockweg - [email protected]

ACF Administration

for Children

and Families

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration on Children, Youth and Families

1. Log No: ACYF-CB-PI-10-01 2. Issuance Date: February 18, 2010

3. Originating Office: Children’s Bureau

4. Key Words: Title IV-E Plans, Kinship Guardianship Assistance, Training, Fostering Connections to Success and Increasing Adoptions Act of 2008 (Supersedes ACYF-CB-PI-08-07 and ACYF-CB-PI-09-04)

PROGRAM INSTRUCTION

To: State, Tribal and Territorial Agencies Administering or Supervising the Administration of Title IV-E of the Social Security Act (the Act), Indian Tribes, Tribal Organizations and Tribal Consortia (Tribes)

Subject: Title IV-E Plan Amendment – Guardianship Assistance Program; Title IV-E Guardianship Demonstration Projects; Fostering Connections to Success and Increasing Adoptions Act of 2008

Legal and Related References: Title IV-E of the Social Security Act; P.L. 110-351; ACYF-CB-PI-08-07 and ACYF-CB-PI-09-04 superseded.

Purpose: This Program Instruction (PI) supersedes ACYF-CB-PI-08-07 issued December 24, 2008 and ACYF-CB-PI-09-04 issued March 24, 2009. The purpose of this PI is to provide interested State title IV-E agencies and Tribes revised instructions on how to implement and operate the Guardianship Assistance Program (GAP) title IV-E plan option as authorized by the Fostering Connections to Success and Increasing Adoptions Act of 2008, Public Law (P.L.) 110-351.

Background: ACYF-CB-PI-08-07 provided the Children’s Bureau’s (CB) initial instructions for implementing the title IV-E option under section 471(a)(28) of the Act. The option provides for kinship guardianship assistance payments to relatives who assume legal guardianship of certain children for whom they have cared while foster parents. The PI limited title IV-E claims for guardianship assistance to those payments made on behalf of children newly entering guardianship on or after the first day of the quarter in which the State or Tribe’s approved title IV-E plan amendment was submitted to ACF. Since that issuance, a number of stakeholders have expressed great concern with the interpretation in the PI that Federal reimbursement was available only on behalf of new guardianships and requested that we revisit the issue. We have done so and determined that an alternative interpretation is permissible. Therefore, this PI supersedes ACYF-CB-PI-08-07 in its entirety; republishes and updates the instructions regarding the program and eligibility criteria; and provides new guidance regarding the payments available for Federal reimbursement pursuant to an amended title IV-E plan. This instruction allows title

IV-E agencies to convert legal guardianships that existed prior to the plan submission, including those that may have been supported through State or Tribal funds, to the title IV-E GAP program provided that those children meet all eligibility criteria as described herein.

Information: P.L. 110-351 adds section 471(a)(28) to the Act, creating a new title IV-E plan option for States and Tribes to provide kinship guardianship assistance payments to relatives who assume legal guardianship of children for whom they have cared while foster parents. The law also adds new section 473(d) of the Act, which establishes eligibility and other requirements for the title IV-E GAP. Federal financial participation (FFP) using the applicable Federal medical assistance percentage is available for kinship guardianship assistance payments pursuant to section 474(a)(5) of the Act.

Federal reimbursement for allowable title IV-E GAP assistance is available as of the first day of the quarter in which an approvable title IV-E plan amendment is submitted to ACF to implement the GAP (45 CFR 1356.20(d)(8)), as described herein. A discussion of the amendments, effective dates for implementation and FFP follows.

Eligibility

Once a title IV-E agency begins operating a guardianship assistance program under title IV-E, it is obligated to provide such assistance to any child who is eligible for title IV-E kinship guardianship assistance payments (section 473(d)(1)(A) of the Act).

