Improving the Economic Security of Children in and Young People Who are Transitioning from Foster Care A Guide to Eligibility and Access to Food Assistance, Supplemental Security Income, and Medicaid

ust over 400,000 children are currently in foster care. They face higher Jeconomic, health, and academic obstacles than most young people. And when they leave foster care to live on their own, they face particular challenges in transitioning to adulthood and long-term economic security.

Children in foster care and youth who transitioned from foster care are often eligible for public benefits and services that can increase their economic security, meet their health care needs, and help them do better in school. But eligible kids and the adults in their lives may not know or have incorrect

eligibility information. Complex application processes may also limit access to

benefits and services. Even when foster children get the benefits they need,

bureaucratic processes can detract from more important activities, including

school and employment. Foster children can also lose benefits unnecessarily

when, as is common, their placements or other life circumstances change.

This guide discusses ways to help foster children and youth who aged out of

foster care access critical public benefits including the Supplemental Nutrition

Assistance Program (SNAP), the School Lunch Program, Supplemental Security

Income (SSI), and Medicaid and the Children’s Health Insurance Program

(CHIP). Though not the only available benefits, improving access to these initiatives offers real potential to improve children’s lives.

This guide is written for state and local child advocates and human July 2012 services staff. Collaborative efforts between these groups have already made

major strides in improving access in some states. California, for example, has improved SNAP and SSI screening and enrollment policies, as discussed in Shawn Fremstad greater detail later. Consultant and Senior Research Associate, Center for Economic and Policy Research [email protected] The following section provides background on the foster care system and the well-being of children in foster care. Later sections discuss each of the four major programs covered in this guide.

Summary of Recommendations

Supplemental Nutrition Assistance Program: o Screen youth leaving foster care for SNAP eligibility as part of the foster care transition planning process required under federal law, and enroll those who are eligible. o Design SNAP policies and procedures to provide youth who age out of foster care with individualized assistance with employment, education, and training needs, and ensure they are not denied SNAP eligibility because they pursue post-secondary education. o Use available waivers and exemptions to ensure youth who age out of foster care do not automatically lose SNAP access three months after enrollment.

School Lunch Program: o Use electronic data matches to qualify foster children for the School Lunch Program without requiring an application. o Encourage officials to enroll foster children during the required notification period for schools when a child enters foster care or changes foster homes. o Notify foster that foster children are automatically eligible for free meals. o Work with education policymakers to revise School Lunch Program applications. Clarify that foster children are eligible for free meals regardless of income and exempt from additional information requirements.

Supplemental Security Income: o Screen children entering foster care for SSI eligibility and maintain a dedicated position responsible for SSI eligibility determinations. o Rescreen children initially found SSI-ineligible at least annually or whenever there is a change in circumstances. o Submit an SSI application on behalf of likely eligible youth in time, when possible, to permit a determination before the child ages out, and minimize benefit interruptions. o Use state funds rather than Title IV-E funds to finance foster care placement for children who are in IV-E funded placements in the month the youth applies for SSI, to meet SSI’s financial eligibility requirements. o Inform foster youth receiving SSI benefits and approaching their 18th birthday about U.S. Social Security Administration’s redetermination process and assist youth with this process.

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Medicaid: o Phase in Medicaid coverage for youth who aged out of foster care up to age 26 before the 2014 deadline required by federal law. o Enroll automatically youth leaving foster care in Medicaid until age 26 without requiring applications. Identify and enroll foster youth newly-eligible for Medicaid in 2014, using public education, federal funding matches, resources available through private foundations, and other resources.

Background on Foster Care

This guide focuses on children who are in, or have been in, foster care. This includes young people who aged out of foster care without the supports a family customarily provides young adults. While improving access for current and former foster children is the objective of this guide, it is also important to note that a substantial number of children-- about 2.6 million-- have not been formally placed in foster care, but live away from their parents with other relatives. This includes instances where non- relatives raise children without the involvement of child protective services (CPS) and more formal kinship care, in which CPS is involved.i

How many children are in foster care and how long are they typically there for? There were 408,425 children in foster care on September 30, 2010, according to the most recent federal data.ii Table I illustrates their placement settings on a single day in 2010. This table does not illustrate the reality that placements change frequently for children in foster care, in some cases affecting eligibility for benefits.

Table II illustrates that more than one-in-ten foster youth are emancipated, that is, they “aged out” of foster care, typically without the supports a family customarily provides a young adult. Although the number of children in foster care has declined somewhat over the last decade, the number of youth aging out of care has increased.

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Table I. Placement Settings of Children in Foster Care (on September 30, 2010)

Number of children As a percent of all children in foster care Foster family home (non-relative) 194900 47.8 Foster family home (relative) 103943 25.5 Institution 36607 9.0 25066 62 Trial home visit 21340 5.2 Pre-adoptive home 14886 3.7 Runaway 6563 1.6 Supervised independent living 4050 1.0

Total children in foster care 407355 100.0

Source: Children's Bureau, AFCARS Report FY2010 Estimates

Table II. Outcomes for Children Who Exited Foster Care During 2010

Number of children As a percent of all children in foster care Reunification with Parent(s) or primary caretaker(s) 128913 51.0 Living with other relative(s) 20423 8.1 52340 20.7 Emancipation 27854 11.0 Guardianship 16208 6.4 Transfer to another agency 5114 2.0 Runaway 1504 0.6 Death 338 0.1

Total 252694 100.0

Source: Children's Bureau, AFCARS Report FY2010 Estimates

The well-being of children in foster care and youth who aged out of foster care Children generally enter foster care following traumatic events. This trauma and instability can compromise their development and well-being:iii

Children in family foster care settings are more than twice as likely as other children living in family settings to be in fair or poor health, and nearly four times as likely to have a disability.iv

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Transition Planning is an Opportunity to Promote Access Under federal law, all states must develop a transition plan for a young person during the 90-day period before he or she reaches the state’s age limit for foster care. The plan must be personalized and developed with the young person, and include specific options on housing, health insurance, education, continuing supports, education, work force supports, and employment services. States can and should adopt policies that expand on this minimum federal requirement. For example, New York state requires agencies to begin planning at least 180 days before a young person is scheduled to leave care and that the plan is completed at least 90 prior to leaving care.

The transition planning process provides an important opportunity to screen foster youth for SSI, SNAP, and other benefits, and assist them with applying for these and other benefits. For more on transition planning, see the Transition Toolkit produced by FosterClub in collaboration with FosteringConnections.org.

