DCS Comprehensive Health Plan

Members Residing Out-of-State

Statement/Purpose

This policy outlines health plan enrollment criteria and Medicaid eligibility requirements for children in the custody of the department, in an out-of-home placement; who are residing out-of-state.

Definitions

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Policy

Members who are Title IV-E eligible, and for whom a Title IV-E payment is made, are eligible for Medicaid in the state of residence (where they are physically residing) pursuant to 42 CFR 435.403.

When members placed out-of-state are Medicaid eligible and enrolled in the state where they are residing, DCS CHP requires that medical assistance be obtained through the Medicaid program in that state. DCS CHP covers only AHCCCS-approved, medically necessary services that are not covered or are denied by that state’s Medicaid program.

Title XIX eligible members who are placed out-of-state solely for the purpose of obtaining Medicaid covered services (such as Behavioral Health Inpatient Facility services or Transplant-related treatment) are considered Arizona residents for purposes of Medicaid responsibility and, therefore, remain enrolled with DCS CHP as the AHCCCS health plan.

Members who are not Title IV-E eligible, who are placed in a licensed out-of-state home and are not related to the caregivers, and for whom no Title IV-E payment is made, remain enrolled with DCS CHP. DCS CHP encourages caregivers to apply for Medicaid in their state of residence even if it is determined that the member is not Title IV-E eligible. Contingent on the Medicaid eligibility criteria in their state of residence, the member may be eligible for Medicaid even though they are not Title IV-E eligible.

The DCS CHP Out-of-State Coordinator continuously identifies members who are placed out-of-state and/or return to the state of Arizona to facilitate appropriate health plan enrollment. In addition, the DCS CHP Out-of-State Coordinator conducts outreach to ensure caregivers are familiar with Medicaid eligibility criteria while providing education related to DCS CHP enrollment changes.

Members who are not Title XIX eligible (such as those who do not meet the Title XIX citizenship requirements) and are placed in an out-of-state placement, are not Medicaid eligible therefore, all medically necessary services are the responsibility of DCS CHP.

Procedure

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