Child Requirements. To be eligible for title IV-E kinship guardianship assistance payments, a child must have been: 1) removed from his or her home pursuant to a voluntary placement agreement or as a result of a judicial determination that continuation in the home would be contrary to the welfare of the child; and 2) eligible for title IV-E foster care maintenance payments during at least a six-consecutive month period during which the child resided in the home of the prospective relative guardian who was licensed or approved as meeting the licensure requirements as a foster family home. While the Act does not require title IV-E foster care maintenance payments to have been paid on behalf of the child during the six-month timeframe, it does require that such a child meet all title IV-E foster care maintenance payment eligibility criteria pursuant to section 472(a), (b) and (c) of the Act and 45 CFR 1356.21 in the home of the fully licensed or approved relative foster parent for a consecutive six-month period to be eligible for title IV-E kinship guardianship assistance payments with that prospective relative guardian (section 473(d)(3)(A)(i)(II) of the Act).

Additionally, the title IV-E agency must determine that: 1) return home or adoption are not appropriate permanency options for the child; 2) the child demonstrates a strong attachment to the prospective relative guardian; and 3) the relative guardian has a strong commitment to caring permanently for the child. Finally, the IV-E agency must determine that a child who is 14 years or older has been consulted regarding the kinship guardianship arrangement. These determinations are not judicial findings but rather determinations made by the title IV-E agency (section 473(d)(3)(A) of the Act).

Prospective Relative Guardian Requirements. Before a relative guardian may receive title IV-E kinship guardianship assistance payments on behalf of a child, the title IV-E agency must conduct fingerprint-based criminal records checks of the national crime information databases of the relative guardian(s) and child abuse and neglect registry checks of relative guardian(s) and

2

other adults living in the guardian's home consistent with section 471(a)(20)(C) of the Act. Consistent with existing policy, if the IV-E agency has established an appropriate timeframe that such background checks remain valid and such timeframe has not expired for the foster parent who previously received the background checks and is now seeking to become a prospective relative guardian, the IV-E agency can consider the requirement of section 471(a)(20) of the Act met without conducting new background checks (Child Welfare Policy Manual 8.4F Q/A #13).

Title IV-E Kinship Guardianship Assistance Agreements and Payments. Section 473(d)(1)(A) requires that a title IV-E agency negotiate and enter into a written, binding kinship guardianship assistance agreement with the prospective relative guardian, and provide the prospective relative guardian with a copy of the agreement. Section 473(d)(1)(B) of the Act prescribes certain requirements for the kinship guardianship assistance agreement. It must specify the following: the amount of, and manner in which the kinship guardianship assistance payment will be provided to the prospective relative guardian; the manner in which the payment may be adjusted periodically, in consultation with the relative guardian, based on the circumstances of the relative guardian and the needs of the child; the additional services and assistance for which the child and relative guardian will be eligible under the agreement; and the procedure by which the relative guardian may apply for additional services.

Additionally, the kinship guardianship assistance agreement must provide that the agreement will remain in effect without regard to the State residency of the relative guardian pursuant to 473(d)(1)(C) of the Act, and must specify that the agency will pay the total cost of nonrecurring expenses associated with obtaining legal guardianship of the child to the extent the total cost does not exceed $2,000.

A kinship guardianship assistance agreement must be in place with a prospective relative guardian prior to the establishment of the legal guardianship. Once the relative guardian has committed to care for the child and has assumed legal guardianship for the child consistent with sections 471(a)(28) and 475(7) of the Act, the title IV-E agency may then pay kinship guardianship assistance payments on behalf of a child to the relative guardian provided that the agreement meets, or is amended to meet, all the requirements of section 473(d)(1) of the Act. Kinship guardianship assistance payments may not exceed the foster care maintenance payment the child would have received if he or she remained in a foster family home (section 473(d)(2) of the Act).

Siblings. The title IV-E agency may make kinship guardianship assistance payments pursuant to a kinship guardianship agreement on behalf of each sibling of an eligible child who is placed with the same relative under the same kinship guardianship arrangement if the title IV-E agency and the relative guardian agree that the placement is appropriate (section 473(d)(3)(B) of the Act). Title IV-E nonrecurring expenses are also available for siblings so placed. The Act does not require that the IV-E agency place siblings with the relative guardian of the child simultaneously with the title IV-E eligible child for the siblings to qualify for payment under section 473(d)(3)(B) of the Act. The sibling does not have to meet the eligibility criteria in section 473(d)(3)(A) to receive kinship guardianship assistance payments or for the legal guardian to be reimbursed for the nonrecurring expenses related to costs of the legal guardianship.