About one-in-five children in foster care for a year or more had a disability severe enough to meet the strict child-disability standard used in the SSI program, according to the National Survey of Child and Adolescent Well-Being (NSCAW).v

About one-half of children involved in the child welfare system had a “special health care need” at some point during a three-year period, according to NSCAW data.vi High levels of behavioral and emotional problems were three times as likely for children age 6 to 17 in family foster care settings as for children living with parents overall.vii Low levels of engagement in school were twice as common for children age 6 to 17 in family foster care settings as for children overall living with their parents.viii

Youth who transitioned from foster care face particular challenges. The most extensive longitudinal survey of these youth is the Midwest Evaluation of the Adult Functioning of Former Foster Youth. The “Midwest Study,” analyzing data from Iowa, Illinois, and Wisconsin, found that:ix o Education: youth who aged out of foster care were more than three times less likely than their peers to have a high school diploma or GED at age 25 to 26, and they were ten times less likely to have completed a four-year college degree. Just over one-third of youth who aged out of foster care reported having ever dropped out of a postsecondary education program, citing financial constraints as the most common reason. o Employment and earnings: survey results show 94 percent of youth who aged out of foster care have held a job, but those employed at the time of the survey were much less likely to have health insurance, paid sick days, and other benefits than their peers, and their median annual earnings were less than one-third those of their peers. In fact, nearly 40 percent of youth who aged out of foster care earned less than $5,000 a year.

5 o Economic hardship: youth who aged out of foster care were more than twice as likely as their peers to have been unable to pay rent or utilities, had utilities shut off, or been evicted. o Health and disability: twice as many youth who aged out of foster care reported fair or poor health as youth in the comparison group, and nearly twice as many had a disability. o Incarceration: woman who had aged out of foster care were ten times more likely than their peers to have been incarcerated at least once since age 18, and men were eight times more likely.

Foster care maintenance payments Foster care parents and other foster care providers receive payments to cover the basic cost of caring for foster children, including providing food, clothing, school supplies, and certain other items.x State and local governments set these rates, and there is no standardized methodology states are required to follow to determine the typical costs of these items for foster children. A study that used a standardized methodology and consumer expenditure data found the rates in a vast majority of states are too low to cover the actual costs of these items.xi Researchers found the national average foster care rate for 2-year-olds was about $141 lower each month than the national average cost of actually caring for foster children that age, about $212 lower for 6-year-olds, and about $222 lower for 16-year-olds.

States can be reimbursed for a portion of foster care maintenance payments benefitting “needy” children. To claim the federal match for a child, a state must document that the child was removed from the home of a parent with extremely low income requirements and countable assets below $10,000.xii

Eligibility and Access to Public Benefits for Foster Children and Youth Who Aged Out of Foster Care

Supplemental Nutrition Assistance Program SNAP-- previously Food Stamps-- helps low-income families buy the food they need.xiii SNAP is wholly federally funded, and states pay about half of the administrative costs and some of the costs of operating SNAP employment and training programs. State public assistance agencies provide SNAP benefits through their local offices.

SNAP can be a lifeline for youth who aged out of foster care and depend upon the benefit for basic nutrition. Especially for younger adults in this situation, effective state SNAP policies can help facilitate a successful transition to independent adult life.

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Children living in foster care: Children living in foster care are not eligible for SNAP benefits on their own.xiv They may, however, benefit from SNAP indirectly if they live in a qualifying household. Because foster care families must have sufficient income to support their current household without relying on foster-care reimbursement, the vast majority of foster parents have income ineligible for SNAP benefits. Still, foster care parents, like other middle and working-class parents, are not impervious to economic insecurity. Especially during economic downturns, foster care parents may need to turn to SNAP and other work and income supports if they are out-of-work temporarily or experience other events that reduce their economic security.xv This is also true of kinship care households. Less than half of low-income kinship care households receive assistance from SNAP, despite the fact most report food insecurity.xvi

SNAP benefits are generally determined based on the resources and needs of everyone in the household. The U.S. Department of Agriculture (USDA), which administers SNAP, defines “household” as a group of people who live together and purchase and prepare meals together, even if they are not all related. However, SNAP rules exclude foster children from SNAP households, unless the head of the household affirmatively requests their inclusion. If a foster child is included, the SNAP agency will count any foster care payments made on behalf of the child as income to the household. Thus, it is often best for the foster care family to not request the inclusion of a foster child in their SNAP household. Counting this additional income may push the household over the SNAP income limit, making it ineligible for benefits, or, if they remain eligible, reduce the amount of benefits it receives.

Given SNAP’s default requirement to exclude foster children from the household, applications for SNAP benefits should include language asking applicants to identify any children in the household who are foster children. Otherwise, foster care children may be mistakenly included in the SNAP household, and reduce the household’s benefits or make them ineligible. Advocates can help foster care families understand their options by providing information explaining the rules. For example, the Massachusetts Law Reform Institute produced a fact sheet on these rules for foster care families available on the Internet and in Massachusetts legal services offices.xvii

Youth who age out of foster care: Youth who age out of foster care tend to have low incomes and assets. Therefore, many are eligible for SNAP. Although there is no reliable national data, state-level surveys suggest that many such youth, particularly younger ones and males, do not receive benefits. For example, in the three- state Midwest Study, only 22.3 percent of youth who aged out of foster care received SNAP benefits at age 19.xviii

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Child welfare agencies can help by ensuring SNAP benefits are easily accessible for eligible youth. For example, California adopted a statewide policy requiring county child welfare and SNAP staff to "work collaboratively to ensure all youth receive an opportunity to apply for SNAP benefits."xix The policy encourages counties to: o Provide SNAP benefits to youth "as soon as administratively possible." o Establish a designated SNAP eligibility worker to receive and process applications from foster care youth, and to receive information from the foster care social worker regarding termination of care or any delays. o Provide youth with contact information for the SNAP office and/or eligibility staff before they exit foster care. o Confirm the mailing address for a SNAP electronic benefits card and inquire about the need for expedited services.

Since its introduction, this policy has increased the number of youth applying for SNAP benefits when they leave care from about 5 percent to about 23 percent.xx While statewide progress is encouraging, local results vary. In Los Angeles County, for example, only 7 percent of youth in Los Angeles County applied, while in San Diego County, 60 percent of youth applied.xxi

Santa Clara County has one of the highest application rates in California. County policy (see Appendix I for a summary) provides detailed procedures for completing SNAP applications for youth leaving care.xxii Santa Clara 1) waives the requirement of a face-to-face interview with SNAP agency staff, and instead allows a telephone interview; 2) facilitates preparing application forms and establishing eligibility in advance; 3) promotes filing applications on the same day the young person leaves care; and 4) expedites processing of applications even when not required under federal regulations.

