CABINET FOR HEALTH AND FAMILY SERVICES

Department for Medicaid Services

Division of Policy and Operations

(As Amended at ARRS, February 10, 2014)

 

††††† 907 KAR 20:075. Eligibility Provisions and Requirements Regarding Former Foster Care Individuals.

 

††††† RELATES TO: KRS 205.520

††††† STATUTORY AUTHORITY: KRS 194A.010(1), 194A.030(2), 194A.050(1), 205.520(3), 42 U.S.C. 1396a(a)(10)(A)(i)(IX).

††††† NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services has responsibility to administer the Medicaid Program. KRS 205.520(3) authorizes the cabinet, by administrative regulation, to comply with any requirement that may be imposed or opportunity presented by federal law to qualify for federal Medicaid funds. This administrative regulation establishes the Medicaid eligibility provisions and requirements for an individual between the age[ages] of nineteen (19) and twenty-six (26) years, who formerly was in foster care and was receiving Medicaid benefits at the time that the individual aged out of foster care.

 

††††† Section 1. Former Foster Care Eligibility Criteria. An individual between the age[ages] of nineteen (19) and twenty-six (26) years, who formerly was in foster care, and was receiving Medicaid benefits at the time the individualís age exceeded the foster care age limit shall be eligible for Medicaid benefits if the individual meets the requirements of

this administrative regulation.

 

††††† Section 2. Income Standard. There shall be no income standard for individuals between the age[ages] of nineteen (19) and twenty-six (26) years and who formerly were in foster care but aged out of foster care.

 

††††† Section 3. Resource Standard. There shall be no resource standard for individuals between the age[ages] of nineteen (19) and twenty-six (26) years and who formerly were in foster care but aged out of foster care.

 

††††† Section 4. Attestation of Having Aged Out of Foster Care. (1) An individual between the age[ages] of nineteen (19) and twenty-six (26) years, who formerly was in foster care, and was receiving Medicaid benefits at the time the individualís age exceeded the foster care age limit, shall attest, during the application process, that the individual was receiving Medicaid benefits at the time that the individual reached the age which exceeded[exceeds] the foster care age limit.

††††† (2) An individual who does not attest as established in subsection (1) of this section shall not be eligible for Medicaid benefits under this administrative regulation.

 

††††† Section 5. Citizenship and Residency Requirements. (1) The citizenship requirements established in 42 C.F.R. 435.406 shall apply.

††††† (2)[Except as established in subsection (3) or (4) of this section,] To satisfy the Medicaid:

††††† (a) Citizenship requirements, an applicant or recipient shall be:

††††† 1. A citizen of the United States as verified through satisfactory documentary evidence of citizenship or nationality presented during initial application or if a current recipient, upon next redetermination of continued eligibility;

††††† 2.[Except as provided in subsection (3) of this section,] A qualified alien who entered the United States before August 22, 1996, and is:

††††† a. Lawfully admitted for permanent residence pursuant to 8 U.S.C. 1101;

††††† b. Granted asylum pursuant to 8 U.S.C. 1158;

††††† c. A refugee admitted to the United States pursuant to 8 U.S.C. 1157;

††††† d. Paroled into the United States pursuant to 8 U.S.C. 1182(d)(5) for a period of at least one (1) year;

††††† e. An alien whose deportation is being withheld pursuant to 8 U.S.C. 1253(h), as in effect prior to April 1, 1997, or 8 U.S.C. 1231(b)(3);

††††† f. Granted conditional entry pursuant to 8 U.S.C. 1153(a)(7), as in effect prior to April 1, 1980;

††††† g. An alien who is granted status as a Cuban or[and] Haitian entrant pursuant to 8 U.S.C. 1522;

††††† h. A battered alien pursuant to 8 U.S.C. 1641(c);

††††† i. A veteran pursuant to 38 U.S.C. 101, 107, 1101, or 1301 with a discharge characterized as an honorable discharge and not on account of alienage;

††††† j. On active duty other than active duty for training in the Armed Forces of the United States and who fulfills the minimum active duty service requirements established in 38 U.S.C. 5303A(d);

