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Alien Medical

Revised March 28, 2008

Alien Emergency Medical (F09) Children's Health Program (F08) Nursing Facility (L04) SSI Related Alien Emergency Medical (S07) Undocumented Alien Pregnancy Medical(P04)

ALIEN EMERGENCY MEDICAL PROGRAM (AEM) – F09 Processing Alternative Medical F09   Who is eligible to receive F09 medical? How long is the F09 certification period? How do I screen F09 medical? How do I process a pending F09 AU?   Who is eligible to receive F09 medical?   ·         Undocumented aliens who are ineligible for any other medical program due to citizenship or alien status and meet the criteria in EAZ Manual – WAC 388-438-0110 The Alien Emergency medical (AEM) program.   How long is the F09 certification period? ·         The F09 certification period is three months.    ·         See EAZ Manual – WAC 388-438-0110 The Alien emergency medical (AEM) program #9. How do I screen F09 medical?   1.      From theWelcome Backpage in aces.online, click the Screen New Application link at the top of the page. 2.      On the Applicant page: o        Enter the applicant’s (head of household) name in the Applicant Name field. o        Enter applicant’s residential address in the Residential Address field. o        If applicant has a mailing address, uncheck the box next to Mailing Address and enter the applicant’s mailing address. o        Click the Next button. 3.      On the Address Validation page: o        Make sure applicant’s address is validated or validation is skipped if needed. o        Click the Next button. 4.      Complete the address validation process.   o        See Screening – aces.online, Address Validation for additional instructions on this process.   5.      On the Programspage:    o        Click the checkbox next to Medical.   o        Click the Next button.   6.      On the Finalize page:   o        Click on Specify Program button.   o        From the Program drop-down list, select Medical Assistance (MA).   o        From the Medical Coverage Group drop-down list, select Non-Citizen Family Related CN Emergency Medical (F09).   o        Click the Next button.   o        Enter the application date. (This is the date the client entered the hospital.)   o        Click the Commit button to commit the screening data. How do I process a pending F09 AU? To process a pending F09 AU take the following steps:   1.      Select AMEN, Option O – Interview.   2.      On the STAT screen, complete the Finl Resp fields as follows:   o        [PN] – Applicant o        [SP]– Spouse (if spouse in the home) o        [SC]– SSI Child/Child of SSI Related Parents/Child used to determine household size for any documented or undocumented children.   3.      On the ALAS screen, code the Alien Med Emer field with [Y]– Yes, if the alien applicant’s medical condition has been verified.   4.      Complete the interview following the instructions in the Interview chapter.   5.      After committing the interview data, follow the instructions in the Process   Application Month chapter for all pending months.   6.      After all pending months have been processed; follow the instructions in the Finalize Application chapter to complete the F09 eligibility determination.

