DCS Comprehensive Health Plan

Member Information Requirement

Statement/Purpose

This policy outlines the method in which Title XIX (Medicaid) coverage is initiated for individuals who meet the Arizona Department of Child Safety Comprehensive Health Plan (DCS CHP) enrollment standards set forth in A.R.S. § 8-512.

Definitions

AHCCCS: the Arizona Health Care Cost Containment System, which is the State’s program for medical assistance available under Title XIX of the Social Security Act and state public insurance statutes, A.R.S. Title 36, Chapter 29.

Health-e-Arizona PLUS: A system developed by AHCCCS and the Department of Economic Security (DES) used to apply for AHCCCS Health Insurance, KidsCare, Nutrition Assistance and Cash Assistance benefits and to connect to the Federal Insurance Marketplace.

Title XIX: The section of the Social Security Act which describes the Medicaid program's coverage for eligible persons, (i.e., medically indigent). Title 19 benefits are provided through the Medicaid federal entitlement program; benefits are delivered in Arizona through the Arizona Health Care Cost Containment System.

Title IV-E: Title IV-E of the Social Security Act 42 U.S.C. 670-679, the statutes establishing the foster care and adoption assistance programs.

Policy

DCS CHP maximizes its use of federal Title XIX funds to provide health care services for children in out-of-home placement by initiating eligibility determinations within the Health-e-Arizona PLUS system for all qualifying children.

Title XIX of the Social Security Act provides federal funding for the Medicaid program. Title XIX is an entitlement program, with funding contingent on establishing individual financial eligibility for children in out-of-home placement.

Any child in an out-of-home placement is eligible for Title XIX when the child:

• Has income and resources that do not exceed the maximum allowable for a household of one; and

• Has a Social Security Number (or has applied for one); and

• Is a citizen of the United States.

Children who are eligible for Title IV-E or Supplemental Security Income (SSI) may also be eligible for Title XIX.

Procedure

Custodial agency representatives work in coordination with the DCS CHP Eligibility and Enrollment team to initiate a prompt determination regarding a child’s eligibility for Title XIX.

Upon receipt of eligibility information from the custodial agency representative, the DCS CHP Eligibility and Enrollment team is responsible for gathering information to be entered into the Health-e-Arizona PLUS system in an effort to initiate a Title XIX eligibility determination.

Information is obtained from a variety of sources including, but not limited to the:

• Custodial agency representative;

• DCS Child Welfare case management system (GUARDIAN);

• Arizona Health Care Cost Containment (AHCCCS) case management system, Prepaid Medical Management Information System (PMMIS);

• Health-E-Arizona Plus (HEAplus);

• Arizona Department of Corrections, Juvenile Probation Office Staff.

Approved eligibility cases are manually reviewed for continued eligibility upon notification of changes in out-of-home status and reviewed annually via automated criteria with the Health-e-Arizona Plus system.