DAR File No. 44129

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-303

Coverage Groups

Notice of Proposed Rule

(Amendment)

DAR File No.: 44129
Filed: 10/15/2019 02:05:10 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of these changes is to allow foster care children from other states or tribes to receive Former Foster Care coverage.

Summary of the rule or change:

This amendment allows Former Foster Care coverage for foster care individuals who arrive from any state or tribe, as long as they received Medicaid coverage during the foster care period in which they turned 18 years of age. It also updates federal citations, removes duplicative language, and makes other technical changes.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Pub. L. No. 111-148
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Removes 42 CFR 435.115(e)(2), published by Government Printing Office , 10/01/2015
• Removes Title XIX of the Social Security Act, Section 1931(c)(1) and Section 1931(c)(2), published by Social Security Administration, 01/01/2013
• Removes 42 CFR 435.112 and 435.115(f), (g) and (h), published by Government Printing Office, 10/01/2012
• Removes Subsection 1902(a)(10)(A)(i)(I) of the Social Security Act, published by Social Security Administration, 01/01/2014
• Removes 42 CFR 435.227, published by Government Printing Office, 10/01/2013
• Removes Subsection 1902(a)(10)(A)(i)(IX) and Subsection 1902(a)(10)(A)(ii)(XVII) of the Social Security Act, published by Social Security Administration, 10/01/2013
• Removes 42 CFR 435.115(e)(1), published by Government Printing Office, 10/01/2013

Anticipated cost or savings to:

the state budget:

There is an annual cost of about $56,200 to the state budget.

local governments:

There is no impact on local governments because they neither fund nor provide foster care services under the Medicaid program.

small businesses:

Small businesses may see a share of annual revenue up to $56,200 with the increase in foster care coverage.

persons other than small businesses, businesses, or local governmental entities:

Medicaid providers may see a share of annual revenue up to $56,200 with the increase in foster care coverage, while individuals who become eligible for the Former Foster Care Individuals Program may see a share of out-of-pocket savings based on that amount.

Compliance costs for affected persons:

There are no compliance costs because this change can only result in increased revenue and out-of-pocket savings.

Comments by the department head on the fiscal impact the rule may have on businesses:

Businesses will see a share of revenue with the expansion of foster care coverage.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office 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 801-237-0750, or by Internet E-mail at [email protected]

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:

12/02/2019

This rule may become effective on:

12/09/2019

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2020	FY 2021	FY 2022
State Government	$56,200	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$56,200	$0	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$16,900	$0	$0
Non-Small Businesses	$39,300	$0	$0
Other Persons	$56,200	$0	$0
Total Fiscal Benefits:	$56,200	$0	$0
Net Fiscal Benefits:	$56,200	$0	$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

About 27,000 non-small businesses are Medicaid providers and they may see a share of revenue up to $39,300, with the increase in foster care coverage.

 

The Executive Director of the Department of Health, Joseph K. Miner, MD, has reviewed and approved this fiscal analysis.

 

 

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-303. Coverage Groups.

R414-303-7. Four-Month Transitional Medicaid.

(1) The Department provides coverage to individuals as described in 42 CFR 435.115. This coverage group is known as the 4 Month Extended program.[adopts and incorporates by reference 42 CFR 435.112 and 435.115(f), (g) and (h), October 1, 2012 ed., and Title XIX of the Social Security Act, Section 1931(c)(1) and Section 1931(c)(2) in effect January 1, 2013, to provide four months of extended medical assistance to a household when the parent or caretaker relative is eligible and enrolled in Medicaid as defined in 42 CFR 435.110, and loses eligibility for the reasons defined in 42 CFR 435.112 and 435.115.]

(a) A pregnant woman who is eligible and enrolled in Medicaid as defined in 42 CFR 435.116, and who meets the income limit defined in 42 CFR 435.110 for three of the prior six months, is eligible to receive four-month extended coverage.[Four-Month Transitional Medicaid for the reasons defined in 42 CFR 435.112 and 435.115.

(b) Children who live with the parent are eligible to receive Four-Month Transitional Medicaid.]

( b[2]) Changes in household composition do not affect eligibility for the four-month extension period. Newborn babies are considered household members even if they are not born the month the household became ineligible for Medicaid. New members added to the case will lose eligibility when the household loses eligibility. Assistance shall be terminated for household members who leave the household.

 

R414-303-8. [ Foster Care, ]Former Foster Care [ Youth ]and Independent Foster Care Individuals [ Adolescents ].

(1) [The Department adopts and incorporates by reference 42 CFR 435.115(e)(2), October 1, 2015 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, 2016.

(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 provides coverage to individuals as described in 42 CFR 435.150. The coverage group is known as the Former Foster Care Individuals program.[covers individuals who are under the responsibility of any state 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]2) When funds are available, the[The] Department elects to cover individuals who are under 21 years of age as described in 42 CFR 435.226. The coverage group is known as the Foster Care Independent Living program.[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.]

(3) The Department elects to cover an individual under the responsibility of any state or tribe at the time the individual turns 18 years of age, and was enrolled in Medicaid or the 1115 demonstration project at any time during the foster care period in which the individual turned 18.

(4) There is no income or asset test for eligibility under the Former Foster Care or the Foster Care Independent Living programs.

 

R414-303-9. Foster Care, Subsidized Adoptions, and Kinship Guardianship Children.

(1) The Department provides coverage to foster care, subsidized adoption, and kinship guardianship individuals as described in 42 CFR 435.145.[The Department adopts and incorporates by reference 42 CFR 435.115(e)(1), October 1, 2013 ed, in regard to Subsidized Adoption Medicaid.]

(2) The Department elects to cover individuals under a state adoption agreement as defined in 42 CFR 435.227 .[, October 1, 2013 ed., which is adopted and incorporated by reference.

(3) The Department may not impose resource or income tests for a child eligible under a state subsidized adoption agreement.

(4) The Department adopts and incorporates by reference Subsection 1902(a)(10)(A)(i)(I) of the Social Security Act, effective January 1, 2014, in regard to Kinship Guardianship Medicaid.]

( 3[5]) The Department of Human Services determines eligibility for Foster Care, [s]Subsidized [a]Adoption, and Kinship Guardianship Medicaid.

 

KEY: MAGI-based, coverage groups, former foster care youth, presumptive eligibility

Date of Enactment or Last Substantive Amendment: [ August 29, ]2019

Notice of Continuation: January 8, 2018

Authorizing, and Implemented or Interpreted Law: 26-18-3; 26-1-5