Using California’s data, advocates and local officials have worked together to highlight and address low application rates. For example, to address Los Angeles County’s low application rate, the county’s Board of Supervisors recently directed the responsible county agencies to develop and implement a plan to ensure SNAP applications are submitted on behalf of foster youth leaving care. The issue even garnered the attention of the Los Angeles Times, the nation’s fourth largest newspaper, which editorialized in support of improving SNAP access for foster children.xxiii

SNAP employment, training, and education provisions: Youth who aged out of foster care are likely to be subject to SNAP provisions related to employment, education, and training, and may also be subject to limits on the number of months they can receive SNAP without being employed or engaged in certain other activities. The precise details of these provisions vary considerably by state and local area, and states have considerable flexibility in determining the effect of the provisions most important to youth who aged out of foster care. This

8 includes providing individualized assistance with employment, education, and training, and exempting youth from the time limit. Advocates are encouraged to work with state officials to maximize the value of this flexibility for youth who recently aged out of foster care and who need nutrition assistance.

Employment, training and education requirements: Any SNAP participant who does not receive Temporary Assistance to Needy Families is eligible for SNAP employment and training services. These funds can be used to provide case management and employment and training services. States should review their policies to maximize opportunities for education and training for youth who aged out of foster care. Several states have developed innovative SNAP employment and training initiatives that support access to college.xxiv

SNAP participants between the ages of 16 and 60 must generally register for work and, absent good cause, accept a job or go to an employment and training program required by their SNAP office. SNAP beneficiaries must be exempted if they meet certain criteria (see Table III).

States should promote and facilitate access to employment and training as a means to long-term economic security. Agencies should coordinate SNAP employment and training with the transition plans of youth who transitioned out of foster care. Policymakers should also ensure SNAP work requirements offer exemptions or deferrals for good cause. For youth who aged out of foster care, examples of good cause might include a family crisis or legal difficulties that preclude participation.

SNAP full-time student eligibility rules: When youth who aged out of foster care require nutrition assistance while pursuing an education, SNAP can be an invaluable resource. However, SNAP’s student eligibility rules can pose a barrier for certain students who are enrolled at least half-timexxv in an institution of higher education.

Under federal rules, a student over 17-years-old who is enrolled at least half-time must meet at least one criterion in the second column of Table III to remain eligible for SNAP benefits. In general, the best way for a state to ensure students remain eligible for SNAP benefits is by giving them the option to enroll voluntarily in the SNAP Employment and Training Program with their current course of study as their program activity.

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Table III: Exemptions from SNAP Employment and Training Requirements, Post-

Secondary Student Eligibility Restriction, and Time Limits

Employment and Training Requirements Post-Secondary Student Eligibility Restriction Time Limits SNAP beneficiaries are exempt from SNAP SNAP applicants and beneficiaries who are SNAP beneficiaries who are potentially subject to Employment and Training requirements if they potentially subject to SNAP’s post-secondary SNAP’s time limit—because they received SNAP meet any of the following criteria: student restriction because they enrolled at least for three months in which they did not work half-time in an institution of higher education more than 80 hours, or participate for 20 hours remain eligible as long as they meet any of the or more in an employment and training following criteria: program–are exempt from limit if they meet any of the following criteria: o under age 16 or age 60 or older o under age 18 or age 50 or older o under age 18 or age 50 or older o age 16 or 17 if not a head of household o not be physically or mentally fit o live in a state or area of a state in which o physically or mentally unfit for employment o participating in the SNAP Employment and the time limit has been waived because of o students in recognized programs Training Program or in certain other high unemployment or a labor surplus o complying with a TANF work requirement employment and training programs o pregnant o household member caring for a child under o employed a minimum of 20 hours per o a person who lives in a household with a 6 or an incapacitated person week child o receiving unemployment compensation o participating in a work study program o a person caring for an incapacitated o participating regularly in a drug addiction o a parent with responsibility for the care of household member or alcoholic treatment and rehabilitation a dependent child under age 6 (or under o medically certified as physically or mentally program age 12 if certain additional conditions are unfit for employment o works 30 hours per week or receives met) o participating regularly in a drug addiction earnings equal to or greater than the o receiving TANF benefits or alcoholic treatment and rehabilitation minimum wage multiplied by 30 program o receiving unemployment compensation o works 30 hours per week or receives earnings equal to or greater than the minimum wage multiplied by 30 o a student enrolled at least half time

Note: For a more detailed table comparing elements of the SNAP employment and training requirement and the SNAP time limit, see the Appendix in National Skills Coalition, SNAP Employment and Training: A Users’ Guide, February 2012.

SNAP time limits: SNAP’s “able-bodied adults without dependents” provision places a time limit on benefits. Such adults are ineligible for SNAP benefits if, during the preceding 36 months, they received SNAP benefits for three months in which they did not: 1) work 20 hours or more per week (averaging 80 hours per month), or 2) participate in and comply for 20 hours or more per week with the requirements of the SNAP Employment and Training Program or other work program. Adults are exempt from the time limit provision if they meet any of the criteria listed in the third column of Table III.

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This time limit may be waived because of high unemployment or a labor surplus. The U.S. Department of Labor determines what states and areas meet one or both of these waiver criteria. Eligible states then have the option to request the waiver. Currently, 46 states and territories were authorized to suspend this restriction through at least September 30, 2012 based on high unemployment. States not authorized include Nebraska, New Hampshire, North Dakota, South Dakota, and Vermont. All but two states, New Hampshire and Vermont, had authorization to suspend the restriction in at least one county because of a labor surplus.xxvi

States may also exempt a specific number of individuals each year who do not qualify for any of the exemptions listed above. Federal officials notify each state of the number of people who may be exempted in a given federal fiscal year. States and local agencies in some states then decide which individuals to exempt.

Those who lose eligibility under the SNAP time limit may regain benefits if during a 30-day period they 1) work 80 or more hours, 2) participate in and comply with the requirements of the SNAP Employment and Training Program or some other work program for 80 or more hours, or 3) comply with the requirements of the SNAP Work Experience Program or a comparable state or local program.

Exemptions and waivers can, when appropriate, protect youth who aged out of foster care from the SNAP time limit. To the extent appropriate to facilitate a successful transition to independent adult life, states should also adopt policies specific to youth who aged out of foster care: o Use the general exemption to exempt all youth who aged out of care who do not meet one of the federal exemption criteria from the three-month limit. o Automatically refer youth who aged out of care to the SNAP Employment and Training Program and allow them to participate in the program on a voluntary basis.

