Public Benefits for Youth in Juvenile Justice Pacific Juvenile Defender CenterJuvenile Delinquency Roundtable November 6, 2010
Hypo 1 • Alex Smith is a 17.9 year old child with a mental health history who is currently confined in juvenile hall on a placement order. Because of his age, Alex is unlikely to be placed by Probation absent a caregiver who is willing to take him. His godmother, Edna, has talked to Probation about having Alex placed with her, but she is concerned that there are not sufficient mental health services for him in the community. She also worries about who will pay for his treatment if he comes to live with her.
Program Overview • Medi-Cal • Foster Care – AFDC-FC • CalWORKS (TANF) • Kin-GAP (Kinship Guardianship Assistance) • AAP • SSI • Education and Special Education
Why is this so complicated? • The rules don’t make sense • Relatives are different – sometimes • Different funding sources mean different rules • Incomplete information – people who should talk to each other do not always talk at all.
Probation Supervised Foster Care • 41 USC §672(c)(2) • ACF Child Welfare Policy Manual 8.3A.1, 8.3A.8a (Question 3) • WIC §11401(b)(2) (AFDC-FC) • WIC §§727.1 – 727.31
Foster Care Placements WIC §11402 • Relative Care (and NREFMs) • Non-related legal guardian • Foster Family • Foster Family Agency • Group Home • Community Treatment Facility
Medi-Cal Eligibility • Categorical • Foster care (AFDC-FC) • Transitional foster care (FFCC) • SSI • CalWORKS • Refugee • Income: • FPL Programs for Children
Medi-Cal - EPSDT Early and Periodic Screening, Diagnosis, and Treatment
Medi-Cal - EPSDT • Screening • Physical • Developmental • Vision • Hearing • Dental
Medi-Cal - EPSDT Diagnostic and treatment services necessary to correct or ameliorate defects or physical or mental illnesses or conditions
Medi-Cal - EPSDT • Targeted Case Management • Therapeutic Behavioral Services (TBS) • Rehabilitation Services • Related services, such as transportation
Medi-Cal for Former Foster Care Children (FFCC) • To age 21 • In foster care on the 18th birthday • 42 U.S.C. §§1396a(a)(10)(A)(ii)(XVII) & 1396d(w)(1). • WIC §14005.28; ACWDL 00-41, 00-61, 01-41. • Health Care Reform: 2014 to age 26
Inmate Payment Exclusion • No FFP for services provided to individuals who are inmates of a public institution. • Affects FFP, not eligibility.
Inmate Payment Exclusion • “Inmate” and “public institution” have specific definitions. • Eligibility vs. coverage • Suspension vs. termination issue
Inmate Payment Exclusion: Federal Law • 42 USC §1396d(a)(27)(A) • 42 CFR §§435.1009 -1010 • HCFA and CMS Guidance and letters
Inmate Payment Exclusion: State Law • WIC §§, 11016, 14011.10, 14029.5, &14053 • 22 CCR § 50273 • Medi-Cal Eligibility Procedures Manual, Article 6
Inmate Payment Exclusion: Medi-Cal Policy • Ends on the day inmate status ends • CMS 1997 Letter: • Suspension of coverage not termination of eligibility • Obligation to provide immediate coverage
Inmate Payment Exclusion:State Developments • SB 1469 • MOU with CDCR – ACWDL 09-16 • SB 1147 • San Francisco and Santa Clara v. Department of Health Care Services
Inmate Payment Exclusion: State Law • ACWDL 07-34 -- SB 1469 Implementation • ACWDL 08-36 -- SB 1469 Contacts • ACWDL 09-10 -- SB 1469 Contacts • ACWDL 09-16 -- MOU with CDCR • ACWDL 10-06 -- SB 1147 Implementation
Hypo Questions • If Alex stays in juvenile hall until 18, will he be eligible for extended FFCC MediCal when he is released? • If Alex is placed with his godmother by Probation, what types of services can be put in place to keep him in the community? • Will Alex have MediCal to cover those services if he is placed with his godmother? • Will Alex have MediCal to cover those services if he is released to his godmother?
Hypo 2 • Alex has been placed with his godmother, Edna. Edna’s grandson, Mark Sanchez, is also a 602 and is placed with Edna one week later. Mark has been diagnosed with borderline intellectual functioning and depression. Edna is on a fixed income and is struggling financially to care for these children. If she does not receive assistance, the children may lose this placement.
An adult related to the child by blood, adoption, or marriage within the fifth degree of kinship. Includes: Aunts and Uncles (great, great-great) First cousins First cousins once-removed Nieces and nephews Spouse of any relative on list (even if relative is divorced or deceased) Who is a relative? • Mother • Father • Stepparents • Siblings • Step-Siblings • Grandparents (great, great-great, great-great- great) Everyone else is a non-relative!
Aid to Families with Dependent Children-Foster Care (AFDC-FC) • Title IV-E of the Social Security Act • 42 U.S.C. § 670 et seq. • 45 C.F.R. § 1356 et seq. • Cal. Welf. and Inst. Code§ 11400 et seq. • California’s Manual of Policy and Procedure (MPP) § 45-200 et seq.
