Department for Community Based Services

Standards of Practice Online Manual

31.2 Title IV-E Eligibility and Reimbursability

Cabinet for Health and Family Services

Department for Community Based Services
Division of Protection and Permanency
Standards of Practice Online Manual
Chapter:
Chapter 31-Standards of Practice Regarding Title IV-E, Medicaid and Other Applicable Benefits
Effective:
1/29/2021
Section:
31.2 Title IV-E Eligibility and Reimbursability
Version:
3

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Legal Authority/Introduction

LEGAL AUTHORITY:

Title IV-E provides for federal payments to states for foster care maintenance and adoption assistance payments made on behalf of eligible children. The objective is:

  • To improve the quality of care provided to children in substitute care;
  • To reduce the number of children who are removed from their own homes for placement in substitute care. Substitute care includes foster family, group home, and institutional care;
  • To return children from substitute care to their homes as soon as conditions in the home permit; and
  • To facilitate the adoption or other permanent placement for those children who cannot be returned to their own homes.

There are two (2) major components of title IV-E: eligibility and reimbursability.  Eligibility does not automatically confer federal benefits. The reimbursability criterion must be met for the state to receive federal support for the child.
Title IV-E eligibility is determined by the children’s benefits worker (CBW) based upon information provided by the SSW.  Standards of practice (SOP) procedures for the SSW are located in SOP 31.1 Title IV-E Determination.

  • The Department for Community Based Services (DCBS) is responsible for:
  • Determining eligibility;
  • Determining reimbursability;
  • Maintaining compliance with Medicaid regulations pursuant to  KRS 205 §§ 510-630; and
  • Monitoring the case to ensure that title IV-E foster care maintenance payments are being made correctly on the child’s behalf.

The CBW case assignment is determined using all factors to attain equitable caseloads as determined by the DCBS Division of Administrative and Financial Management (DAFM).
 
Title IV-E provides for federal payments to states for foster care maintenance and adoption assistance payments made on behalf of certain eligible children.  