††††† k. The spouse or unmarried dependent child of an individual described in clause i. or j. of this subparagraph or the unremarried surviving spouse of an individual described in clause i. or j. of this subparagraph if the marriage fulfills the requirements established in 38 U.S.C. 1304; or

††††† l. An Amerasian immigrant pursuant to 8 U.S.C. 1612(a)(2)(A)(v); or

††††† 3. A qualified alien who entered the United States on or after August 22, 1996 and is:

††††† a. Granted asylum pursuant to 8 U.S.C. 1158;

††††† b. A refugee admitted to the United States pursuant to 8 U.S.C. 1157;

††††† c. An alien whose deportation is being withheld pursuant to 8 U.S.C. 1253(h), as in effect prior to April 1, 1997, or 8 U.S.C. 1231(b)(3);

††††† d. An alien who is granted status as a Cuban or[and] Haitian entrant pursuant to 8 U.S.C. 1522;

††††† e. A veteran pursuant to 38 U.S.C. 101, 107, 1101, or 1301 with a discharge characterized as an honorable discharge and not on account of alienage;

††††† f. On active duty other than active duty for training in the Armed Forces of the United States and who fulfils the minimum active duty service requirements established in 38 U.S.C. 5303A(d);

††††† g. The spouse or unmarried dependent child of an individual described in clause e. or f. of this subparagraph or the unremarried surviving spouse of an individual described in clause e. or f. of this subparagraph if the marriage fulfills the requirements established in 38 U.S.C. 1304;

††††† h. An Amerasian immigrant pursuant to 8 U.S.C. 1612(a)(2)(A)(v); or

††††† i. An individual lawfully admitted for permanent residence pursuant to 8 U.S.C. 1101 who has earned forty (40) quarters of Social Security coverage; and

††††† (b) Residency requirements, the applicant or recipient shall be a resident of Kentucky who meets the conditions for determining state residency pursuant to 42 C.F.R. 435.403.[(3) A qualified or nonqualified alien shall be eligible for medical assistance as provided in this subsection.

††††† (a) The individual shall meet the income, resource, and categorical requirements of the Medicaid Program.

††††† (b) The individual shall have, or have had within at least one (1) of the three (3) months prior to the month of application, an emergency medical condition:

††††† 1. Not related to an organ transplant procedure;

††††† 2. Which shall be a medical condition, including severe pain, in which the absence of immediate medical attention could reasonably be expected to result in placing the individualís health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

††††† (c)1. Approval of eligibility shall be for a time limited period which includes, except as established in subparagraph 2 of this paragraph, the month in which the medical emergency began and the next following month.

††††† 2. The eligibility period shall be extended for an appropriate period of time upon presentation to the department of written documentation from the medical provider that the medical emergency will exist for a more extended period of time than is allowed for in the time limited eligibility period.

††††† (d) The Medicaid benefits to which the individual is entitled shall be limited to the medical care and services, including limited follow-up, necessary for the treatment of the emergency medical condition of the individual.

††††† (4)(a) The satisfactory documentary evidence of citizenship or nationality requirement in subsection (2)(a)1 of this section shall not apply to an individual who:

††††† 1. Is receiving SSI benefits;

††††† 2. Previously received SSI benefits but is no longer receiving them;

††††† 3. Is entitled to or enrolled in any part of Medicare;

††††† 4. Previously received Medicare benefits but is no longer receiving them;

††††† 5. Is receiving:

††††† a. Disability insurance benefits under 42 U.S.C. 423; or

††††† b. Monthly benefits under 42 U.S.C. 402 based on the individualís disability pursuant to 42 U.S.C. 223(d);

††††† 6. Is in foster care and who is assisted under Title IV-B of the Social Security Act; or

††††† 7. Receives foster care maintenance or adoption assistance payments under Title IV-E of the Social Security Act.

††††† (b) The departmentís documentation requirements shall be in accordance with the requirements established in 42 U.S.C. 1396b(x).

††††† (5) The department shall assist an applicant or recipient who is unable to secure satisfactory documentary evidence of citizenship or nationality in a timely manner because of incapacity of mind or body and lack of a representative to act on the applicant's or recipient's behalf.