3

Medicaid Eligibility. Children who receive kinship guardianship assistance payments are categorically eligible for title XIX Medicaid pursuant to section 473(b)(3)(C) in the State where such child resides.

Fair Hearings

The title IV-E agency must provide an opportunity for a fair hearing to any individual whose claim for kinship guardianship assistance available under title IV-E is denied or is not acted upon with reasonable promptness (section 471(a)(12) of the Act, and 45 CFR 205.10).

Case Plan Requirements

Section 475(1)(F) of the Act requires the title IV-E agency to include specific information in the case plan for each child with a permanency plan of placement with a prospective relative guardian and receipt of kinship guardian assistance payments. The case plan must describe the following: 1) how the child meets the eligibility requirements; 2) the steps the agency has taken to determine that return to the home or adoption is not appropriate; 3) the efforts the agency has made to discuss adoption with the child's relative foster parent and the reasons why adoption is not an option; 4) the efforts the agency has made to discuss kinship guardianship with the child's parent or parents or the reasons why efforts were not made; 5) the reason why a permanent placement with a prospective relative guardian and receipt of a kinship guardian assistance payment is in the child's best interests; and 6) the efforts made by the agency to discuss with the child's parent(s) the kinship guardianship assistance arrangements or why efforts were not made. If the child's placement with the prospective relative guardian does not include siblings, the case plan must also include a description of the reasons why the child is separated from siblings during placement.

Title IV-E Plan Requirements

The title IV-E plan requirements that are not specifically limited to the title IV-E foster care maintenance payment or adoption assistance programs also apply to the guardianship assistance program under title IV-E. These requirements are in sections 471(a)(2) through 471(a)(9); 471(a)(12), 471(a)(13), 471(a)(25), 471(a)(26), and 471(a)(30) through (a)(32) of the Act, and address topics such as agency organization and program administration, program audits and monitoring, confidentiality of information, fair hearings, interstate placements, school attendance and sibling placement. Further, Departmental regulations at 45 CFR 1355.30 apply to the title IV-E guardianship assistance program to the same extent that they apply to the title IV-E foster care maintenance payments and adoption assistance programs.

Title IV-E Agency Option to Extend the Duration of Title IV-E Kinship Guardianship Assistance Payments after October 1, 2010

Beginning October 1, 2010, a title IV-E agency may extend the age that a child is eligible to receive kinship guardianship assistance payments up to age 19, 20 or 21 (at title IV-E agency option) under certain conditions. For a child on whose behalf a kinship guardianship assistance agreement was entered into after the child turned age 16, the title IV-E agency may opt to continue kinship guardianship assistance payments until the child attains age 19, 20 or 21 if the child, once he/she reaches 18, is: 1) completing secondary school (or equivalent); 2) enrolled in post-secondary or vocational school; 3) participating in a program or activity that promotes or

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removes barriers to employment; 4) employed 80 hours a month; or 5) determined incapable of any of the above due to a documented medical condition (section 475(8)(B)(iv) of the Act). Further information on this option will be issued at a later date.

Also beginning October 1, 2010, a title IV-E agency may not provide a kinship guardianship assistance payment if the agency determines that the relative guardian is no longer legally responsible for the support of the child or if the child is no longer receiving any support from the relative guardian. A relative guardian who receives kinship guardianship assistance payments on behalf of a child must keep the title IV-E agency administering the guardianship assistance program informed of circumstances which would make him/her ineligible for payments or eligible for the payments in a different amount (sections 473(a)(4)(A) and (B) of the Act).

Administration and Training

A title IV-E agency that is operating a title IV-E GAP may claim allowable administrative and training costs for the proper and efficient administration of the guardianship assistance program. These costs may be claimed in accordance with an approved public assistance cost allocation plan as per Departmental regulations at 45 CFR 95.507 at the following Federal financial participation (FFP) rates:

50% for nonrecurring expenses up to $2,000 as well as administrative costs related to child placement and administration of the GAP pursuant to section 474(a)(3)(E) of the Act;

75% for short and long-term training of GAP personnel employed or preparing for employment by the public agency pursuant to section 474(a)(3)(A) of the Act;

75% for short-term training of prospective or existing foster parents pursuant to section 474(a)(3)(B) of the Act;

55% for short-term training of (among other individuals identified in the Act) relatives who have assumed guardianship in FY 2009, increasing by five percent each fiscal year until it reaches 75% in FY 2013, pursuant to section 474(a)(3)(B) of the Act and 203(b) of P.L. 110-351.

