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ACES
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Revised June 3, 2008 |
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Categorically Needy Newborn Medical (F05) Categorically Needy Children's Medical (F06) Children's Health Insurance Program-CHIP (F07) Children's Health Program (F08) | ||
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Categorically Needy Newborn Medical (F05) Who is eligible to receive F05 Medical?
How long is the F05 certification period?
How do I process a pending F05 medical?
When will the F05 MAID be issued?
What medical is the newborn covered under during the post partum period?
Who is eligible to receive F05 Medical?
· A child under the age of one is eligible for categorically needy (CN) Newborn Medical assistance when:
o The child's mother was eligible for and receiving coverage under a medical program at the time of the child's birth; and
o The child remains with the mother and resides in the state.
· See EAZ Manual – WAC 388-505-0210 Children's medical eligibility .
How long is the F05 certification period?
· The F05 medical program may be certified up to 12 months, through the end of the month of the child’s first birthday.
To screen a F05 AU, take the following steps:
1. 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.
2. On the Applicant page enter the head of household’s Name, Residential and Mailing Addresses.
3. On the Programs page,
o Click the checkbox next to Medical, and
o Click the Next button.
4. Continue the screening process until you reach the Finalize page.
o If the medical program does not contain F05 Coverage Group, click the Specify Program button. The Finalize – Program Details page displays.
o On the Finalize – Program Details page, select Medical Assistance (MA) from the Program drop-down box, and
o Select Newborns (F05) from the Medical Coverage Group drop-down box, and
o Click the Next button.
o See Screening - aces.online, Screening a Client for additional information on completing screening.
5. On the Finalize page:
o Click the checkbox next to the F05 program.
o Enter the newborn’s Date of Birth in the application date field.
o Click the Commit button to commit the screening data. | ||
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How do I process a pending F05 medical?
To process a pending F05 take the following steps:
1. On the AMEN, select Option O – Interview in the Selection field.
2. On the STAT screen, complete the Finl Resp field as follows:
o [PN] – Applicant for the newborn.
o [IP] – Ineligible Person for the parents financially responsible to the newborn.
o [SC] – SSI Child/Child of SSI Related Parents/Child used to determine Family Size for the siblings of the newborn.
o [NM] – Not Related and Not Financially Responsible to the Applicant for members of the household not part of the newborn’s family.
3. Complete the interview following instructions in the Interview chapter.
4. After committing the interview data, follow instructions in the Process Application Month chapter for all pending months. | ||
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5. When all pending months have been processed, follow instructions in the Finalize Application chapter to complete the F05 application process.
When will the F05 MAID be issued?
· The F05 MAID issues the month after the 60th day following the birth of the baby. The 60 day count begins on the baby's birthday as entered in the DOB (MMDDYY) field on the DEM1 screen.
What medical is the newborn covered under during the post partum period?
· The newborn is covered under the mother’s medical from the time the baby is born until the first medical ID card is issued. | ||
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Categorically Needy Children's Medical (F06) Who is eligible to receive F06 medical?
Can a child be eligible for F06 if the household’s income exceeds F06 income standards?
How long is the F06 certification period?
How do I process a pending F06 AU?
Who is eligible to receive F06 medical?
· Children under the age of 19 are eligible for F06 when they meet certain requirements. See EAZ Manual – WAC 388-505-0210 Children's medical eligibility.
· Children under the age of 21 are eligible for F06 when they meet certain requirements. See EAZ Manual – WAC 388-505-0210 Children’s medical eligibility.
· For income standards see EAZ Manual – WAC 388-478-0075 Medical programs -Monthly income standards based on the federal poverty level (FPL).
Can a child be eligible for F06 if the household’s income exceeds F06 income standards?
· Children may be eligible for F06 as a separate Medical Assistance Unit (MAU) when certain conditions exist.
o See EAZ Manual, Assistance Units - Medical Programs and Medical, Sneede vs. Kizer Medical for those conditions and instructions concerning financial responsibility and the establishment of separate MAUs as required by the Sneede vs Kizer Ninth Circuit Court decision.