Children's Health Program (F08) What is F08 medical? Who is eligible for F08 medical? How is F08 opened? How long is the certification period for F08? How do I screen an F08 AU? How do I process an F08 AU? How do I deny an application for F08 when enrollment is capped? How are shared cases between CSO's and MEDS processed? What is F08 medical? The Children's Health Program (CHP) F08 is for children under the age of 18 who are not eligible for Medicaid due to citizenship and whose countable income is at or below 100% if the Federal Poverty Level (FPL). See EAZ Manual WAC 388-505-0210 (8). Who is eligible for F08 medical? Non-citizen children under the age of 18 are eligible for F08 when they meet the requirements described in EAZ Manual WAC 388-505-0210 (8). How is F08 opened? The Medical Eligibility Determination Services unit (MEDS) CSO 076 will administer and maintain the CHP F08 medical program. Only workers in CSO 076 (MEDS) are able to screen/ finalize, reopen, add-a-program, reinstate, recertify and close/deny F08 medical AU's. How long is the certification period for F08? The certification period for F08 is 12 months. See EA-Z Manual - WAC 388-416-0015 Certification periods for Categorically Needy (CN) medical and Children's Health Insurance Program (CHIP). Changes during the certification period that affect eligibility should be processed according to EAZ Manual WAC 388-418-0025 Effect of changes on medical. How do I screen an F08 AU? To screen an F08 AU, take the following steps: From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window. On the Applicant page, enter the applicant's (head of household) Name, Residential and Mailing Addresses. Continue with the screening process until you reach the Programs page. On the Programs page: Click the checkbox next to Children's Health Program; or On the Finalize page, click the Specify Program button. On the Finalize - Program Details page: From the Program drop-down list, select Medical Assistance (MA). From the Medical Coverage Group drop-down list, select Children's Health Program (F08). Complete the screening process. See Screening a Client. How do I process an F08 AU? To process a pending F08 AU take the following steps: Through Option O - Interview, follow the steps detailed in the Interview chapter. Household members must be coded correctly on the STAT screen for ACES to determine the correct income standard to use based on household composition. On the STAT screen, complete the Finl Resp fields as follows: [PN] - Applicant for the undocumented child [PN] - Applicant for the parents of the applicant child [SC] - Child of SSI Related Parents/Child used to determine household size for any documented child. NOTE: ACES will change the financial responsibility code to [IP] - Ineligible Person when the parent(s) are not eligible. If you are processing a case with Sneede Kizer characteristics, see Sneede vs. Kizer Medical. Process all months through Option P - Process Application Months. See Process Application Month chapter. Finalize the F08 through Option Q - Finalize. See Finalize Application chapter. How do I deny an application for F08 when enrollment is capped? To deny an F08 application when enrollment has been capped because available funds have been expended, use the F08 Denial/Capped Program option in aces.online. When this function is used, the application can be denied without going through Options O - Interview, P - Process Application Month, and Q - Finalize. The F08 Denial/Capped Program option is only available when an AU meets the following conditions: The AU Status is Pending (P). All clients in the AU have the same application date. All assistance units processed using this option will be denied using Reason Code 562 - Children's Health Program Waiting List. The F08 Denial/Capped Program option will generate Letter 004-03 Medical/LTC Denial for AU with the appropriate denial text. To deny a pending F08 AU using the F08 Denial/Capped Program option, take these steps: On the Welcome Back page, use the Quick Navigation section to do the following: From the Select a Type of ID drop down box, click Assistance Unit. Enter the AU number you want to deny in the Enter an ID box. From the Select a Page drop down box, click F08 Denial/Capped Program. Click the Go button. The Applicant page for head of household is displayed in a new window. OR From the Assistance Unit >> Summary page of the AU you want to deny, select the Case Maintenance link and then click F08 Denial/Capped Program. The Applicant page for the head of household is displayed in a new window. The Applicant page for the head of household cannot be updated. In this situation, the Applicant page is used to verify the head of household. Review the Applicant page to ensure the client displayed is the HOH of the AU you are denying. Once you have verified the HOH, click the Next button. The Finalize page is displayed. The Finalize page will list all pending AU's for the same HOH that are eligible to be denied with the F08 Denial/Capped Program option. Click the checkbox next to all AU's to be denied for Reason Code 562 - Children's Health Program Waiting List. Click the Commit button. The Commit Status page is displayed. The Commit Status page will display a list of all AU's denied with the F08 Denial/Capped Program option during the current session. How are shared cases between CSO's and MEDS processed? Shared cases exist when MEDS has a CHP (F08) and the CSO has another assistance unit active for the household. For shared AU's, if a non-CSO 076 user takes a non-financial action on the related AU that affects the F08, Alert 404 - ANOTHER CSO UPDATED SHARED AU, will be sent to the CSO 076 user of record for the F08 AU. For shared AU's, If the MEDS CSO 076 worker takes an action (financial or non-financial) on the F08 AU that causes a change to the related AU - Alert 404 will be sent to the non-CSO 076 user of record for the related AU. See Shared Cases By More Than One CSO for additional information. Nursing Facility (L04) If the client is aged, blind, or disabled, screen in L02. Complete all screens as usual for the L series. During finalize, the AU will trickle from L02 to L04. ACES generates Letter 002-17, Approval for LTC and Medical Benefits. SSI Related Alien Emergency Medical (S07) Who is eligible for S07 medical? How long is the S07 certification period? How do I screen S07 medical? How do I process a pending S07 AU? How do I open a COPES S07 AU? Who is eligible for S07 medical? Undocumented aliens with a medical emergency and who are SSI-related (aged, blind, or disabled) may be eligible to receive S07 (Alien SSI Related Emergency Medical) medical coverage. See EA-Z Manual - Emergency Assistance Programs WAC 388-438-0110 How long is the S07 certification period? The S07 medical program is certified for 3 months. If additional time is required for treatment of the emergency condition, additional certification periods can be authorized. If income is over the standard for S07, the AU trickles to S95 or S99 and follows MN program certification periods. How do I screen S07 medical? S07 should be screened initially as an S02 AU; it trickles to S07 when the AU is finalized. See Trickle and Sprout - ABD SSI Related track. See How do I screen an S02 AU? Include all immediate family members in the household/AU to ensure proper allocation/deeming of income. How do I process a pending S07 AU? To process a pending S02/S07 AU, take the following steps: From the AMEN, access the pending AU via Option O – Interview. On the STAT screen, complete the Finl Resp field as follows: [PN] – for applicant [SP] – for spouse (Ineligible Spouse) [SC] – for children (Used to determine household size; Documented or Undocumented) On the DEM2 screen: Enter [U – Undocumented Alien] in the Citizenship field Enter [N - No] in the Qualified Alien field. Enter the appropriate [disability code] in the Disability/Incapacity field if the client is disabled. See <F1> Help. On the ALAS screen, enter [Y] in Alien Med Emer field. The Alien Med Emer field must be updated at each subsequent certification. For SSI related individuals, enter a [1] or [2] under the ABD Area field on the MISC screen. See <F1> Help. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the S07 eligibility determination. How do I open a COPES S07 AU? To open a COPES S07 AU, take the following steps: If a client is aged, blind, or disabled, screen in as an S02 AU.  See How do I screen an S02 AU? Follow the procedures above for interviewing and processing S07 medical. On the INST screen, enter the [date and Approval source] under the HCB Waiver field. See <F1> Help. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the S07 eligibility determination. Undocumented Alien Pregnancy Medical (P04) The Alien Pregnancy Medical Program P04 is a state-funded medical program for pregnant woman who are not eligible for CN medical due to citizenship or alien status. This program has full scope coverage for pregnant woman. Determine eligibility for pregnant alien children, ineligible for CN, who are under the age of 18 for the children's health program (F08). If ineligible due to income, determine eligibility for the state-funded pregnant woman's program (P04). If an alien pregnant woman is ineligible for the Alien Pregnancy related Medical Program (P04), due to income exceeding 185% of the FPL., look at MN P99, then MI M99. To open P04 medical: Screen in a P04 AU through Option J – Screening off of the (AMEN).  Include all immediate family members in the household. NOTE: In a P04 medical AU only one person can be a (PN). The (STAT) coding for FINL RESP codes should be completed as follows: Pregnant woman [PN] - Applicant Spouse (if married) [SP] - Ineligible Spouse Father of unborn (if not married) [NM] - Non-member Other Children in the household  [SC] - Children used determine household size  NOTE:  The income standard used for P04 will be the total number of household members plus one for each unborn indicated on the (DEM1).

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Modification Date: March 28, 2008

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