AFDC-FC: Basic Eligibility Removed From Home: • Removed by court • Required findings • remaining in the home would be contrary to the child’s welfare • reasonable efforts were made to avoid removal
AFDC-FC: Basic Eligibility • Relinquished for adoption or parental rights terminated • Voluntarily placed by parent or guardian • Living with non-related legal guardian, OR • In foster care under the Indian Child Welfare Act
AFDC-FC: Basic Eligibility Placement: • Licensed foster family home, group home, or foster family agency • Approved home of a relative or non-relative extended family member • Home of a non-related legal guardian
Federal AFDC-FC: Linkage Requirement Meet the 1996 AFDC criteria in the home of removal • in the month the petition is filed OR • in any of the 6 months prior to the month the petition is filed.
AFDC-FC: What Do They Get? • Monthly cash benefit • Medi-Cal • Other, such as clothing allowance
AFDC-FC: Cash Benefit • Foster Family Homes: • Basic rate: $446 - $659 • Specialized Care Increments: $18 - $1413 • Foster Family Agencies: • Non-Treatment: $ 373 - $522 • Treatment: $1430 - $1679 • Intensive Treatment: • $2687 - $ 4028 • Group Homes: $2118- $8974 Rates Are Per Child!
AFDC-FC Out of County Youth • When a child is placed in a county different from the county with payment responsibility: • the county pays the host county basic rate and the host county specialized care rate • If the host county has no specialized care rate, then the county pays its own specialized care rate. • When a child is placed out of state, the Interstate Compact on the Placement of Children applies. • The sending agency continues to have financial responsibility for the child.
AFDC-FC: Regional Center Clients • Receive AFDC-FC benefits, and • Regional Center clients • Eligibility for regional center services: • Mental retardation, cerebral palsy, epilepsy, autism, and the “5th Category”
AFDC-FC: Regional Center Clients • Standard rates July 1, 2007 • Current placements grandfathered • Lower rates raised to July 1, 2007 level • Vendored providers get DDS rates
AFDC-FC: Regional Center Clients • Regional Center: $2006 per month • Regional Center, Extraordinary care and supervision: $1000 county discretion (ACL 08-54) • Regional Centers must purchase or secure services in the child’s IPP or IFSP
AFDC-FC (Federal or State): When Does It End? Age 18 OR Age 19 IF: • In foster care AND • Full time high school or equivalent training, or pursuing high school equivalency AND • Reasonably expected to graduate, complete the program or receive a high school equivalency certificate, before his or her 19th birthday.
AFDC-FC (Federal or State): When Does It End? • Leonard v Wagner • Fostering Connections • AB 12
Hypo Questions • What benefits are Alex eligible for? • What other information do you need? • What needs to happen so that Alex can receive these benefits? • What benefits are Mark eligible for? What other information do you need? What needs to happen so that Mark can receive these benefits?
Temporary Assistance for Needy Families (TANF) & California Work Opportunity and Responsibility to Kids (CalWORKs) • “Title IV-A”: Title 42 of the Social Security Act, Chapter 7, Subchapter IV, Part A • 42 U.S.C. § 601 et seq. • 45 C.F.R. § 260 et seq. • Calf. Welf. and Inst. Code § 11200 et seq. • California’s Manual of Policy and Procedure (MPP) § 45-200 et seq.
CalWORKs: Who Gets It? Children living with relatives: • Not in foster care – informal care • In foster care but do not qualify for federal Title IV-E foster care benefits
CalWORKs: Who Gets It? Needy caretaker relatives when the child receives: • CalWORKs • AFDC-FC • Kin-GAP, or • SSI
CalWORKs: What Do they Get? Payment Decreases Per Child!
CalWORKs: When Does It End? Age 18 OR Age 19 IF: • Reside with the relative caregiver AND • Full time high school or equivalent training, OR pursuing a high school equivalency certificate AND • Reasonably expected to graduate, complete the program or receive a high school equivalency certificate, before his or her 19th birthday
CalWORKs: When Does It End? • Fry v Saenz • Youth with disabilities have no completion requirement
Hypo • Are Alex and Mark eligible for CalWORKs? • What other information do you need? • What is the best possible benefit available to Alex thus far? Mark?
Supplemental Security Income/ State Supplemental Payment (SSI/SSP) • Title 42 of the Social Security Act, Chapter 7, Subchapter XVI • 42 U.S.C. § 1381 et seq. • 20 CFR § 416 et seq. • “Foster Care Social Security and Supplemental Security Income Program,” Calif. Welf. and Inst. Code § 13750 et seq. • “State Supplementary Program for the Aged, Blind, and Disabled,” Calif. Welf and Inst. Code § 12000 et seq.
SSI/SSP: Basic Eligibility Children may be eligible for SSI/SSP benefits if they meet the following criteria: • Income and resources • No deeming if the child is living apart from parents • Citizen or certain categories of immigrant • Disability
SSI/SSP: Basic Eligibility Disability: Marked or severe functional limitation expected to result in death or last for at least 12 continuous months
SSI/SSP: What Do They Get? • Disabled child - $739.00 • November 1 - $737.40 • In foster care – non-medical out-of-home care facility: $1086 • Must complete the SSP 22 to get the full benefit!