· Children who are not eligible to receive F06 medical, may be eligible under another program:
o If all F06 eligibility requirements are met other than income, a child may be eligible for coverage under the Children’s Health Insurance Program-CHIP (F07) or the Children’s Medically Needy Program (F99).
o A child who receives SSI benefits is eligible to receive medical coverage under the S01 program. See SSI Medical (S01).
o An SSI-related child may be eligible to receive medical coverage under the S02 or S99 programs. See SSI Related Medical.
· Children who were previously approved for certain medical benefits within the last 12 months may be eligible for continuous eligibility. See Continuous Eligibility for Categorically Needy Childrens Medical.
How long is the F06 certification period?
· The F06 medical program is certified for 12 months.
· A child’s certification ends at the end of the month the child turns 19, even if the 12 months is not over.
o The certification may extend beyond the end of the month of the child’s 19th birthday when certain conditions are met. See EAZ Manual – WAC 388-416-0015 Certification periods for categorically needy (CN) scope of care medical assistance programs .
· See EAZ Manual – WAC 388-416-0015 Certification periods for categorically needy (CN) scope of care medical assistance programs for additional information.
· Changes during the certification period that affect eligibility should be processed according to EAZ Manual – WAC 388-418-0025 Effect of changes on medical program eligibility.
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To screen an F06 AU, take the following steps:
1. 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.
2. On the Applicant page:
o Enter the head of household’s Name, Residential and Mailing Addresses.
o Click the AREP/Payee checkbox if you will be entering an Authorized Representative or Payee to the case. For instructions to add an Authorized Representative, see Screening – aces.online, Authorized Representatives.
o Click the Next button.
3. Complete the address validation process.
o See Screening – aces.online, Address Validation for additional instructions on this process.
4. On the Programs page:
o Click the checkbox next to Medical.
o Click the Next button.
5. Continue the screening process until you reach the Finalize page.
o See Screening - aces.online, Screening a Client for additional information on completing screening.
6. On the Finalize page:
o If the household contains both children and adults, the default program will be F04. Click the checkbox next to the F04 program if you need to determine eligibility for the family as one MAU.
o If you have already determined the family is not eligible as one MAU and wish to screen an F06 AU rather than F04, use the Specify Program option to select the F06 program.
o Enter the application date.
o Click the Commit button to commit the screening data.
How do I process a pending F06 AU?
To process a pending F06 AU take the following steps:
1. Select AMEN, Option O – Interview.
2. On the STAT screen, enter [PN] – Applicant in the Finl Resp field for each applicant.
o See Medical, Sneede vs. Kizer Medical for instructions on coding the STAT screen when Sneede vs. Kizer rules apply to the AU.
o See EAZ Manual, Assistance Units - Medical Programs for information on who must be included in the AU.
3. Complete the interview following the instructions in the Interview chapter.
4. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.
5. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the F06 eligibility determination.
o If all F06 eligibility requirements are met other than income, the F06 AU may trickle to Children’s Health Insurance Program - CHIP (F07) or the Children’s Medically Needy Program (F99) program during finalize. See Trickle and Sprout for additional information . | ||
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Children's Health Insurance Program-CHIP (F07) Who is eligibile to receive F07 medical?
How long is the F07 certification period?
How do I process a pending F07?
What are the premium requirements for F07 medical?
Who is eligible to receive F07 medical?
· Children under the age of 19 are eligible for F07 when they meet the requirements described in EAZ Manual – WAC 388-505-0210 Children's medical eligibility.
· Children under the age of 21 are eligible for F07 when they meet the requirements described inEAZ Manual – WAC 388-505-0210 Children's medical eligibility.
How long is the F07 certification period?
· F07 medical is certified for twelve months.
· When the child turns nineteen the certification period ends even if the twelve-month period is not over.
· The certification may extend beyond past the end of the month of the child’s 19th birthday when the conditions of WAC 388-416-0015 Certification periods for categorically needy (CN) scope of care medical assistance programs are met.