National School Lunch Program The National School Lunch Program provides funding to participating schools that meet federal requirements. Participating schools must offer free lunches to children from families with incomes at or below 130 percent of the federal poverty line and reduced price lunches to children with incomes between 130 and 185 percent of the federal poverty line.

Access to nutritious food is particularly important for children in foster care, and a well-administered School Lunch Program can provide a stable source of nutrition for many foster children.

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The Healthy, Hunger-Free Kids Act of 2010 made children in foster care eligible for free school lunches, regardless of their income or the income of their foster family. This policy is known as “categorical eligibility.” As a result, when a foster parent applies for school lunch benefits for a foster child, they need only check a box indicating the child is in foster care. No other documentation is needed. According to USDA, categorical eligibility is available to all foster children, including those formally placed in kinship foster care.xxvii Children in informal kinship care or other arrangements outside of state or court-based systems are not eligible.

States and school districts also have the option to “directly certify” foster children for free school meals, meaning directly enroll them without requiring an application. By eliminating the paperwork required for school lunch enrollment, direct certification relieves families in transition of an unnecessary burden and increases the likelihood that eligible foster children will be enrolled.

Nate Frentz and Zoe Neuberger of the Center on Budget and Policy Priorities authored a comprehensive guide to implementing school lunch categorical eligibility for foster children. They recommend states conduct frequent electronic data matches to ensure children entering foster care midyear are enrolled.xxviii Even if a child moves out of foster care during the school year, he or she remains eligible for free lunches for the entire school year, and for up to 30 days into the next school year. At least three states conduct electronic eligibility matches- - Illinois, Indiana, and Washington.xxix School districts are required by federal law to use SNAP eligibility data to inform school lunch eligibility determinations. Alabama has integrated foster care data into this system. Delaware has adopted a certification process for foster children separate from its process for children who receive SNAP.

In addition, Frentz and Neuberger recommend that: o Caseworkers should take the additional step of directly notifying school officials responsible for administering the school meals program when a child enters foster care. They are already required to notify school officials. o Applications should be revised to clarify that foster children are eligible for free meals regardless of income, and that income information is not required to enroll foster children. USDA’s prototype application and letter includes this information.xxx o Child welfare agencies should notify foster parents that foster children are automatically eligible. Frantz and Neuberger offer a sample letter in their report.

Supplemental Security Income Administered by the Social Security Administration, SSI supplements the income of adults and children with severe who have low incomes and limited resources. Eligible applicants must have countable income

12 below the SSI maximum benefit ($698 a month in 2012) that includes, in states that provide it, the amount of any state supplemental payment.xxxi Benefit amount is determined by subtracting countable income from the maximum benefit and any state supplement.xxxii Though modest, SSI benefits can be a valuable income supplement for children in foster care and youth who aged out.

Many eligible foster children do not receive SSI. According to the federal Administration on Children and Families, about 21 percent of foster care children placed into foster care approximately one year before being surveyed, and were still there when surveyed, were potentially eligible for SSI based on a severe disability.xxxiii Similarly, they estimated about 20 percent of children in a larger group, including both newly entering foster children and children who had stays in foster care in the past, were potentially eligible for SSI. Thus, it appears as many as three to four times as many foster care children are eligible for SSI than the approximately 5 percent currently receiving it.xxxiv

Access to SSI benefits is complicated by the following issues: 1) maintenance payments to foster parents are counted as income for SSI purposes; 2) children’s SSI benefits must generally be paid to representative payees-- for children in foster care that is often the state child welfare agency; 3) when appointed as a representative payee, nearly all state child welfare agencies use child’s SSI benefits to reimburse themselves for foster care maintenance payments they made on the child’s behalf; and 4) SSI’s asset restrictions limit the amount of SSI benefits, outside of back payments, that can be saved for a child’s future use. Effective state-level policies and procedures can address these issues to some extent.

SSI’s treatment of foster care maintenance payments and independent living payments: Foster care maintenance payments are counted as income by SSI, reducing-- or even eliminating-- a disabled child’s SSI benefit.xxxv Since these payments are made on behalf of the majority of children in foster care, this is a frequent complication for foster children otherwise eligible for SSI.

However, not all foster children are subject to this rule. Foster care payments made with federal, state, or local funds other than those provided under Title IV-E are generally not counted as income by SSI. This includes: o Foster care payments funded wholly by a state or local government. This exclusion applies as long as income is an eligibility factor for the foster care maintenance payment (i.e., the child’s income) before the placement, although it need not be low enough to meet the Title IV-E income standard for eligibility. o Foster care payments involving federal funds provided under Title IV-B (Stephanie Tubbs Jones Child Welfare Services Program and Promoting Safe and Stable Families) or Title XX (Social Services Block Grant) of the Social Security Act) are excluded from income.xxxvi Foster care payments made by the Bureau of Indian Affairs are also excluded from income.xxxvii

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Thus, otherwise eligible children whose foster care parents or providers receive maintenance payments from sources other than Title IV-E should generally be eligible for SSI. As discussed further below, advocates should encourage states to temporarily shift a disabled foster youth’s foster care funding source in certain situations to establish SSI eligibility.

Finally, certain payments made to youth who aged out of foster care, specifically payments made under section 477 of Title IV-E (The Foster Care Independence Program), are excluded from income.xxxviii These should include room and board payments made to former foster youth who are living independently, and educational and training vouchers provided to former foster youth to cover the costs of higher education.

Representative payees and state use of SSI as reimbursement for foster care payments: In nearly all cases, SSI payments for children under age 18 must be made to a representative payee selected by the SSA. SSA provides specific guidance on selecting payees when a child is in foster care.xxxix This guidance provides that appointment of a foster care agency as representative payee for a child in foster care is not automatic and that SSA must decide each case individually and “remember to consider other concerned relatives as possible payee choices.” In 2009, state agencies served as representative payees for 17,343 children, about 1.4 percent of children receiving SSI that year.xl

The U.S. Supreme Court upheld in 2003xli the practice that, when a state or local agency serves as the representative payee, the agency may retain the child SSI’s benefits to reimburse itself for any foster care maintenance payments it makes on the child’s behalf. Expenditure data collected by Child Trends for state fiscal year 2006 suggests this amount may be in excess of $250 million a year.xlii

The Foster Children Self-Support Act (H.R. 6192, 111th Congress) would have prohibited states from using more than half of a foster child’s SSI or Social Security benefits to reimburse themselves. Child welfare agencies would have been required to develop a plan for using the funds in a way that best met the current and future needs of the child, including educational and employment interests. The legislation was not enacted and has not been reintroduced in Congress.