50% for Statewide Automated Child Welfare Information System (SACWIS) costs pursuant to 474(a)(3)(D) and (E) of the Act and, if required under 45 CFR 95.601, an approved Advanced Planning Document.

Allowable training costs and activities associated with the GAP may be claimed at the applicable FFP rate and must be addressed in the title IV-E agency's title IV-B training plan in accordance with 45 CFR 1356.60(b)(2) and in an approved cost allocation plan.

Title IV-E Guardianship Waiver Demonstration Projects

States with approved waiver demonstration projects providing guardianship assistance or services pursuant to section 1130 of the Act may continue to operate such projects in accordance with the existing applicable terms and conditions. Upon termination of such a project, the title IV-E State agency may continue to claim title IV-E and provide Medicaid if applicable, for the same assistance and services under the same terms and conditions that a child received under a guardianship demonstration project as of September 30, 2008. This claiming authority exists

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whether or not the State opts to operate a GAP pursuant to 473(d) of the Act (section 474(g) of the Act).

Financial Reporting

Until a revised form ACF-IV-E-1 is issued, title IV-E agencies should report GAP expenditures consistent with this PI as a component of and in the same manner as adoption assistance program expenses. To the extent that training costs are incurred where the transitional FFP rate of 55% or higher is applicable, the costs are to be reported as part of “State and Local Training” with the reported amounts in the Federal share columns reflecting the actual total claimed FFP (combination of amounts subject to 75% and 55%). The form ACF-IV-E-1 must be supplemented with information to clearly identify (on a line by line basis) the portion of reported adoption assistance program expenditures that support the GAP. Further guidance on the submission of the ACF-IV-E-1, and clarifying the provisions of ACYF-CB-PI-09-04 which are superseded by this Policy Instruction, is forthcoming under separate cover.

Effective Date for Implementation of Guardianship Assistance Program

The State or Tribal title IV-E agency may implement and claim allowable guardianship assistance program costs beginning on the first day of the quarter in which an approvable title IV-E plan amendment is submitted to ACF to implement the GAP (45 CFR 1356.20(d)(8)). Allowable administrative costs for the title IV-E GAP can be claimed pursuant to an amended and approved public assistance cost allocation plan (PACAP) or a pending PACAP in some situations (45 CFR 95.515).

A State or Tribe with an approved title IV-E plan amendment may claim title IV-E on or after the first day of the quarter in which the approved title IV-E plan amendment was submitted to ACF (sections 471(a)(28) and 473(d)(1)(A) of the Act). The requirement for the agency to negotiate and enter into a guardianship assistance agreement with a prospective relative guardian prior to the legal guardianship per section 473(d)(1)(A) of the Act may be satisfied by agreements entered into prior to the title IV-E plan submission if they also meet or are amended to meet the requirements of section 473(d)(1)(B) and (C) of the Act prior to claiming costs for title IV-E. Additionally, a child may satisfy the requirement pursuant to section 473(d)(3)(A)(i)(II) of the Act (eligibility for title IV-E foster care maintenance payments while residing in the home of the prospective relative guardian for six-consecutive months) prior to the first day of the quarter in which an approvable title IV-E plan amendment is submitted to ACF to implement the GAP.

INSTRUCTIONS: Plan Submissions

Each title IV-E agency that elects to operate a guardianship assistance program must submit to ACF a title IV-E plan pre-print amendment that reflects the title IV-E statutory requirements for a GAP. In completing the amendment, title IV-E agencies must record the applicable statutory, regulatory or policy references and citations for the affected Federal requirement. Title IV-E agencies may submit their title IV-E plan amendment using the preprint attached to ACYF-CB-PI-09-08 (section 6), an electronic version of which can be found at the Children's Bureau web page at: http://www.acf.hhs.gov/programs/cb. Title IV-E agencies may use a different format, provided that the format used includes all of the applicable title IV-E plan requirements of the Act as set forth in the new law. If a title IV-E agency chooses to use its own format, it must

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http://www.acf.hhs.gov/programs/cb/

include all applicable statutory, regulatory or policy references and citations for each requirement.

