|Release 65A: Effective May 1, 2012|
Medical Assistance Programs -
The Medical Assistance to Children in Substitute or Adoptive Care (SAC) program provides medical assistance to children placed in substitute care and children who are the subject of adoption assistance agreements. Non-CAWEM SAC children may qualify for Continuous Eligibility for Medicaid if they lose eligibility for SAC prior to their next scheduled 12-month redetermination.
Effective September 15, 2011, Child Welfare (CW) assumed responsibility for most SAC (C5) applications, including:
- Children receiving Foster Care and Adoptions Assistance from other states who reside in Oregon;
- Healthy Kids referrals (2116 referrals);
- Chafee Medical Program referrals for children aging out of Oregon Foster Care;
- Tribal CW children;
- Children in CW custody who are placed in Psychiatric Residential Treatment Services (PRTS).
Branch 5503 carries the remaining C5 SAC cases, including children in Behavioral Rehabilitation Services (BRS) and children in PRTS who are not in the custody of CW; typically these children are referred to the PRST or BRS facility by a parent or guardian.
When a parent or guardian refers a child to drug or alcohol treatment, the child is not considered for a C5 SAC case; they are considered for MAA, MAF, EXT, OHP, or CHIP.
When a request is made for SAC medical assistance, use the Application for Children in Substitute Care (DHS 1462) or the Medical Assistance Application for Children Receiving Adoptive Care (DHS 1462A).
DHS 1462 applications are completed by facilities on the behalf of children in substitute care. The DHS 1462 is also completed by foster care providers on the behalf of children approved for foster care in another state but who are currently residing in Oregon.
DHS 1462A applications are completed by adoptive parents for children who are the subject of an adoption assistance agreement between the parents and a public agency of another state. These children are assumed eligible for SAC medical assistance.
When a child moves to Oregon from another state where an adoption assistance agreement is in effect between the agency in the other state and the adoptive parents, the other state usually sends forms to Oregon's DHS Adoption Assistance Unit indicating the family has moved to Oregon and is eligible for medical assistance.
When an application for a child who may be eligible for SAC is received, please fax the completed DHS 1462, DHS 1462A, MSC 415F, OHP 7210 or SDS 539A application to the CMED eligibility specialist at 503-945-7032.
For a child who has an immediate need for a medical ID card, please indicate "emergency application" on the fax cover sheet.
Leslee V. Star Margaret L. Roberts
To be eligible for the SAC program, an individual must be under the age of 21 and:
A child in substitute care must meet all TANF nonfinancial and financial eligibility requirements. However, there are no school attendance requirements for SAC.
Children subject to an adoption assistance agreement described above are assumed eligible for the SAC program.
Assumed Eligibility for Medical Programs: 461-135-0010
Specific Requirements; SAC: 461-135-0150
Household group (who is in the household?)
For the SAC program when there is no Child Welfare involvement, if a child has been referred by a parent or guardian to a PRTS or BRS facility, the facility will apply for the child as a household of one. The child is still considered to be in the household when absent for illness. This includes children in PRTS or BRS facilities. (For a child referred by the family or guardian to a drug or alcohol treatment facility, please see the OHP medical chapter.)
Household Group: 461-110-0210
Filing group (who must apply togther?)
When there is no Child Welfare involvement, the SAC filing group includes only the child who meets all nonfinancial eligibility requirements.
Filing Group; Overview: 461-110-0310
Filing Group; EXT, MAA, TANF: 461-110-0330
Filing Group; MAF and SAC: 461-110-0340
Filing Group; HKC, OHP: 461-110-0400
Financial group (whose income and resources are counted?)
For SAC when there is no Child Welfare involvement, the financial group is comprised of the child in the filing group who meets all nonfinancial eligibility requirements.
Financial Group: 461-110-0630
Need group (what income standard is used?)
For SAC when there is no Child Welfare involvement, the need group is comprised of the child from the financial group who meets all financial eligibility requirements.
Need Group: 461-110-0630
Resource limits and transfers
For SAC, the need group is not eligible for benefits if the financial group has countable resources equal to or greater than the need group resource limit. The resource limit for SAC is $2,500.
When a transfer of assets occurs it must be reported at application, redetermination, and when the transfer occurs.
To qualify for SAC benefits, a member of the financial group must not have made a disqualifying transfer of their assets within three years preceding the date of request. The transfer of asset is only disqualifying if the client is an inpatient in a nursing facility or medical institution in which payment for the client is based on a level of care provided in a nursing facility.
Making a disqualifying transfer of available assets will result in termination of benefits. When the client is ineligible for benefits because of a disqualifying transfer of assets, the client remains ineligible until the disqualification period ends, or when the full equity rights in the asset are transferred back to the client, or the client receives adequate compensation.
Availability of Resources: 461-140-0020
Asset Transfer; General Information and Timelines: 461-140-0210
Income deductions and exclusions
Exclusions are subtracted prior to the countable income test.
Deductions are subtracted after the client has passed the countable income test.
Instead of allowing the TANF income deductions, use the following deductions and exclusions:
Child support disregard
Because SAC covers individuals who are below 21 years of age, there may be times when an individual may be eligible for SAC and their earned income would be counted. This section provides self-employment income deductions allowed for SAC eligibility.
Once the amount of countable earned income is determined (including countable self-employment income) allow the following deductions from each person's earned income.
Earned Income Deductions and Order Applied; MAF and SAC: 461-160-0190
Unearned Income Exclusion for Child and Spousal Support; MAF and SAC: 461-160-0200
Verify the following eligibility requirements for SAC:
When An Application Must Be Filed: 461-115-0050
Verification; General: 461-115-0610
Required Verification; BCCM, EXT, HKC, MAA, MAF, OHP, SAC: 461-115-0705
The effective date for starting medical benefits for an eligible client is as follows:
In the SAC program when converting from HKC (KCE) subsidy:
In the SAC program when not converting from an HKC (KCE) subsidy:
SAC retroactive eligibility effective dates
Clients who are eligible for SAC are also potentially eligible for retroactive medical benefits.
Specific Requirements; Retroactive Medical: 461-135-0875
Effective Dates; Initial Month Medical Benefits: 461-180-0090
Effective Dates; Retroactive Medical Benefits: 461-180-0140