21-01 Version of 11.1 Out-of-Home Care (Foster Care)

11.1.1 Foster Care Medicaid Certification
11.1.2 Foster Care Medicaid Disenrollment

Children or youth placed into any of the following placements are categorically eligible for Foster Care Medicaid:

Foster Care (either IV-E or non-IV-E)
Subsidized guardianship
Court-ordered Kinship Care

Eligibility determinations for Foster Care Medicaid are not the responsibility of the IMincome maintenance agency. Child welfare agencies determine eligibility for Foster Care Medicaid when a child has been removed from the home and enters an out-of-home care placement, often referred to as Foster Care.

11.1.1 Foster Care Medicaid Certification

Eligibility for Foster Care Medicaid begins on the date the child or youth enters out-of-home care. Paper documentation is not required when certifying children placed in out-of-home care.

Foster Care Medicaid must be certified for no longer than 12 months. Children or youth certified for Foster Care Medicaid through eWiSACWISWisconsin Statewide Automated Child Welfare Information System who remain in placement during the 12th month of eligibility will have their Foster Care Medicaid administratively renewed based on their placement. Children or youth certified for Foster Care Medicaid through other means should be certified for no longer than 12 months and re-certified if the child or youth is still eligible.

11.1.2 Foster Care Medicaid Disenrollment

When a child or youth is discharged from out-of-home care, Foster Care Medicaid eligibility must be maintained until one of the following occurs:

The child or youth is determined eligible for another category of Medicaid or BadgerCare Plus.
The child or youth is determined ineligible for all categories of Medicaid and BadgerCare Plus.
The child, youth, or family failed to provide the required information to complete an eligibility determination or chooses not to pursue other Medicaid benefits.
The child or youth dies or leaves Wisconsin.

When the child or youth is discharged from out-of-home care, the child welfare agency will extend Foster Care Medicaid eligibility under the Foster Care medical status code for an additional three months. During this time, IM agencies must redetermine the child or youth’s health care eligibility with assistance from the child welfare agencies, when needed. The IM agency should set up a formal communication process with the child welfare agency to ensure IM agencies are made aware of all children leaving the Foster Care system, and provided with information necessary to redetermine eligibility. To prevent children from losing eligibility entirely, the Department of Health Services and Department of Children and Families have set up a process to send communication to families or share information with the IM agency. See Process Help 9.6.2 Youth's Discharged from Out-of-home Care and Updated All FFYC Processes for more information.

The agency must determine eligibility for the youth or child as of the date the child returned to the home. If the youth or child is determined eligible, a Notice of Decision must be sent. If the IM agency does not have sufficient information to redetermine Medicaid eligibility, the agency must request needed information from the individual or family.

If the individual or family does not comply with a request for information after 30 days or if the youth or child is determined ineligible, a Notice of Decision must be sent denying BadgerCare Plus or Medicaid eligibility for the appropriate reasons. In addition, the IM agency must send a manual negative Notice of Decision specifically terminating eligibility for Foster Care Medicaid. The manual notice must be mailed at least 10 days before the Foster Care Medicaid end date. The end date can be found on the Child or Youth Discharge from Out-of-Home Care Change Report.

This page last updated in Release Number: 21-01
Release Date: 3/29/2021
Effective Date: 3/29/2021