Representative payees must use SSI payments to pay for children’s day-to-day needs first, then for any medical and dental care not covered by health insurance and personal needs, such as clothing and recreation. Any funds that remain after paying for these needs must be put into savings for the child. However, if the amount of benefits put into savings along with other countable resources exceeds SSI’s resource limit (typically $2,000 for a child in foster care), the child will have his or her benefits suspended.

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The Age-18 Redetermination Process for Children Receiving Benefits SSI’s disability standard for adults is somewhat different than it is for children. When children turn age 18, they are required to have their eligibility redetermined using the adult standard. Typically, the redetermination is done within 12 months after the child turns age 18. Most children have their benefits continued at the initial stage of this process, but about 31 percent of children are initially determined not disabled under the adult standard. (Jeffrey Hemmeter and Elaine Gilby, The Age-18 Redetermination and Postredetermination Participation in SSI, Social Security Bulletin, 2009) Another 12 percent lose eligibility at this stage for other reasons, typically because they could not be contacted by the Disability Determination Service and there was insufficient medical evidence in their records to make a disability determination using the adult standard.

Youth who are determined to be no longer eligible under the adult rules must get a written notice from SSA and will receive two months of benefits after the date of the notice. Youth who lose SSI eligibility at the initial redetermination stage can appeal or reapply. Over a four-year period, just over one in four of them are subsequently found disabled under the adult standard after appealing or reapplying.

There is an exception to this rule when a child receives back benefits exceeding six times the maximum monthly benefits, which happens when a child who was initially denied benefits appeals and is subsequently found eligible back to his or her date of application. In this case, the back benefits must be put into a separate dedicated account and used to meet specified expenses, other than food and shelter. The back benefits in this dedicated account are not counted toward the child’s asset limit. Under the proposed Foster Children Self- Support Act (H.R. 6192, 111th Congress) SSI funds retained under state plans for a child’s benefit would be unavailable under the child leaves care or turns age 18, and would not count toward SSI’s asset limit.

Application processing issues for foster youth transitioning out of care: Processing SSI applications often takes several months. After initial processing, initial disability determinations typically take nearly three months. Most claims are denied at this stage, so applicants generally must ask for a reconsideration, which can take another two months. If denied at this stage, administrative hearings often take as long as a year.

If an SSI applicant’s countable income exceeds the maximum benefit amount, SSA generally will not take his or her application and will not make an initial disability determination. Thus, a child whose foster parents are receiving IV-E maintenance payments in excess of the SSI maximum benefit will not have a disability determination until the payments are stopped.

Youth transitioning out of foster care are exempt from this rule. They may file an SSI application 90 days before aging out of foster care, with the standard rule for accepting applications beginning the month before the month eligibility would begin.xliii This makes it more likely eligible youth will be able to receive SSI benefits not long after they leave care, or, if denied at the initial disability determination stage, given a modest head start on pursuing an appeal.

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While helpful, this policy remains quite limited in at least two major ways. First, it is not available to disabled foster children who are likely to stop receiving IV-E benefits for other reasons, such as being reunited with their parents or placed with a guardian. Second, it provides only marginal improvement of a very long administrative process.

States and localities can address these issues by establishing policies allowing for the temporary switching of funding for a disabled child’s foster care maintenance payments from Title IV-E to a non-Title IV-E source. Non- Title-IV funds include state or local funds, the Title XX block grant, and, in certain states, Title IV-B funds. This switch need only be done for one month while the application for SSI is submitted. SSA will establish the child’s financial eligibility for SSI in that month, allowing him or her to accept the application and begin the disability determination process. If SSA subsequently finds the child disabled during a month in which he or she is once again receiving Title IV-E funded care, the child will remain medically eligible for SSI, but receive no actual benefit, for up to 12 months. If the child stops receiving IV-E funded care during this 12-month suspension period, he or she can begin receiving benefits and need not go through the disability determination process again. As discussed in more detail later, a California law adopted in 2008 requires child welfare agencies in the state to make this funding shift when necessary to allow foster youth with disabilities to establish financial eligibility for SSI.

Screening foster children for SSI eligibility: California’s approach: Advocates should encourage agencies to routinely screen foster children for SSI eligibility. Recent California reforms have improved access to SSI for children in foster care and youth who aged out of foster care. A 2005 law directed the California Department of Social Services to convene a workgroup that included county agencies and child advocacy organizations to develop best practices guidelines for county agencies.xliv The resulting guidelines are a useful model for other states:xlv o All children who enter foster care should receive an initial disability and financial screening within three months using a screening tool developed by the state. o Special attention should be given to youth already receiving SSI benefits and entering care at 16.5 years or older. o If child is found likely to be eligible, refer him or her to a county designated SSI liaison, an employee or team of employees who specialize in the SSI application process and serve as a central point of contact for SSA. o Children initially screened and not referred for an SSI application should be rescreened at least annually or whenever there is a change in circumstances.

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SSI as a Work and Education Support Although SSI is limited to low-income people with severe disabilities, this does not mean that beneficiaries are precluded from working,

going to school, or engaging in other activities that could improve their economic security. In determining monthly benefits, SSA does not count the first $20 of any kind of income, then the first $65 in earned income, then the remaining half of the earned income that remains after applying these first two disregards. For youth who are under age 22 and regularly attending school, college, or training, all earned income, up to $1,700 monthly and $6,840 annually is disregarded in 2012. For students with earned income

above these amounts, SSI’s other earned income disregards still apply.

In addition, under SSI’s Plan to Achieve Self-Support (PASS) provisions, beneficiaries can set aside income and resources for a specified period of time, without having them count when determining SSI eligibility or benefits, in order to pay for items or services needed to achieve a specific work goal. PASS is especially useful for individuals who have income or resources that would otherwise make them ineligible for SSI or reduce their benefits, and who are willing to use this excess income to meet an occupational goal.

For youth aging out of foster care receiving SSI benefits and approaching their 18th birthday, the 2005 legislation also requires counties to:xlvi o Provide information to youth regarding the disability redetermination that SSA conducts after a child turns age 18. o Provide information to the youth regarding the process for receiving SSI benefits directly (rather than having them paid to a representative payee as is generally required for children) or designating an alternative representative payee.

