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Information Regarding the Department of Human Services' Intent to Continue to Provide Medical Assistance for Former Foster Care Youth from a Different State

[47 Pa.B. 1442]
[Saturday, March 4, 2017]

 The purpose of this notice is to announce that the Department of Human Services (Department) intends to continue to provide Medical Assistance (MA) coverage for former foster care youth who were in foster care and receiving Medicaid at 18 years of age or older in a different state and later moved to this Commonwealth.

 The Affordable Care Act (ACA), which was signed into law on March 23, 2010, created a new mandatory Medicaid eligibility group in section 1902(a)(10)(A)(i)(IX) for former foster care youth who were in foster care and receiving Medicaid at 18 years of age or older. Under this new group, former foster care individuals can obtain coverage until 26 years of age from the state responsible for their foster care and are not subject to income or resource limits. In accordance with the ACA, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking at 78 FR 4594 (January 22, 2013) that provided guidance on Medicaid eligibility under 42 CFR 435.150 (relating to former foster care children), which allowed states the option to cover individuals who are now residents of their state but were in foster care and enrolled in Medicaid at 18 years of age or older in a different state. On January 1, 2014, the Commonwealth began providing MA coverage to individuals who ''aged out'' of foster care in this Commonwealth as well as in other states under its Medicaid State Plan. CMS published a final rule at 81 FR 86382 (November 30, 2016) titled ''Medicaid and Children's Health Insurance Programs: Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Other Provisions Related to Eligibility and Enrollment for Medicaid and CHIP'' which clarified that the ACA does not give states the option to provide coverage for former foster care youth from a different state under the new mandatory group, and that states can cover these individuals through a Section 1115 Demonstration program.

 In an informational bulletin to states titled ''Section 1115 Demonstration Opportunity to Allow Medicaid Coverage to Former Foster Care Youth Who Have Moved to a Different State,'' CMS stressed that they will assist states that have approved state plans to continue coverage for these former foster care youth under Section 1115 Demonstration authority. The ACA requires former foster care youth be reviewed for other mandatory eligibility groups before the former foster care group. Additionally, because the Commonwealth expanded MA coverage to adults with income at or below 133% Federal Poverty Level (FPL), the Commonwealth will cover former foster care individuals from a different state who have income at or below 133% FPL under a mandatory coverage group or under the new adult group and request a Section 1115 Demonstration program for former foster care youth with income above 133% FPL. The Department projects that on an annual basis there will be about 30 individuals under 26 years of age who ''aged out'' of foster care in a different state and seek MA coverage in this Commonwealth. Out of those 30, the Department estimates 20 will fall under a mandatory coverage group or the new adult group and 10 will be covered under the Section 1115 Demonstration program. The Department is committed to providing MA coverage to former foster care youth from a different state, and to strengthening and improving health outcomes for these youth.

 There will be no changes to the medical benefits received by this population and there will be no new cost sharing requirements. The delivery system and payment rates for services used to provide these benefits will also remain the same.

 The Department is not requesting Section 1115 expenditure authority as the affected population will be covered under the new adult group described in section 1902(a)(10)(ii)(XX) of the ACA. The Department will submit an eligibility State Plan Amendment to cover the group for youth above 133% FPL and is requesting waivers of section 1902(a)(8) and (10) to limit the State Plan group coverage to former foster care youth who were in foster care and receiving Medicaid in a different state.

 The Department expects to have the Section 1115 Demonstration application submitted to CMS by May 21, 2017. CMS anticipates that the Section 1115 Demonstration application will be processed within 90 days of receipt. There will be no break in coverage for former foster care youth from a different state while the Section 1115 Demonstration application is pending. The Commonwealth will switch from providing coverage under its State Plan to providing coverage under Section 1115 Demonstration authority effective the date the Section 1115 Demonstration is approved.

 The Department conducted two public meetings to receive comments from Commonwealth citizens. These meetings were held as follows:

 • January 24, 2017, in Room 416, Health and Welfare Building, Harrisburg, PA from 1 p.m. to 4 p.m.

 • January 26, 2017, at Temple University, Strawberry Square, Harrisburg, PA from 10 a.m. to 12 p.m.

 The Department also intends to hold a formal public hearing regarding its intent to continue to provide MA coverage for former foster care youth from a different state on March 16, 2017, from 1 p.m. to 2 p.m. in Room 227, Willow Oak Building, DGS Annex Complex, 1006 Hemlock Drive, Harrisburg, PA. This public hearing will have telephonic and web conference capabilities. To call into the hearing, call toll free (650) 479-3208 and use access code 647 902 488. To participate in the web conference, go to https://copa.webex.com/copa/k2/j.php?MTID=t388e6ea4c9f01f87b56e0d201f18e686. Individuals may be asked to enter a name and e-mail address. The password for the meeting is Public#1.

 A copy of the Department's Section 1115 Demonstration application may be found at http://www.dhs.pa.gov/citizens/healthcaremedicalassistance/. To request a physical copy of the Demonstration application, contact the Office of Income Maintenance, Bureau of Policy at (717) 787-4081.

Public Comment

 Interested persons are invited to submit written comments, suggestions or objections regarding this information to the Department of Human Services, Office of Income Maintenance, Catherine Buhrig, Director, Bureau of Policy, Room 427, Health and Welfare Building, Harrisburg, PA 17120. Comments may also be submitted to RA-OIMcomments@pa.gov. Comments received within 30 days will be reviewed and considered.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

THEODORE DALLAS, 
Secretary

Fiscal Note: 14-NOT-1119. No fiscal impact; however, costs will shift between appropriations as a result of this change; (8) recommends adoption.

[Pa.B. Doc. No. 17-391. Filed for public inspection March 3, 2017, 9:00 a.m.]



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