5450            INDIVIDUAL UNDER 21 IN CUSTODY OF THE STATE

An individual under age 21 who is in custody of the Office of Children's Services ( OCS Office of Children's Services ) and is not covered under Title IV-E Foster Care (see Section 5195), Denali KidCare, or any other Medicaid coverage category (see Note below) is  eligible for Medicaid if the individual meets the eligibility criteria set out in Section 5410.

The Family Medicaid one person ANI standard is used to determine eligibility for these individuals.  If OCS Office of Children's Services places the individual with his or her birth parents or adoptive parents, the income, resources, and needs of the parents must be considered in determining eligibility as explained in Section 5420, even if OCS Office of Children's Services retains legal custody of the child.

Application for this coverage must be made by the individual's OCS Office of Children's Services social worker, who is responsible for:

1. Completing a GEN 33 application form;

2. Providing all required verification;

3. Notifying the Division of Health Care Services Third Party Liability Unit of any court-ordered payments or any health insurance available to the child;

4. Advising the foster parents of the Well-Child ( EPSDT Early Periodic Screening, Diagnosis and Treatment ) program;

5. Reporting any changes to the eligibility caseworker in the individual's income, resources, medical insurance, or placement; and

6. Completing a GEN 33A-review application every six months.

Note:  

Although most children in the custody of the state do not have access to resources or income, occasionally a child will be found ineligible due to one of those factors.  If this happens, the caseworker should consider eligibility under the more liberal Denali KidCare.

Example:  

An OCS Office of Children's Services social worker submits an application for a child who is in OCS Office of Children's Services custody and placed in a foster home.  The child is not eligible under  Title IV-E Foster Care.  Under 21 eligibility is determined by counting only the child's resources and income against the Family Medicaid limits, using the ANI 01 standard.