A 2008 law applies specifically to youth transitioning from care, and requires all California counties to:xlvii o Screen all youth who are in foster care and between the ages of 16.5 and 17.5 for a physical and mental disability. o Screen all youth who are in foster care and between the ages of 16.5 and 17.5 for physical and mental disabilities. o Submit an SSI application on behalf of youth likely to be determined eligible for benefits. To the extent possible, the application must be timed to allow for a determination of eligibility by the SSA prior to the youth's emancipation from care including, if appropriate, the suspension of SSI benefits for no more than 12 months. o If necessary, use state funds rather than Title IV-E funds to fund the foster care maintenance payment in the month the youth applies for SSI to meet SSI’s financial eligibility requirements. The Foster Children Self-Support Act would have required all states receiving federal foster care funding to develop and implement procedures to screen all foster children for SSI and Social Security eligibility shortly after entering foster care and thereafter when any material change in the child’s circumstances could affect their potential eligibility for SSI. It would have also required agencies to help potentially eligible foster children enroll in SSI and to appeal decisions about the benefits.

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Medicaid and the Children’s Health Insurance Program Children in foster care are automatically eligible for Medicaid.xlviii However, eligibility does not always translate into consistent coverage, especially for children and youth whose placements frequently change. A 2008 report from the National Academy for State Health Policy, an independent body of state health officials, provides a comprehensive set of recommendations for improving Medicaid and CHIP access for foster care children and youth transitioning from care.xlix Key recommendations include enhancing retention of benefits during transitions by: o Providing 12 months of continuous eligibility, so status does not need to be re-determined at every transition. States have the option under federal law to provide up to 12 months of continuous eligibility for Medicaid or CHIP, even if a youth’s income exceeds the eligibility level during part of the period. In states that take this option, foster children who leave care will retain coverage through the 12-month period. As of January 2009, 30 states had 12-month continuous eligibility for Medicaid and/or CHIP. o Conducting “administrative renewals” of Medicaid. This is especially important in the 20 states that have not adopted continuous eligibility. In these states, leaving foster care may prompt a cumbersome eligibility review. However, federal rules require states to obtain information from other sources, including SNAP and SSA records, before requesting new information from the family.

Youth who transitioned from care also face barriers to obtaining health coverage, in part because their Medicaid eligibility varies by state. An exception is youth who aged out of foster care and receive SSI, as these youth are automatically eligible for Medicaid in every state.

For all other youth who aged out of foster care, Medicaid eligibility depends on the options and waivers implemented by their state. For such youth, the most important of these is the state option to extend Medicaid to all youth who aged out of foster care ages 18 to 21. To date, 30 states have taken this option.l

The Affordable Care Act (ACA) requires states to extend Medicaid coverage to youth who aged out of foster care up to age 26, even if their income is above other Medicaid limits for adults, beginning in 2014. States should consider phasing in this coverage before 2014. Hawaii has budgeted to phase in ACA coverage for youth who aged out of foster care, beginning with those under age 24 this year and covering those under age 25 next year. This plan is awaiting approval from the federal Centers for Medicare and Medicaid Services.

To ensure continuity of coverage when foster youth covered by Medicaid leave care, states should automatically enroll them in Medicaid until they reach age 26 without requiring them to submit a new application.

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States should conduct targeted outreach to identify and enroll newly eligible youth who aged out of foster care in Medicaid, beginning in 2014. This should include providing information to public and non-profit agencies that work with such youth. States can receive a dollar-for-dollar federal match for funds, including funds provided by private foundations, for what they spend on Medicaid outreach and enrollment. This reimbursement is not limited to state Medicaid agencies, so the outreach and enrollment activities of state and local child welfare agencies can be funded with Medicaid dollars.

Benefits Eligibility and Access for Children of Immigrants Almost one-quarter of U.S. children have a parent or parents who are immigrants to the United States. Recent research using the NSCAW suggests that about 8.6 percent of children involved in the child welfare system have immigrant parents. (Yali Lincroft and Alan Dettlaff, Children of Immigrants in the U.S. Child Welfare System, First Focus, June 2010). Less than 3 percent of children involved in the child welfare system are non-citizens. Citizen children of immigrant parents are eligible for public benefits to the same extent as children with citizen parents. However, children living with immigrant parents or other immigrant relatives still face many access barriers, often related to language or the immigration status of their parents.

Non-citizens’ eligibility for benefits varies based on their precise immigration status, how long they have lived in the United States, the state the live in, and various other factors (and, of course, non-citizens have to meet the same financial and other eligibility standards as U.S. citizens). A detailed discussion of the complex eligibility rules related to immigration status is beyond the scope of this brief, but in general, the following rules apply to the programs discussed in this brief: o Undocumented immigrants are ineligible for nearly all federally funded benefits, including Title IV-E foster care. Exceptions to this general rule of ineligibility include child welfare services under Title IV-B, child nutrition programs and Emergency Medicaid. Undocumented children who are in long-term foster care may be eligible for Special Immigrant Juvenile Status or other forms of immigration relief, which allows them to become lawful permanent residents. o Lawful permanent residents (sometimes referred to as “green card” holders or LPRs) who are 18 or older are eligible for SNAP if they have been in a “qualified” immigrant status (in general, been an LPR or had some other immigration status enabling them to reside in the United States) for five years or more. LPR children are eligible without any such waiting period. o LPRs are generally eligible for Medicaid and CHIP if they have been in a qualified immigrant status for five years or more. However, states have the option to waive this waiting period for pregnant women and children. Over half the states currently take this option. In addition, some states used state funds to provide health insurance to LPR adults during this five-year period. o LPRs are generally ineligible for SSI if they entered the United States on or after August 22, 1996, unless they have accumulated 40 quarters of work. o LPRs who are active duty military (and their spouses and children), are eligible for SSI and SNAP. Most “humanitarian” immigrants—specifically refugees, asylees, persons granted withholding of deportation, Cuban/Haitian entrants, Amerasians, Iraqi or Afghan special immigrants, and victims of trafficking—are eligible for benefits without any length of residency requirement. These immigrants will generally lose eligibility for SSI seven years after their status was granted if they do not become U.S. citizens. Even if they meet these standards, there are various other access issues faced by immigrants and citizen children with immigrant parents. For more on these eligibility and access issues, see http://www.firstfocus.net/library/reports/public-benefits-and-child-welfare-financing and the National Immigration Law Center’s web page on Access to Public Benefits, http://www.nilc.org/access-to-bens.html.

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Conclusion

Working together, state and local-level child welfare advocates, and state and local human services employees involved in developing child welfare and benefit policies, can improve access to these benefits and services. Advocates can play a critical role in educating state officials about available reforms and building political support for their adoption.

