What drives health insurance enrollment for a child who is the legal responsibility of DHS?

• Medical Assistance Eligibility: For every child who enters care, the Medical Eligibility Unit (MEU) begins the process to determine whether s/he is eligible to receive Medical Assistance (MA). Initially, there is 'presumptive eligibility'. Every child who enters care is eligible for MA, unless that child (not the family) has income (such as Social Security Survivor benefits) that exceeds the limit set by law. If a child's income exceeds the limit, and the child is younger than 19 years old and is placed in Pennsylvania, an application is submitted for CHIP. All children who receive SSI are MA eligible.

• 85-29s: It is vitally important for appropriate health insurance coverage that an 85-29 utilizing the correct discharge/admit codes is submitted in a timely fashion for every child (within 24 hours of when a child is placed or there is a change in placement location).

• Child Medical Insurance Information Forms (CMIIF): The CMIIF is submitted simultaneously with the 85-29. Although there are times when the social worker will not have some of the information requested, it is important to have the following information readily available in the case record prior to placement so that it can be shared with the provider agency:
  • child's full legal name, along with any AKAs used by the child or family
  • child's date of birth
  • child's insurance carrier name and phone number
  • child's pediatrician/primary care physician/family practitioner
  • child's health history, including any diagnoses
  The Quality Health Management Unit attempts to ensure that every child receives continous medical care. If a child is expected to return home to parents/family, or has a chronic medical condition that requires frequent supervision, it may be appropriate to maintain the child's physician as opposed to changing the practitioner for the convenience of the foster parents or provider agency.