DAR File No. 40040
This rule was published in the January 15, 2016, issue (Vol. 2016, No. 2) of the Utah State Bulletin.
Health, Health Care Financing, Coverage and Reimbursement Policy
Foster Care, Former Foster Care Youth and Independent Foster Care Adolescents
Notice of Proposed Rule
DAR File No.: 40040
Filed: 12/30/2015 08:54:33 AM
Purpose of the rule or reason for the change:
The purpose of this change is to comply with a mandate from the Centers for Medicare and Medicaid Services, which specifies who may become eligible for the Former Foster Care Medicaid program.
Summary of the rule or change:
This amendment expands coverage to foster care youth who reside in Utah and were in foster care in any state at the time they turned 18 years old. Coverage continues for these individuals through the month in which they turn 26 years of age.
State statutory or constitutional authorization for this rule:
- Pub. L. No. 111-148
- Section 26-1-5
- Section 26-18-3
This rule or change incorporates by reference the following material:
- Updates Subsection 1902(a)(10)(A)(ii)(XVII) of the Social Security Act, published by Social Security Administration, 01/01/2016
- Updates 42 CFR 435.115(e)(2), published by Government Printing Office, 10/01/2015
Anticipated cost or savings to:
the state budget:
The Department estimates an annual cost of about $124,800 to the state budget, regardless of which state is responsible for foster care payment.
There is no impact to local governments because they neither fund nor make eligibility determinations for Medicaid programs.
Small businesses may see a portion of $124,800 in annual revenue with the additional youth who will qualify for the Former Foster Care Medicaid program.
persons other than small businesses, businesses, or local governmental entities:
Medicaid providers may see a portion of $124,800 in annual revenue with the additional youth who will qualify for the Former Foster Care Medicaid program. Individuals who qualify for this program may also see a portion of this amount in total out-of-pocket savings.
Compliance costs for affected persons:
A single Medicaid provider may see a portion of $2,400 in annual revenue with the additional youth who will qualify for the Former Foster Care Medicaid program. An individual who qualifies for this program may also see a portion of this amount in out-of-pocket savings.
Comments by the department head on the fiscal impact the rule may have on businesses:
There is impact on business because Medicaid providers may see an increase in revenue for providing treatment to these eligible individuals.
Joseph K. Miner, MD, Executive Director
The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231
Direct questions regarding this rule to:
- Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at firstname.lastname@example.org
Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:
This rule may become effective on:
Joseph Miner, Executive Director
R414. Health, Health Care Financing, Coverage and Reimbursement Policy.
R414-303. Coverage Groups.
R414-303-8. Foster Care, Former Foster Care Youth and Independent Foster Care Adolescents.
(1) The Department adopts and incorporates
by reference 42 CFR 435.115(e)(2), October 1, 201[
4] ed. The Department also adopts and incorporates by
reference Subsection 1902(a)(10)(A)(i)(IX) and Subsection
1902(a)(10)(A)(ii)(XVII) of the Social Security Act, effective
January 1, 201[ 5].
(2) Eligibility for foster children who meet the definition of a dependent child under the State Plan for Aid to Families with Dependent Children in effect on July 16, 1996, is not governed by this rule. The Department of Human Services determines eligibility for foster care Medicaid.
(3) The Department covers individuals who
are under the responsibility of [
the] [ S]tate and meet the criteria of Subsection
1902(a)(10)(A)(i)(IX) of the Social Security Act. Former Foster
Care Youth is the name of this coverage group.
(a) Coverage is available through the month in which the individual turns 26 years of age.
(b) There is no income or asset test for eligibility under this group.
(4) The Department elects to cover individuals who are in foster care under the responsibility of the State at the time the individual turns 18 years of age, are not eligible under the Former Foster Care Youth coverage group, and who are 18 years old but not yet 21 years old as described in Subsection 1902(a)(10)(A)(ii)(XVII) of the Social Security Act. This coverage is under the Independent Foster Care Adolescents program. The Department determines eligibility according to the following requirements.
(a) At the time the individual turns 18 years of age, the individual must be in the custody of the Division of Child and Family Services, or the Department of Human Services if the Division of Child and Family Services is the primary case manager, or a federally recognized Indian tribe, but not in the custody of the Division of Youth Corrections.
(b) Income and assets of the child are not counted to determine eligibility under the Independent Foster Care Adolescents program.
(c) When funds are available, an eligible independent foster care adolescent may receive Medicaid under this coverage group until he or she reaches 21 years of age, and through the end of that month.
KEY: MAGI-based, coverage groups, former foster care youth, presumptive eligibility
Date of Enactment or Last Substantive Amendment: [
August 1, 2015]
Notice of Continuation: January 23, 2013
Authorizing, and Implemented or Interpreted Law: 26-18-3; 26-1-5
More information about a Notice of Proposed Rule is available online.
The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2016/b20160115.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.
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For questions regarding the content or application of this rule, please contact Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at email@example.com. For questions about the rulemaking process, please contact the Division of Administrative Rules.