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Child is in need of

substitute care 24

Child’s BASIC
hours per day away
from parents or
legal guardians

Title IV-E Foster Care
Eligibility Determination LSSA and/or Tribe and/or
Court Services is involved NO

Start to Finish!
No basic IV-E
foster care
eligibility
YES

Does LSSA have legal
responsibility for the care
and placement of the
child?

NO
3 Major Factors to Consider: YES

Legal Responsibility Does Court Services have
legal responsibility with an
AFDC Relatedness agreement in place with
the LSSA, which states
One Time Court Approval how all IV-E requirements
will be met?
YES NO

Was legal responsibility
obtained by a court order
or a voluntary placement No basic IV-E foster
agreement? care eligibility, check
if child qualifies for
medical assistance

If by COURT
ORDER If by
VOLUNTARY
PLACEMENT
AGREEMENT Determine if AFDC
(DHS 1776) Relatedness can be
established for basic IV-E
Did first court action leading foster care eligibility
to placement contain a “best
interest” or “contrary to the
child’s welfare” statement?

YES
Was there a “best
NO interest” statement
Was there a judicial determination obtained within 180 days
within 60 days of the placement of the placement date?
No basic IV-E foster NO
date that the agency made
reasonable efforts to prevent care eligibility, check
placement? if child qualifies for Basic IV-E eligibility can be
NO medical assistance potentially established for only
YES
the first 180 days of placement
if AFDC Relatedness can be
YES met

Basic IV-E eligibility can
be potentially established
for the length of the
placement if AFDC Go to
Relatedness can be met. page
2

© Copyright by the University of Minnesota (2007)
EDTP-IVE-05 Developed by Paula Katzenmeyer, Lynn Olund, Debbie Retterath and Deb Trotter DATE: 3/19/01

and one child live with the specified time court approval requirements: relative from whom legal ♦ VPA Eligibility Month is the month a VPA responsibility was transferred? is signed by all parties No basic IV-E ♦ Court Ordered Placement Eligibility NO foster care Month is the month the first petition eligibility. Has the application been provided. legal responsibility. check if YES which led to placement is filed child qualifies for ♦ The Removal Home is the home of the medical assistance parent/s or guardian from whom legal responsibility was transferred to the agency A IV-E application must be completed by the specified relative. the preceding 6 months. assets. or designated agency personnel based on the eligibility month and removal home to determine AFDC relatedness. Debbie Retterath and Deb Trotter . and child qualifies for return medical assistance Use forms to acquire verifications Application and all documentation are Go to provided to the Financial Assistance unit Page for processing 3 © Copyright by the University of Minnesota (2007) Developed by Paula Katzenmeyer. did the eligibility month. Page 2 Determine if AFDC Relatedness can be established for basic IV-E foster care eligibility It is recommended to use the Title IV-E Eligibility Determination Checklist (SSIS 39) to In the eligibility month or any of assist in determining the removal home. including verifications of identity. Lynn Olund. check if complete. authorized representative. and income for the removal home family unit? NO Request verifications YES Did they Did they ask for Did they refuse Can provide them? help? to comply? another person act YES on their YES YES behalf? NO Provide Authorization No basic IV-E for Release of foster care Information to eligibility. sign.

check if child qualifies for medical assistance Is the family’s income within the AFDC gross and net limit? YES Child meets Basic Title IV-E Eligibility Criteria Make appropriate referral for Child Support and/or parental fees per agency policy Financial worker enters case in Maxis/MMIS Inform Accounting and Social Service Department of IV-E status including automatic eligibility for medical assistance. 12/14/99) medical assistance No IV-E foster care YES NO eligibility. Lynn Olund. and provide documentation to Social Service Department Maintain IV-E Case Record © Copyright by the University of Minnesota (2007) Developed by Paula Katzenmeyer. see separate “AFDC Relatedness Flowchart” YES NO No IV-E foster care eligibility. based on AFDC policy and rules effective 07/16/96. check if Are the family’s assets under child qualifies for $10. Page 3 Was there an AFDC relatedness basis in the eligibility month for the removal home family unit (including this child). and do they meet basic AFDC requirements? ♦ For Detail of AFDC relatedness process. Debbie Retterath and Deb Trotter .000? (eff.