Practice Guidance 

  • Agencies may claim title IV-E foster care maintenance payments (FCMPs) for a child placed with a parent in a licensed residential family-based treatment facility for substance abuse for up to twelve (12) months in accordance with requirements in section 472(j) and 472(a)(2)(C) of the Act.  Agencies may also claim administrative costs during the twelve (12) month period consistent with 45 CFR 1356.60(c) for the administration of the title IV-E program, which includes such things as case management.  A licensed residential family-based treatment facility for substance abuse is not a child care institution (CCI) as defined in section 472(c) of the Act.  While the facility must be licensed, there is no requirement that it meet the title IV-E licensing and background check requirements for a CCI.
  • The agency may claim FCMPs in accordance with the definition in section 475(4)(A) of the Act, which includes such things as the cost of providing food, clothing, shelter, and daily supervision.  However, because a licensed residential family-based treatment facility for substance abuse is not a CCI, the title IV-E agency may not include the costs of administration and operation of the facility in the child's title IV-E FCMP. Also see section 472(k)(1)(A) of the Act.
  • A qualified residential treatement program (QRTP) placement is a specific category of a non-foster family home setting, for which title IV-E agencies must meet detailed assessment, case planning, documentation, judicial determinations, and ongoing review and permanency hearing requirements for a child to be placed in and continue to receive title IV-E FCMPs for the placement (sections 472(k)(1)(B) and 475A(c) of the Act).  The facility must also meet the definition of a CCI at sections 472(c)(2)(A) and (C) of the Act, including that it must be licensed (in accordance with section 471(a)(10) of the Act) and that criminal record and child abuse and neglect registry checks must be completed in accordance with section 471(a)(20)(D) of the Act.  Further, it must be accredited by one of the independent, not-for-profit organizations specified in the statute.
  • The title IV-E agency may claim title IV-E FCMPs to transition a child from the QRTP to the next placement or permanent home up to thirty (30) calendar days after: 
    • ​The assessment required under section 475A(c)(1) determines that the QRTP is not appropriate; 
    • A court disapproves such a placement under section 475A(c)(2); or
    • A determination is made that a child in an approved QRTP placement is going to return home or be placed with a fit and willing relative, a legal guardian, or an adoptive parent, or in a foster family home (section 473(k)(3)(B) of the Act).
  • ​The agency may not receive federal payments under section 474(a)(1) for amounts expended for foster care maintenance payments on behalf of a child who remains placed in a QRTP after the end of the thirty (30) calendar day period that begins on the date a determination is made that the placement is no longer the recommended or approved placement for the child.
  • The agency may claim fourteen (14) calendar days of title IV-E FCMPs each time a child is placed in a private child care (PCC) agency, regardless of whether the child has had previous placements in a PCC setting during his or her foster care episode (section 472(k)(1) of the Act).  If the PCC agency is one of the following settings, title IV-E FCMPs may continue after fourteen (14) calendar days if the setting meets all requirements specified in section 472(k)(2) of the federal law and described below: 
    • ​A setting specializing in providing prenatal, post-partum, or parenting supports for youth.  The facility must meet the definition of a CCI at sections 472(c)(2)(A) and (C) of the Act, but the statute does not provide additional parameters for placing a child in this setting (section 472(k)(2)(B) of the Act),
    • A setting providing high-quality residential care and supportive services to children and youth who have been found to be, or are at risk of becoming, sex trafficking victims as identified by DCBS.  The facility must meet the definition of a CCI at sections 472(c)(2)(A) and (C) of the Act (section 472(k)(2)(D) of the Act).  The Division of Protection and Permanency (DPP) designates whether an agency has met the high quality residential care and supportive services to children and youth who have been or found to be, or are at risk of being, sex trafficking victims. 
    • A supervised setting in which the child is living independently (in the case of a child who has attained eighteen (18) years of age).  This setting must be consistent with the statute at sections 472(c)(2)(B) and (C) of the Act, and the instruction provided in ACYF-CB-PI-10-11 as follows: “a title IV-E agency has the discretion to develop a range of supervised independent living settings which can be reasonably interpreted as consistent with the law, including whether or not such settings need to be licensed and any safety protocols that may be needed”. 
  • ​Title IV-E agencies may claim title IV-E FCMPs for a child placed in a CCI prior to the effective date of section 472(k) of the Act for as long as the eligible child continuously remains in that setting.  If the child later leaves this setting and enters a different non-foster family home setting, the title IV-E agency must apply section 472(k) of the Act.

Procedure

The SSW:

  1. Notifies the children's benefit workrer (CBW) on the day that the agency assumes legal responsibility for the supervision and care of a child;
  2. Within ten (10) working days:
    1. Completes the DSS-1260 Title IV-E and Child Support Referral in TWIST;
  3. Notifies the CBW within ten (10) working days of any changes in:
    1. Placement;
    2. Custody status;
    3. TPR status; or
    4. AFDC relatedness, including:
      1. Need (resources and income, including receipt of SSI benefits); or
      2. Age (A youth who has attained eighteen (18) years of age, but who has not attained ninteen (19), twenty (20), or twenty one (21) years of age, and who meets any of the following conditions:
        1. Is completing secondary education or a program leading to an equivalent credential;
        2. Is enrolled in an institution which provides post-secondary or vocational education;
        3. Is participating in a program or activity designed to promote, or remove barriers to employment;
        4. Is employed for at least eighty (80) hours per month; or
        5. Is incapable of doing any of the above described activities due to a medical condition, which incapability is supported by regularly updated information in the case plan of the child.  

