Medicaid

Medicaid: Interstate Medicaid and the Interstate Compact

on Adoption and Medical Assistance (ICAMA)

Medicaid is publicly funded medical assistance. Medicaid is not a single, national program. Each state, territory, and the District of Columbia has its own individual Medicaid program. Medicaid is a form of health insurance for special groups and low-income individuals and is provided and administered by an individual’s state of residence. Children receiving Adoption Assistance are uniquely eligible for Medicaid.

The receipt of Medicaid between states is aided and protected by the Interstate Compact on Adoption and Medical Assistance (ICAMA). All states, the District of Columbia, and Puerto Rico participate in the ICAMA. The Compact is implemented by the Association of Administrators of the Interstate Compact on Adoption and Medical Assistance (AAICAMA).

Medicaid is a federal-state partnership in oversight and funding. The Centers for Medicare and Medicaid Services (CMS) is the federal agency that oversees the program and states administer the program. Federal law and federal regulations provide the framework for state administration and include mandates on services and coverage. States must include mandatory categories of individuals and services in their Medicaid State Plan. States can choose to include optional categories of individuals and services at their discretion according to federal guidelines.

Medicaid can be seen in two parts – the recipient and the services provided.

1. Recipients are divided into eligibility groups. There are three broad Medicaid eligibility groups: categorically needy (mandatory or optional), medically needy, and special groups. All categories of Title IV-E, including Adoption Assistance, Guardianship Assistance, and Foster Care are part of the mandatory, categorically needy group under Medicaid law and Medicaid receipt is mandatory. States must provide Medicaid to mandatory groups and can elect to provide to optional groups.

2. Services are divided into two groups: mandatory and optional. All states, territories, and the District of Columbia must provide mandatory services. These services are identical across jurisdictions. Optional services will vary widely across jurisdictions. This fact is important for children and youth in interstate cases whose Medicaid services may change when they move. Note that all mandatory and optional services must be provided to all recipients so that they are sufficient in amount, duration, and scope to reasonably achieve their purpose and must be provided throughout the state.

Medicaid Interstate and AAICAMA Resources

The state of residence provides Medicaid. Medicaid services vary by state due to state election of optional services. Moving from one state to another means exchanging one Medicaid State Plan for another. This section provides links to Medicaid and information on receiving Medicaid interstate.

Questions: How is Medicaid received interstate? How can adoptive families and state, ICAMA staff work together to ensure that Medicaid is received interstate when a child is placed or moves to a new state?

AAICAMA Resource: Receiving Medicaid: Process and Interstate Implications

Question: What is Medicaid and where can I find information on state, Medicaid programs and Medicaid resources? Note: Medicaid is overseen by CMS and operated independently by each state.

Medicaid: Medicaid.gov- Keeping America Healthy

Medicaid Benefits: Medicaid.gov- Benefits

Medicaid State Overviews:  Medicaid.gov- State Overviews

(National map of each state with state’s Medicaid and CHIP profiles.)

AAICAMA Resource: Medicaid- General Information and FAQs

Title IV-E Adoption Assistance and Medicaid

AAICAMA Resource: Medicaid- Eligibility and Title IV-E Adoption Assistance/FAQs

AAICAMA Resource: Medicaid- Title IV-E Adoption Assistance and Interstate Case Scenarios

Non-Title IV-E Adoption Assistance (aka State-Funded) and Medicaid

Children and youth eligible for Non-Title IV-E Adoption Assistance are not guaranteed Medicaid eligibility in all states. If they are placed for adoption or move after finalization outside the state that provides Adoption Assistance and which the adoptive family has an Adoption Assistance Agreement with, they may not receive Medicaid. Medicaid interstate for youth receiving Non-Title IV-E Adoption Assistance is currently not provided in the following states: Illinois, Nevada, and New Mexico.

AAICAMA Resource: Medicaid- Eligibility and Non-Title IV-E Adoption Assistance/FAQs

AAICAMA Resource: Medicaid- Non-Title IV-E Adoption Assistance Reciprocity Chart (rev. January 2024)

Special Note: The role of EPSDT in securing Medicaid services interstate.

EPSDT: Early and Periodic Screening, Diagnostic and Treatment is a mandatory service under Medicaid and must be provided in and across all states. EPSDT was developed to provide preventive services and treatment to children under the age of 21 enrolled in Medicaid. This was done in recognition that meeting children’s medical needs is crucial to their development and life-long health. EPSDT mandates that any service found to be a “medical necessity” for children to receive must be provided- even if the service is optional and a state has not opted to include it in their Medicaid State Plan. Goals and mission of EPSDT:

• Early: Assessing a child’s health early in life so that potential diseases and disabilities can be prevented or detected in the early stages, when they can be most effectively treated.
• Periodic: Assessing a child’s health at key points in her/his life to ensure continued healthy development.
• Screening: Using tests and procedures to determine if children being examined have conditions requiring closer medical (including mental health) or dental attention.
• Diagnostic: Determining the nature and cause of conditions identified by screenings and those that require further attention.
• Treatment: Providing services needed to control, correct, or reduce physical and mental health problems.