State of Wisconsin Department of Health Services

Release 24-02 August 22, 2024

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11.1 Out-of-Home Care (Foster Care)

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

• Foster Care (either IV-E or non-IV-E)
• Active Subsidized Guardianship Agreement
• Court-ordered Kinship Care
• Active Adoption Assistance Agreement

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 getting Foster Care Medicaid leaves their out-of-home placement, or their Subsidized Guardianship or Adoption Assistance agreement ends, they will remain eligible under Foster Care Medicaid for the rest of their 12-month period, or three months after their placement or agreement ends, whichever is later.

If a youth ages out, is discharged, or their agreement ends, and the youth already is or will turn 19 during the 12-month continuous coverage period, their Foster Care Medicaid will end at the end of the month they turn 19 or three months after they age out, are discharged, or their agreement ended, whichever is later.

After a child leaves their out-of-home placement or their Subsidized Guardianship, or their Adoption Assistance agreement ends, 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, or their Subsidized Guardianship or Adoption Assistance agreement ends the IM agency 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, Section 9.6 Youths 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.

If the child or youth has not obtained other full benefits health care coverage, the state will send notice of Foster Care Medicaid ending approximately three months in advance, but at least 10 days before the Foster Care Medicaid end date.

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The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10171