††††† (6)(a) Except as established in paragraph (b) of this subsection, an individual shall be determined eligible for Medicaid for up to three (3) months prior to the month of application if all conditions of eligibility are met.

††††† (b) The retroactive eligibility period shall begin no earlier than January 1, 2014 for an individual who gains Medicaid eligibility solely by qualifying:

††††† 1. As a former foster care individual pursuant to this administrative regulation; or

††††† 2. As an adult with income up to 133 percent of the federal poverty level who:

††††† a. Does not have a dependent child under the age of nineteen (19) years; and

††††† b. Is not otherwise eligible for Medicaid benefits.]

 

††††† Section 6. Provision of Social Security Numbers. (1)[(a)] Except as provided in subsections (2) and (3) of this section, an applicant for or recipient of Medicaid shall provide a Social Security number as a condition of eligibility.[(b) If a parent or caretaker relative and the child, unless the child is a deemed eligible newborn, refuses to cooperate with obtaining a Social Security number for the newborn child or other dependent child, the parent or caretaker relative shall be ineligible due to failing to meet technical eligibility requirements.]

††††† (2) An individual shall not be denied eligibility or discontinued from eligibility due to a delay in receipt of a Social Security number from the United States Social Security Administration if appropriate application for the number has been made.

††††† (3) An individual who refuses to obtain a Social Security number due to a well-established religious objection shall not be required to provide a Social Security number as a condition of eligibility.

 

††††† Section 7. Institutional Status. (1) An individual shall not be eligible for Medicaid if the individual is a:

††††† (a) Resident or inmate of a nonmedical public institution except as established in subsection (2) of this section;

††††† (b) [Patient in a state tuberculosis hospital unless the individual][he][has reached age sixty-five (65);

††††† (c)] Patient in a mental hospital or psychiatric facility unless the individual is:

††††† 1. Under age twenty-one (21) years of age; or

††††† 2. Under age twenty-two (22) if the individual was receiving inpatient services on his or her 21st birthday; or[3. Sixty-five (65) years of age or over; or]

††††† (c)[(d)] Patient in a nursing facility classified by the Medicaid program as an institution for mental diseases[, unless the individual has reached age sixty-five (65)].

††††† (2) An inmate shall be eligible for Medicaid during the period of time the inmate is admitted to a hospital if the inmate:

††††† (a) Has been admitted to a hospital;

††††† (b) Has been an inpatient at the hospital for at least twenty-four (24) consecutive hours; and

††††† (c) Meets the Medicaid[who meets the] eligibility criteria established in this administrative regulation[may be eligible for Medicaid after having been admitted to a medical institution and been an inpatient at the institution for at least twenty-four (24) consecutive hours].

 

††††† Section 8. [Incarceration Status. An inmate who meets the eligibility requirements of this administrative regulation shall be eligible for Medicaid after having been admitted to a medical institution and been an inpatient at the institution for at least twenty-four (24) consecutive hours.

 

††††† Section 9. Application for Other Benefits. (1)(a) As a condition of eligibility for Medicaid, an applicant or recipient shall apply for each annuity, pension, retirement, and disability benefit to which the individual is entitled, unless the individual can demonstrate good cause for not doing so.

††††† (b) Good cause shall be considered to exist if other benefits have previously been denied with no change of circumstances or the individual does not meet all eligibility conditions.

††††† (c) Annuities, pensions, retirement, and disability benefits shall include:

††††† 1. Veterans' compensations and pensions;

††††† 2 Retirement, Survivors, and Disability Insurance;

††††† 3. Railroad retirement benefits;

††††† 4. Unemployment compensation; and

††††† 5. Individual retirement accounts.

††††† (2) An applicant or recipient shall not be required to apply for federal benefits if:

††††† (a) The federal law governing that benefit specifies that the benefit is optional; and

††††† (b) The applicant or recipient believes that applying for the benefit would be to the applicantís or recipientís disadvantage.

††††† (3) An individual who would be eligible for SSI benefits but has not applied for the benefits shall not be eligible for Medicaid.

 

††††† Section 10. Assignment of Rights to Medical Support. By accepting assistance for or on behalf of a child, a recipient shall be deemed to have assigned to the Cabinet for Health and Family Services any medical support owed for the child not to exceed the amount of Medicaid payments made on behalf of the recipient.

