Family Healthcare (FAMIS) Manual

0955.000.00 Medical Assistance for Children in Care (MACC)

CS94-50 September 30, 1994, CS92-59 April 14, 1993

The legal basis for Medical Assistance for Children in Care (MACC) is in 42 CFR 435.222. Although MACC is a separate type of assistance, the instructions are being included in the Family Healthcare manual as general procedures and policies apply (i.e., TPL, reinvestigations, hearings, rights and responsibilities, etc.).

Specific children for whom the Department of Mental Health (DMH), Division of Youth Services (DYS), or a Juvenile Court have full or partial financial responsibility, may be eligible for Medicaid benefits excluding vendor coverage, if they are living in an eligible living arrangement and meet all other eligibility factors as outlined below. If they are in a vendor situation, their eligibility will be determined under procedures outlined under ICF Under 18 and ICF/MR in Chapter VI, Pages 27A-29.

Use “K” as the type of assistance designation for Medical Assistance for Children in Care.

Children in the custody of the Children’s Division also may qualify for Medicaid under the provisions of this program. Eligibility for these children will be determined by Children’s Division staff and benefits provided through their system.

At the time of application, screen each case in the system to determine if a Children’s Division case is currently open. If the Children’s Division case is open, contact the Children’s Division worker to determine if the Children’s Division has custody. If the Children’s Division has custody, Children’s Division will determine eligibility and provide Medicaid benefits. If DYS or a Juvenile Court has custody or financial responsibility, Eligibility Specialists (ES) working for the Children’s Division will determine eligibility for MACC.

If DMH has custody or financial responsibility, the Income Maintenance caseworker will determine eligibility for MACC. When DMH has custody or financial responsibility, there is no advantage to determining the child’s eligibility under MACC rather than MAF or MC+ for children. Any DMH child who would be eligible for MACC should be eligible under the MC+ for children program as non-CHIP. This is because if DMH only has financial responsibility and the parents retain legal custody, the parents’ needs and income must be included to determine MACC eligibility.

HB 564 enacted changes effective January 1, 1994, which expanded MACC to provide state-only-funded medical assistance to children (ineligible for federally-matched Medicaid) placed in a non-profit residential facility by the Juvenile Court.