  4. Ensures that:
    1. The wording of the court order states that continuation in the home is contrary to the welfare of the child or that it is in the best interest of the child to be removed.  This wording is required for the child to be title IV-E eligible as outlined in SOP 31.1 Title IV-E Determination​, and must be obtained on the first order of custody, along with the box checked indicating the Cabinet has custody of the child.  The judicial determination for title IV-E eligibility requires that the results in the child's removal coincide with, (i.e., occur at the same time as) the Cabinet's action to physically or constructively remove the child, unless the court order specifies an alternative timeframe for removal.  If a court makes a judicial determination that it is contrary to the child's welfare to remain at home (without specifying an alternative timeframe) and the child does, in fact, remain at home and no removal occurs, the requirement for removal is not met and the child is ineligible for title IV-E.
    2. The court certifies on an Administrative Office of the Courts (AOC) form that, within the last twelve (12) months, reasonable efforts are being made to finalize a permanency plan or that reasonable efforts to reunify the child and family are not required (must be made at least every twelve (12) months or reimbursability will cease). If this is not made at least every twelve (12) months, reimbursablity will cease;  
    3. The court that orders voluntary commitment contains the appropriate judicial determination within one-hundred, eighty (180) calendar days from when the children were removed;
    4. That a child placed in a QRTP receives an assessment within thirty (30) calendar days of placement in that setting by a QRTP assessor.   A qualified individual must assess a child placed in a QRTP within thirty (30) calendar days of the beginning of each placement in a QRTP (section 475A(c)(1)(A) of the Act).  The assessor will use an age-appropriate, evidence based, validated, functional assessment tool.  The qualified individual may conduct this assessment prior to the placement in the QRTP, but must complete it no later than the end of the thirty (30) calendar day period.  3 If the assessment is not completed within thirty (30) calendar days , the agency cannot claim title IV-E FCMPs for the entirety of the QRTP placement (including the first fourteen (14) calendar days ), but may claim title IV-E administrative costs during the placement in the QRTP (section 472(k)(3)(A) of the Act).  These are administrative costs as defined in 45 CFR 1356.60 for the administration of the title IV-E program, and not the costs of the administration and operation of the QRTP. Those costs are only allowable when a title IV-E FCMP is provided for the child;
    5. Within sixty (60) calendar days of the start of each placement in a QRTP, a family or juvenile court considers the assessment, determination, and documentation made by the QRTP assessor in approving the placement (section 475A(c)(2) of the Act).  If the court does not approve the placement timely, i.e., within the sixty (60) calendar day  timeframe, the title IV-E agency may only claim title IV-E FCMPs for the first sixty (60) calendar days of the placement in the QRTP (section 472(k)(1)(B) of the Act).


AFDC RELATEDNESS TEST

  • To be eligible for title IV-E (per section 472(a)), a child is required to have been removed from the home of a specified relative and to have met technical and financial AFDC eligibility that was in effect on July 16, 1996.  However, if a child is placed with a parent who is residing in a licensed residential family-based substance abuse treatment facility, it is not required that a child meet the AFDC eligibility requirements if the child would otherwise be eligible for title IV-E foster care maintenance payments.  (472 (j)(1) of the Social Security Act)
  • For the purposes of title IV-E eligibility, a specified relative as defined by title IV-E, section 406(a) of the Social Security Act as:
    • A child’s natural or adoptive parent;
    • A blood relative of the child including a relative of the half-blood;
    • Legally adopted or natural children of the adoptive parent and other relatives of such parents;
    • The alleged parent or a relative of the alleged parent may be determined a blood relative through the administrative establishment of paternity; or
    • A relative by marriage of any persons listed in bullet points 2-4 above even if the marriage has ended.  This is true as long as the marriage ended after the child’s birth.

  • The eligibility month is the month during which the child meets the title IV-E AFDC-relatedness test.  That is:
    • The month during which a voluntary commitment agreement was signed by the parent(s); or
    • The month during which the petition that led to the child’s removal from the home was signed by an agency official.
  • The date that the child entered care does not necessarily define the time for which the child meets the AFDC relatedness test.  Rather, it is the petition that directly led to the custody or supervision that defines the petition date for purposes of determining whether the child meets the AFDC relatedness test. 
  • A temporary custody petition may lead to temporary placement, which is then followed by a petition for continued placement.  Assuming the child remained in a placement supervised by the department during the time between the temporary custody placement and the date of the court order granting continued placement, it is the temporary custody petition that determines the eligibility month.
  • If the petition leading to the removal is not filed within six (6) months of the commitment or custody order, the month of the commitment or custody order is the "removal month" for eligibility determination.
  • A child meets AFDC relatedness when one of the following two tests is met:
    • The child was eligible for AFDC, as in effect on July 16, 1996, in the removal home in which the child lived during the removal month; or
    • The child did not live with a specified relative in the removal month, but did live with such a relative in any of the preceding six (6) months, and the child would have been eligible for AFDC as in effect on July 16, 1996, in that relative’s home during that month had an application been made.
  • The AFDC relatedness test requires identification of the removal home.
  • Normally, the removal home is the home from which the child is both physically and legally removed by court action.  However, in cases where at the time of the court order the child is living in a home other than the one from which the court orders the child to be removed, determination of the removal home must be made for eligibility purposes.
  • If the removal home is other than a parent’s or adoptive parent’s home, only the child’s income and resources are used to determine AFDC need.
  • The circumstances that define AFDC related test for title IV-E eligibility are:
    • Living with a specified relative;
    • Deprived of support of one or both parents;
    • Need, which is an income and resources test;
    • U.S. citizen or legal alien; and
    • Age.