The State Policy and Reform Center (SPARC) initiative is supported by the Annie E. Casey Foundation and the Jim Casey Youth Opportunities Initiative. We are grateful for their support in making this report possible.

The author also wishes to thank SPARC staff for their helpful input.

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Appendix I ______

Key Elements of Santa Clara County (California) Policy on Ensuring SNAP Access for Children in Foster Care: o When a young person’s primary social worker sets an Emancipation Hearing date for the youth, the worker must also provide notice of the hearing to the young person’s Independent Living Program (ILP) social worker. o The ILP worker then schedules an appointment with the youth to complete the SNAP application and gather the needed verifications. When the application is completed, the youth signs the form but does not date it. This is done to ensure that the application date does not go beyond the 30-day time frame set for processing food stamps. The application will be dated on the same day that the young person officially leaves care. o The ILP then faxes the application and the verifications to a staff person in the county’s Application Assistance Center (AAC), with a request for the phone interview that is required by the state. o When the AAC worker receives the faxed paperwork, he or she schedules a phone interview for the youth and provide the date to the ILP worker. (If the youth person will live in, and purchase and prepare meals with, a household that that currently receives SNAP benefits, the AAC staff provides the current SNAP eligibility worker’s name and phone number to the ILP worker, and explains that the youth will be added to the existing SNAP case.) o The ILP then notifies the young person of the date of the interview and schedules another appointment with the youth on that same date. o When the court issues a decision to officially end care, the primary social worker notifies the SNAP eligibility worker, who then dates the application already completed by the young person and requests authorization of benefits. o The applications submitted under this procedure are treated as a high priority by the AAC staff. SNAP benefits are authorized on the same day that a young person officially leaves care, and the SNAP EBT care is mailed to him or her that same day. Youth also have the option to make arrangements to pick the card up.

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Notes

iFor more on children in kinship care, see The Annie E. Casey Foundation, Stepping Up for Kids: What Government and Communities Should Do to Support Kinship Families (2012). Another relative category of children who face considerable barriers to accessing benefits are children transitioning out of the juvenile justice system. For more on these children, see Sonya Schwartz and Melanie Glascock, Improving Access to Health Coverage for Transitional Youth, National Academy for State Health Policy, July 2008. ii United States Department of Health and Human Services, Children’s Bureau, The AFCARS Report, Preliminary FY2010 Estimates as of June 2011. This is the number of children in foster care on September 30, 2010. Consistent with the federal definition of foster care, the Adoption and Foster Care Analysis and Reporting System (AFCARS) collects case level information on all children in any foster care setting for whom state or tribal child welfare agencies have responsibility for placement, care or supervision. The data include children whose placement is wholly funded with state or local dollars, i.e., not funded with federal IV-E dollars. iii The NSAF, a nationally representative survey of households with persons under age 65, was conducted in 1997 and 1999. The NSCAW is a nationally representative, longitudinal study of who are in the child welfare system. NSCAW I follows a sample children who entered the child welfare system between October 1999-December 2000. NSCAW II follows a sample of children who entered the system between February 2008-April 2009. Unlike the NSAF and most public surveys, the NSCAW includes children in institutions. Particularly good summaries of findings from these two surveys, include Katherine Kortenkamp and Jennifer Ehrle, “The Well-Being of Children Involved with the Child Welfare System: A National Overview,” The Urban Institute, January 2002 (using the NSAF), Sharon Vandivere, Rosemay Chalk and Kristen Anderson Moore, “Children in Foster Homes: How Are They Faring?, Child Trends, December 2003 (using both the NSCAW and NSAF), and Administration for Children and Families, National Survey of Child and Adolescent Well-Being, A Summary of NSCAW Findings, Research Brief No. 16 (2010). While nationally representative, the NSAF and NSCAW generally cannot be used to provide state-level estimates for children in foster care or the child welfare system. One potential source of state-level data is the American Community Survey, although in many, if not most states, the number of children in foster care in the ACS sample is too small to produce reliable estimates. See William, O’Hare, “Data on Children in Foster Care from the Census Bureau,” The Annie E. Casey Foundation, 2008. iv Katherine Kortenkamp and Jennifer Ehrle, “The Well-Being of Children Involved with the Child Welfare System: A National Overview,” The Urban Institute, January 2002. v Administration for Children and Families, National Survey of Child and Adolescent Well-Being (2010). vi Administration for Children and Families, “Special Health Care Needs Among Children in Child Welfare.” National Survey of Child and Adolescent Well- Being Research Brief No. 7 (2008). Special health care needs is a term used by the federal Maternal and Child Health Bureau since 1998 to identify children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type that go beyond that of children generally. vii Kortenkap and Ehrle 2002. viii Kortenkap and Ehrle 2002. ix Mark E. Courtney and others, Former Foster Youth: Outcomes at Age 26, Chapin Hall at the University of Chicago (2011). x 42 U.S.C. §§ 672(a), 675(4)(A). xi Diane DePanfilis and others, Hitting the M.A.R.C.: Establishing Foster Care Minimum Adequate Rates for Children, Children’s Rights, National Foster Parent Association, University of Maryland School of Social Work, October 2007. xii For more on these requirements, see Children’s Bureau, Child Welfare Policy Manual, Section 8.4A. In addition, the state must document that: 1) the child was removed from the home via a judicial determination, or based on a voluntary placement agreement; 2) reasonable efforts were made to eliminate the need for removal and, subsequently, to finalize a permanency plan for the child (within 12 months of the child’s placement in care and then every 12 months that the child remains in care); 3) the care and placement of the child are the responsibility of the state; 4) the child is placed in a licensed and approved foster family home or public or private child care institution; and 5) the child’s foster parent meets federal safety and background check requirements. xiii In some states, the program has a different name. For example, SNAP is officially called CalFresh in California. For a list of names by state, see United States Department of Agriculture, From Food Stamps to SNAP: State Name Change Tracking Chart, http://www.fns.usda.gov/snap/roll-out/state-chart.pdf, March 2011. xiv This applies both to youth living with foster families as well as those living in institutions when the institution provides them with the majority of their meals. However, certain disabled or blind persons who live in nonprofit group with no more than 16 residents may be eligible for SNAP, even when the group home prepares meals for them. 22

