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Effective: 2/3/2025

5.11 Continuation of Title IV-E Subsidized Permanent Custody (SPC) Subsidy Assistance After Age Eighteen (18)

Legal Authority

Introduction

​​​​​​​​​​​​​​​​​​​​​​​​A child in the subsidized permanent custody (SPC) of a caregiver may have a disability as determined by the Social Security Administration (SSA) or by a Cabinet for Health and Family Services (CHFS/Cabinet) medical review team (MRT) that allows for the continuation of title IV-E subsidy assistance after the age of eighteen (18). A disability includes the inability to engage in any substantial gainful activity because of a medically determined physical or mental impairment(s), which can:

  • Be expected to result in death; or 
  • Last for a continuous period of not less than twelve (12) months.

The Department for Disability Determination Services (DDS) MRT considers the following factors at least six (6) months before the youth’s eighteenth (18th) birthday to allow or deny a disability determination for a child placed with a permanent caregiver:

  • The youth’s medical history and medical testimony, including information related to the alleged physical or mental disability, illness, or impairment, about whether the youth's ability to gain full-time employment or pursue opportunities within a state or federal education program is reduced. 

  • The youth’s age, employment history, education, and physical or mental condition affect their ability to care for and support themselves.


Practice Guidance

Procedure

The recruitment and certification (R&C) worker:​​
  1. Contacts the family when the youth is age seventeen (17) to provide initial information concerning the SSA and/or MRT review process. A review is only applicable for title IV-E subsidy. Please see the Subsidy Extension due to Medical Disability Letter. 
  2. At the request of the permanent caregiver(s), provides the DPP-601 Referral for Determination of Disability to Continue IV-E Funded SPC  Assistance, MRT-15 Procedural Instructions, and MRT-15 Authorization to Disclose Information to Cabinet for Health and Family Services  to the permanent caregiver(s) for completion; 
  3. Requests that the permanent caregiver(s) provide current (within one (1) year) supporting documentation including, but not limited to: 
    1. Educational testing; 
    2. Individual education plans (IEPs); 
    3. Medical records; or 
    4. Psychiatric hospital records;1
  4. Reviews the provided information and forward the DPP-601, MRT-15, applicable supporting documentation, and a copy of the family's DPP-1257 Subsidized Permanent Custody Agreement to central office staff for consideration by the MRT. The R&C worker should contact the Out-of-Home Care (OOHC) Branch to obtain the contact person's name and mailing address for the required documentation submission. 
  5. Should take the following actions if a disability determination is denied: 
    1. Consult with OOHC branch staff; 
    2. Refer the youth for further assessment when necessary; and 
    3. Follow procedures outlined in SOP 5.10  Discontinuance of Subsidized Permanent Custody Assistance. 
  6. Contacts the children’s benefits worker (CBW) to ensure continuation of Medicaid for the youth until age twenty-one (21) if a disability determination is approved. When the MRT makes a disability determination, a report is provided to the OOHC branch. The OOHC branch forwards the report to the R&C worker and the permanent caregiver(s).2 
  7. Should discuss the following with the family if the SSA determines that the child is disabled. 
    • Supplemental security income (SSI) is an entitlement benefit that is based on a child's disability and is income tested. Public Law 110-351 removed the means-tested eligibility criteria for an applicable child. Permanent caregiver(s) should contact the SSA with any questions. 
    • If a child receives both SSI and SPC assistance subsidy, the SSI benefit will be reduced "dollar for dollar" by the amount of the monthly SPC subsidy. 3 
    • In most cases, the amount of the SPC assistance subsidy exceeds the amount of the SSI benefit. The SPC assistance subsidy is time-limited. However, the SSI benefits may be available for the duration of the youth's life. Permanent caregiver(s) families should be advised to consider both outcomes when deciding which benefit to choose.4


​​Footnotes

  1. The permanent caregiver(s) should return the requested documentation six (6) months before the youth's eighteenth (18) birthday. 
  2. The OOHC branch and the R&C worker should not discuss back payments with the permanent caregiver(s). The family should be advised to contact the Division of Administration and Financial Management (DAFM) branch manager with questions related to any back payment. 
  3. For children receiving SPC assistance under title IV-E who do not meet the criteria to be an applicable child, if those children receive both SSI (which is an entitlement, but it is based on a child's disability and is income-tested​) and SPC assistance, the SSI benefit is reduced dollar for dollar by the amount of the monthly subsidy. In almost all cases, the subsidy amount exceeds the amount of the SSI.
  4. The permanent caregiver(s) is responsible for applying for SSI. This can be done by contacting the SSA or by starting an online application at the United States Socal Security Administration (ssa.gov). 

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Documents

Revisions