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
 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, the preceding 6 months, did the
eligibility month, legal responsibility, 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, 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, authorized representative, or
designated agency personnel based on the
eligibility month and removal home to determine
AFDC relatedness.

Has the application been provided,

including verifications of identity,
assets, 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, check if
complete, sign, 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, Lynn Olund, Debbie Retterath and Deb Trotter
 Page
3

Was there an AFDC relatedness basis in the

eligibility month for the removal home family
unit (including this child), based on AFDC
policy and rules effective 07/16/96, and do they
meet basic AFDC requirements?

♦ For Detail of AFDC relatedness process,

see separate “AFDC Relatedness
Flowchart”
YES
NO
No IV-E foster care
eligibility, check if
Are the family’s assets under child qualifies for
$10,000? (eff. 12/14/99) medical assistance

No IV-E foster care

YES
Is the family’s income within the
AFDC gross and net limit?
NO eligibility, check if
child qualifies for
medical assistance

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, and provide
documentation to Social
Service Department

Maintain IV-E Case

Record

© Copyright by the University of Minnesota (2007) Developed by Paula Katzenmeyer, Lynn Olund, Debbie Retterath and Deb Trotter