To the extent that a title IV-E agency seeks to claim title IV-E for children in guardianships in effect prior to the title IV-E plan amendment, the agency must submit a description to ACF that explains the process it will use to ensure that claims will be submitted on behalf of only those children who meet all GAP eligibility criteria. ACF may question costs and if necessary, defer payment consistent with 45 CFR 201.15, until it has such documentation that confirms that the title IV-E agency has a reasonable process in place to support such claims.

Title IV-E agencies that elect to provide a GAP must submit the completed title IV-E plan pre-print to the appropriate ACF Regional Program Manager for approval. The completed plan amendment may be submitted at any time. Please note that the plan amendment must be submitted electronically or on a compact disk. Where title IV-E agencies are unable to submit electronic signatures for purposes of certification, they may submit the appropriate pages with original signatures. In addition, title IV-E agencies must submit copies of referenced material to document compliance for any cited statute, regulation, policy and procedure.

Inquiries: Children's Bureau Regional Program Managers

/s/ Bryan Samuels Commissioner Administration on Children, Youth and Families

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Region I - Boston Bob Cavanaugh [email protected] JFK Federal Building Rm. 2000 Boston, MA 02203 (617) 565-1020 (p) States Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Region II - New York City Junius Scott [email protected] 26 Federal Plaza Rm. 4114 New York, NY 10278 (212) 264-2890 (p) States and Territories New Jersey, New York, Puerto Rico, Virgin Islands Region III - Philadelphia Lisa Pearson [email protected] 150 S. Independence Mall West—Suite 864 Philadelphia, PA 19106-3499 (215) 861-4000 (p) States Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia Region IV - Atlanta Ruth Walker [email protected] Atlanta Federal Center 61 Forsyth Street SW Suite 4M60 Atlanta, GA 30303 (404) 562-2900 (p) States Alabama, Mississippi, Florida, North Carolina, Georgia, South Carolina, Kentucky, Tennessee

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mailto:[email protected]




Region V - Chicago Carolyn Wilson-Hurey [email protected] 233 N. Michigan Avenue Suite 400 Chicago, IL 60601 (312) 353-4237 States Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin Region VI - Dallas June Lloyd [email protected] 1301 Young Street Room 945 Dallas, TX 75202 (214) 767-9648 (p) States Arkansas, Louisiana, New Mexico, Oklahoma, Texas Region VII - Kansas City Rosalyn Wilson [email protected] Federal Office Building Room 276 601 E 12th Street Kansas City, MO 64106 (816) 426-3981 (p) States Iowa, Kansas, Missouri, Nebraska Region VIII - Denver Marilyn Kennerson [email protected] Federal Office Building 1961 Stout Street 9th Floor Denver, CO 80294-3538 (303) 844-3100 (p) States Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming

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Region IX - San Francisco Sally Flanzer [email protected] 50 United Nations Plaza Room 450 San Francisco, CA 94102 (415) 437-8400 (p) States and Territories Arizona, California, Hawaii, Nevada, Outer Pacific—American Samoa, Commonwealth of the Northern Marianas, Federated States of Micronesia (Chuuk, Pohnpei, Yap) Guam, Marshall Islands, Palau Region X - Seattle Carol Overbeck [email protected] 2201 Sixth Avenue Suite 300, MS-70 Seattle, WA 98121 (206) 615-2602 States Alaska, Idaho, Oregon, Washington



Written and published by:The Association of Adminstrators of the Interstate Compact on Adoption and Medical AssistanceSuite 400, 1133 19th Street, NWWashington, DC, 20036 Secretariat Services provided by APHSA

AAICAMA receives many questions from states and families about circumstances that affect a child’s assistance agreement and/or eligibility for and receipt of Medicaid. The goal of this publication is provide ICAMA Professionals with a library of responses to these questions and cites to the law or policy on which the responses rely.

