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General Description of Functions/Services
The main responsibility of the Cost Recovery Unit is to maximize the recovery of federal Medicaid and CHIP entitlement dollars for DSCYF and to ensure that all children who meet the eligibility criteria for Medicaid, CHIP and IV-E have a positive eligibility determination.
Since its creation in 1985, the DSCYF has been engaged in limited efforts to recover federal entitlement revenue. In 1993, the department launched an aggressive initiative to systematically identify and recover entitlement revenue for certain services it provided. The potential for new revenue was determined to be greatest from the following sources:
- the Medicaid program (Title XIX of the Social Security Act) - covering behavioral health services provided by the department
- the Foster Care and Adoption Assistance Program (Title IV-E of the Social Security Act) - covering the cost of children in foster care and case work costs related to the placement
- the Emergency Assistance program (formerly Title IV-A of the Social Security Act) – which covered situations determined to be an “emergency” and was utilized by the department between 1995 and 1997.
This aggressive cost recovery effort required major enhancement of the department's infrastructure and also required the expertise of expert consultants in this field. As can be seen from the following chart, the department’s efforts have yielded great results. State fiscal year 2014 was the department’s banner year, with recoveries of $29.6 million. With the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, the Emergency Assistance program was eliminated as an open-ended entitlement program effective July 1, 1997 and was merged into the TANF (Temporary Assistance for Needy Families) Block Grant, whose funds were no longer accessible to DSCYF. Current ASF revenue from Medicaid and IV-E is approximately $25M per year.
Medicaid Revenue figures include Delaware Healthy Children Program (DHCP) revenue.
- Emergency Assistance Revenue Source: DFMS Intergovernmental Vouchers for appropriation 8601
- Medicaid Revenue Data Source: MMIS Weekly Cycle Report, MMIS "Claims Summary Inquiry" screen (includes CHIP claims) and FACTS RA reports.
- IV-E Revenue Source: "IV-E 1" report and "Quarterly Cost Allocation Schedule Summary Report" prepared by the Fiscal Services Unit
- IV-E direct revenue does not include FFP associated with SACWIS development via the ADP.