DEPRIVATION- NEED- AGE

  • Deprivation:
    • As with the eligibility determination described in this SOP, this means that one or both parents are absent from the removal home, unemployed, disabled or deceased.  It is possible that the deprivation may change at any time between redeterminations.
    • The CBW determines whether the child’s income and resources meet reimbursability criteria and notifies the SSW within ninety (90) calendar days of the date the redetermination is due.
  • Need:
    • The child is required to have a financial "need" in aid for dependent children (AFDC) terms to maintain reimbursability.  When a child’s resources exceed $10,000 in any month, the child is not reimbursable, until the balance is spent down below $10,000.
    • In a "Need" determination for continuing reimbursability, it is only the child’s income and resources that are considered. 
    • In the test of "Need" in a reimbursability determination, the income and resources of the child’s parents are not considered unless the parents are contributing funds to the Cabinet for the care of the child. When the parents are contributing toward the care of the child (child support), the contribution is considered unearned income of the child to be counted in the "Need" determination.
  • Age: 
    • A child loses title IV-E eligibility and reimbursability at the beginning of the month following the child’s eighteenth (18th) birthday, unless they meet any of the following conditions: 
      • ​Is completing secondary education or a program leading to an equivalent credential; 
      • Is enrolled in an institution which provides post-secondary or vocational education;
      • Is participating in a program or activity designed to promote, or remove barriers to employment; 
      • Is employed for at least eighty (80) hours per month; or
      • Is incapable of doing any of the above described activities due to a medical condition, which incapability is supported by regularly updated information in the case plan of the child.
    • When the child meets the expectations for extended foster care as outlined above, reimbursement or eligibility may continue until the beginning of the month no later than the month following the child's twenty first (21st) birthday.
  • When a child has been placed in out-of-home care (OOHC) by voluntary commitment, if the parents or guardians request the child be returned to their home or the home of a relative, the child is no longer eligible for title IV-E assistance; unless the agency obtains a judicial determination that the child’s return would not be in his/her best interests.

​Contingencies and Clarifications

  • In the case of a child who is placed in a QRTP, if the assessment required under section 475A(c)(1) is not completed within thirty (30) calendar days after the placement is made, no federal payment shall be made under section 474(a)(1) for any amounts expended for foster care maintenance payments on behalf of the child during the placement.
  • A QRTP has a trauma-informed treatment model that is designed to address the needs, including clinical needs as appropriate, of children with serious emotional or behavioral disorders or disturbances.  A QRTP, with respect to a child, is able to implement the treatment identified for the child by the assessment of the child required under section 475A(c) and has registered or licensed nursing staff and other licensed clinical staff who provide care within the scope of their practice as defined by state law and are onsite according to the treatment model and are available twenty-four (24) hours a day and seven (7) days a week.  To the extent appropriate, and in accordance with the child’s best interests, a QRTP facilitates participation of family members in the child’s treatment program, including outreach to the family members of the child, including siblings.  This includes documenting the method of outreach (including contact information), and maintains contact information for any known biological family and fictive kin of the child and how family members are integrated into the treatment process for the child, including post discharge.  A QRTP also documents how sibling connections are maintained.  A QRTP provides discharge planning and family-based aftercare support for at least six (6) months post-discharge; and is licensed in accordance with section 471(a)(10) and is accredited.
  • The SSW convenes a family team meeting (FTM), including members of the youth’s Family and permanency team and the Children’s Review Program (CRP) QRTP assessor.  This FTM will be utilized to provide input during the thirty (30) calendar day QRTP assessment process (Please see SOP 4.51 for more details related to case planning).   


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