 

††††† Section 11. Third-party Liability as a Condition of Eligibility. (1)(a) Except as provided in subsection (3) of this section, an individual applying for or receiving Medicaid shall be required as a condition of eligibility to cooperate with the Cabinet for Health and Family Services in identifying, and providing information to assist the cabinet in pursuing, any third party who may be liable to pay for care or services available under the Medicaid program unless the individual has good cause for refusing to cooperate.

††††† (b) Good cause for failing to cooperate shall exist if cooperation:

††††† 1. Could result in physical or emotional harm of a serious nature to a child or custodial parent;

††††† 2. Is not in a child's best interest because the child was conceived as a result of rape or incest; or

††††† 3. May interfere with adoption considerations or proceedings.

††††† (2) A failure of an individual to cooperate without good cause shall result in ineligibility of the individual.

††††† (3) A pregnant woman eligible under poverty level standards shall not be required to cooperate in establishing paternity or securing support for her unborn child.

 

††††† Section 12.] Application Process, Initial and Continuing Eligibility Determination. (1) An individual may apply for Medicaid benefits by:

††††† (a) Using the Web site located at www.kynect.ky.gov;

††††† (b) Applying over the telephone by calling:

††††† 1. 1-855- 459-6328; or

††††† 2. 1-855-326-4654 if deaf or hearing impaired;

††††† (c) Faxing an application to 1-502-573-2007;

††††† (d) Mailing a paper application to Office of Health Benefits Exchange, 12 Mill Creek, Frankfort, Kentucky[,] 40601; or

††††† (e) Going to the applicantís local Department for Community Based Services Office and applying in person.

††††† (2) An individual shall attest in accordance with Section 4 of this administrative regulation when applying for Medicaid benefits.

††††† (3)(a) An application shall be processed (approved, denied, or a request for additional information sent) by the department or other entity involved in processing the given application within forty-five (45) days of application submittal.

††††† (b) If a trusted source indicates that an applicant is incarcerated, a request for additional information shall be generated by the department or other entity involved in processing the application requesting verification of the applicantís incarceration dates or status.

††††† (c) If an applicant fails to provide information in response to a request for additional information within forty-five (45) days of the receipt of the request[beginning of the application process], the application shall be denied.[(4)(a) An annual renewal of eligibility shall occur without an individual having to take action to renew eligibility, unless:

††††† 1. The individualís eligibility circumstances change resulting in the individual no longer being eligible for Medicaid; or

††††† 2. A request for additional information is generated due to a change in income or incarceration status.

††††† (b)1. If an individual receives a request for additional information as part of the renewal process, the individual shall provide the information requested within forty-five (45) days of receiving the request.

††††† 2. If an individual fails to provide the information requested within forty-five (45) days of receiving the request, the individualís eligibility shall be terminated on the forty-fifth day from the request for additional information.

††††† (5) An individual shall be required to report to the department any changes in circumstances or information related to Medicaid eligibility.]

 

††††† Section 9.[13.] Adverse Action, Notice, and Appeals. The adverse action, notice, and appeals provisions established in 907 KAR 20:060 shall apply to former foster care individuals between the age[ages] of nineteen (19) and twenty-six (26) who aged out of foster care while receiving Medicaid coverage.[Section 14. Implementation Date of Former Foster Care Eligibility Provisions and Requirements.

††††† (1) The eligibility provisions and requirements established in this administrative regulation shall be effective beginning on January 1, 2014.

††††† (2) An individual shall not be eligible to receive Medicaid benefits pursuant to the eligibility provisions and requirements established in this administrative regulation any earlier than January 1, 2014.]

 

LAWRENCE KISSNER, Commissioner

AUDREY TAYSE HAYNES, Secretary

††††† APPROVED BY AGENCY: January 13, 2014

††††† FILED WITH LRC: January 14, 2014 at 1 p.m.

††††† CONTACT PERSON: Tricia Orme, Office of Legal Services, 275 East Main Street 5 W-B, Frankfort, Kentucky 40601, phone (502) 564-7905, fax (502) 564-7573, email tricia.orme@ky.gov.