xv There is typically no minimum income requirement for being a foster care parent--as long as ability to meet current household needs and other requirements is shown--and no categorical prohibition on foster parents receiving SNAP or other benefit programs. O’Hare (2008) finds that about 15 percent of households with one or more unrelated foster children received SNAP benefits in 2006, the same as the percentage of all households with children who received SNAP. He also found that households with unrelated foster children were less likely to have incomes above $100,000 than all households with children, and more likely to have incomes between $20,000 to $50,000 per year. xvi The Annie E. Casey Foundation, Stepping Up for Kids: what government and communities should do to support kinship care families, May 2012, available at: http://www.aecf.org/~/media/Pubs/Initiatives/KIDS%20COUNT/S/SteppingUpforKids2012PolicyReport/SteppingUpForKidsPolicyReport2012.pdf. xvii Massachusetts Law Reform Institute, Foster Care Families and SNAP/Food Stamps, January 2012. xviii Mark E. Courtney and others, Midwest Evaluation of the Adult Functioning of Former Foster Youth: Outcomes at Age 19, Chapin Hall at the University of Chicago (2005). xix All County Letter No. 09-25. xx California’s Department of Social Services issued an all-county information notice that reiterated the importance of ensuring SNAP access for former foster youth (DPSS 2012, boldface type on original): “… we strongly encourage counties to revisit ACL 09-25 and to continue to strengthen efforts to provide youths aging out of foster care with information regarding CalFresh and with the opportunity to apply for CalFresh before they exit care. The increase in applications subsequent to the release of the ACL clearly demonstrates the efficacy of this effort. The development of a collaborative process involving both CalFresh and Child Welfare Services staff is critical, and counties are encouraged to communicate with those counties reflecting a higher success rate to identify and incorporate best practices and procedures.” xxi California Department of Social Services, Percentage of Aging out Foster Youth Getting CalFresh by County (Selected Counties), Quarterly Statistical Report, July-September 2011. xxii http://www.sccgov.org/ssa/opp2/18_financial/18-5.2.html xxiii Food Stamps for Foster Kids, Los Angeles Times, December 19, 2011. xxiv For an excellent, comprehensive guide to SNAP Employment and Training, including recommendations for states, see Rachel Gragg and Coleen Pawling, SNAP Employment and Training: A Users’ Guide, National Skills Coalition, February 2012. xxv Under SNAP’s federal rules, a student is considered to be enrolled in an institution of higher education if the individual is enrolled in either: 1) a business, technical, trade, or vocational school that normally requires a high school diploma or equivalency certificate for enrollment in the curriculum; or 2) a regular curriculum at a college or university that offers degree programs regardless of whether a high school diploma is required. xxvi See USDA, Memo to Regional Directors, Supplemental Nutrition Assistance Program (SNAP)-Able Bodied Adults without Dependents Waivers for Fiscal Year 2013, http://www.fns.usda.gov/snap/government/pdf/ABAWD_2013_Trigger_Notice_Memo.pdf. xxvii USDA, Food and Nutrition Service, Child Nutrition Reauthorization 2010: Categorical Eligibility of Foster Children, Questions and Answers Memorandum, March 16, 2011. xxviii Nate Frentz and Zoe Neuberger, “Six Ways that States and School Districts can Make it Easier for Children in Foster Care to Get Free Meals at School,” Center on Budget and Policy Priorities, August 9, 2011. xxix Id. xxx http://www.fns.usda.gov/cnd/Translations/English/E-SchoolMealApp.pdf xxxi Only about one in five children and just less than one in four adults receive a state supplement. For more information on state supplemental programs, see Social Security Administration, January 2011, State Assistance Programs for SSI Recipients. xxxii The income and resources of a foster child’s biological parents are not counted toward the child’s income and resource limits. However, if a foster child is reunified with their parents, this income is subject to certain exclusions and disregards. These include a small exclusion of parental income to meet the basic needs of other children in family (currently $350 per child per month), an exclusion of all of the first $65 of earned income and half of earned amount above this amount, and an exclusion of income to meet parent’s needs ($698 for a single parent, $1,048 for a couple). For more on these rules, see Parent-to-Child Deeming, VCU Work Incentive Planning and Assistance National Training Center, February 2011. xxxiii Administration for Children and Families, “Estimates of Supplemental Security Income Eligibility for Children in Out-of-Home Placements.” National Survey of Child and Adolescent Well-Being Research Brief No. 12 (2009). xxxiv The NSCAW estimates of foster children potentially eligible for SSI included children who were receiving the benefit. However, the researchers did not attempt to separate them out from their estimate because many respondents to the NSCAW are not likely to know whether a child is receiving SSI. xxxv POMS Section: SI 00830.410, https://secure.ssa.gov/apps10/poms.nsf/lnx/0500830410.

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xxxvi According to the Congressional Research Service, about 20 states planned to use some Title IV-B funds for foster care maintenance in FY2010. For a list of these states, see Appendix B of Emilie Stoltzfus, Child Welfare: Funding for Child Welfare and Family Services Authorized Under Title IV-B of the Social Security Act, Congressional Research Service (2011). About 18 states used some SSBG funds for foster care payments in 2009. xxxvii See POMS SI00830.810. xxxviii POMS Section: SI 00830.410. xxxix POMS Section GN 00502.159. xl Adrienne Fernandes-Alcantara, Scott Szymendera, and Emilie Stoltzfus, Supplemental Security Income (SSI) Benefits for Children in Foster Care, Congressional Research Service (2011). xli Washington State Department of Social and Health Services v. Guardianship Estate of Keffeler, 537 U.S. 371 (2003). There is disagreement within the child advocacy community about the use of foster children’s SSI benefits for this purpose. For a summary of arguments made for and against by child advocates, see Fernandes-Alcantara and others (2011). xlii For state-specific data from the Child Trends survey, see Table 3 of Fernandes-Alcantara and others 2011. xliii POMS Section SI00601.011. xliv Section 13752, California Welfare and Institutions Code. xlv California Department of Social Services, All County Letter No. 07-10, Best Practices Guidelines for Screening and Providing for Foster Children with Disabilities, http://www.dss.cahwnet.gov/getinfo/acl07/pdf/07-10.pdf. xlvi Section 13753, California Welfare and Institutions Code. xlvii Section 13757, California Welfare and Institutions Code and California Department of Social Services, All-County Letter No. 08-12, March 19, 2008 xlviii States must provide Medicaid to children in Title IV-E foster care and have a state option, which all states have taken, to extend Medicaid to all other children in foster care. (Geen, Sommers, and Cohen, 2005). xlix Sonya Schwartz and Melanie Glascock, Improving Access to Health Coverage for Transitional Youth, National Academy for State Health Policy, July 2008. ll McDaniel 2012.

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