P r a c t i c e B u l l e t i n

A A I C A M AVolume 3Issue 1May 2015

Association of Administrators of the Interstate Compact on Adoption and Medical Assistance

When a child eligible for adoption assistance moves to or is placed in a new residence state, does s/he need to wait for that state’s Medicaid administrative procedures to be completed before they can receive Medicaid services?

Practice: Some states only open Medicaid cases or issue Medicaid cards on a specific date of the month (e.g. 1st, 15th, etc)

Title IV-E Adoption/Guardianship AssistanceNO, a Medicaid eligible child does not need to wait until a state’s administrative procedures are complete to receive Medicaid services. Administrative procedures can include: opening cases on a specific date in the month or issuing a Medicaid card, etc.

Explanation:Title IV-E recipients are Medicaid eligible no matter what state they live in and must receive Medicaid without interruption until their eligibility ends.

Under Medicaid law, children eligible for Title IV-E assistance are considered Medicaid recipients, not applicants, when they move to a new state. This is an important distinction. A person who is an applicant must first be ‘determined eligible’ before s/he can receive services. But a person who is already a Medicaid recipient must receive Medicaid services in the new state without delay. Eligible Medicaid recipients must have immediate access to Medicaid benefits regardless of state administrative schedules or procedures. Federal regulatory law states that the Medicaid agency must continue to furnish Medicaid until the child is found to be ineligible.

All states can generate a Medicaid number any time prior to its standard opening date or before a Medicaid card is issued.*

Non title IV-E Adoption Assistance NO—for most children with state-funded agreements. A Medicaid eligible child does not need to wait until a state’s administrative procedures are complete to receive Medicaid services.BUT if the child moves to or is placed in Hawaii, Illinois, New Mexico and Nevada the administrative procedures don’t matter because these children are not Medicaid-eligible based on their eligibility for adoption assistance.

state administrative processesmedicaid receipt

Written and published by:The Association of Adminstrators of the Interstate Compact on Adoption and Medical AssistanceSuite 4001133 19th Street, NWWashington, DC, 20036

Secretariat Services provided by APHSA

AAICAMA encourages you share this publication with all interested persons. We invite suggestions, comments and advice.

Explanation:Children with State adoption assistance agreements are part of an ‘optional’ (vs mandatory) eligibility group under Medicaid. States can choose whether to provide Medicaid to resident children who have non title IV-E agreements with another state under their Medicaid State Plans.

Most states, 46 states and the District of Columbia, elect to include resident children with state adoption assistance agreements from other states in their Medicaid coverage (under their Medicaid State Plan). Because state-funded children placed in or moving to any of these 46 states or the District of Columbia are Medicaid eligible, they must receive Medicaid services without (administrative) delay.

The remaining 4 states—HI, IL, NM, and NV—have not included this optional group in their list of those eligible for Medicaid and therefore do not provide Medicaid to resident children with non title IV-E agreements supported by another state.

Children placed in or moving to one of these four states may be eligible for Medicaid under a different program. Families are encouraged to ask the Assistance State for help. They can also apply for medical assistance from an alternative source (e.g. the Children’s Health Insurance Program (CHIP), private insurance, or Supplemental Security Income (SSI)).

Citation: 42 C.F.R. § 435.930. Furnishing Medicaid, which states The agency must—(a) Furnish Medicaid promptly to recipients without any delay caused by the agency's administrative pro-cedures;(b) Continue to furnish Medicaid regularly to all eligible individuals until they are found to be ineligible; and(c) Make arrangements to assist applicants and recipients to get emergency medical care whenever needed, 24 hours a day and 7 days a week.

* If Medicaid providers have any hesitancy in providing benefits without an actual Medicaid card, they can access the automated Eligibility Verification System (EVS). The EVS is available to all providers in all states around the clock. Providers can quickly verify a youth’s Medicaid eligibility before services are provided.

P r a c t i c e B u l l e t i nAssociation of Administrators of the Interstate Compact on Adoption and Medical Assistance

A A I C A M AVolume 3Issue 1May 2015

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