1. An F07 AU is initially screened into ACES as an F04, F06, or F09 AU, following the instruction in Screening – aces.online.
2. An F04, F06, or F09 AU will trickle to a pending F07 during Finalize Application, if appropriate, when the AUs countable income exceeds the 200% Federal Poverty Limit (FPL) but does not exceed the 250% FPL.
o The pending F07 AUTO transfers to CSO 076 in overnight batch and Alert 218 – CASE (S) TRANSFERRED TO THIS CASELOAD generates.
o MEDS CSO 076 financial workers are the only ones who can process the pending F07 cases.
o After CSO 076 has determined eligibility for F07, the active cases are maintained there as well.
How do I process a pending F07?
To process a pending F07 take the following steps:
1. Select AMEN Option O - Interview. Follow the steps detailed in the Interview chapter.
2. On the STAT screen, enter [PN] – Applicant in the Finl Resp field for each applicant.
o See Medical, Sneede vs. Kizer Medical for instructions on coding the STAT screen when Sneede vs. Kizer rules apply to the AU.
o See EAZ Manual, Assistance Units, Medical Assistance Units for information on who must be included in the AU.
3. On the Chip Enrollment CHIP screen, answer the seven questions. These questions on the CHIP screen are part of the eligibility determination process for F07 medical.
4. On the MISC screen:
o Make an entry in the BHP Plus field. See <F1> help.
o Enter your User ID in the User field.
5. Complete the interview following the instructions in the Interview chapter.
6. Complete the interview following the instructions in the Interview chapter.
7. After committing the interview data, follow the instructions in the Process Application Month chapter.
8. Finalize the F07 from AMEN thru Option Q – Finalize. See Finalize Application chapter.
What are the premium requirements for F07 medical?
· Children receiving F07 medical are required to pay premiums and enroll in managed care.
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Children's Health Program (F08)
Who is eligible for F08 medical?
Who is required to pay premiums?
How are F08 monthly premiums calculated?
How do clients pay their F08 premiums?
How long is the certification period for F08?
How are shared cases between CSOs and MEDS processed?
· The Children's Health Program (CHP) F08 is for children under the age of 19 who are not eligible for Medicaid due to citizenship and whose countable income is at or below 250% if the Federal Poverty Level (FPL).
· See EAZ Manual - WAC 388-505-0210 Children’s healthcare programs.
Who is eligible for F08 medical?
· Non-citizen children under the age of 19 are eligible for F08 when they meet the requirements described in EAZ Manual - WAC 388-505-0210 Children’s healthcare programs.
Who is required to pay premiums?
· Families with income between 200% - 250% of the FPL will be required to premiums.
How are F08 monthly premiums calculated?
· The amount of the premiums will be based on the same rules used to determine F07 premium amounts. See EAZ Manual - WAC 388-505-0211 Premium requirements for premium-based children’s healthcare programs.
How do clients pay their F08 premiums?
· 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.
· Changes during the certification period that affect eligibility should be processed according to EAZ Manual - WAC 388-418-0025 Effect of changes on medical program eligibility.
To screen an F08 AU, take the following steps:
1. 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.
2. On the Applicant page, enter the applicant's (head of household) Name, Residential and Mailing Addresses.
3. Continue with the screening process until you reach the Programs page.
4. On the Programs page:
o Click the checkbox next to Children's Health Program; or
5. On the Finalize page, click the Specify Program button.
6. On the Program Details page:
o From the Program drop-down list, select Medical Assistance (MA).
o From the Medical Coverage Group drop-down list, select Children's Health Program (F08).
7. Complete the screening process. See Screening a Client.
To process a pending F08 AU take the following steps:
1. Through Option O - Interview, follow the steps detailed in the Interview chapter.
2. Household members must be coded correctly on the STAT screen for ACES to determine the correct income standard to use based on household composition.
o 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. | ||
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o If you are processing a case with Sneede Kizer characteristics, see Sneede vs. Kizer Medical.
1. Process all months through Option P - Process Application Months. See Process Application Month chapter.
2. Finalize the F08 through Option Q - Finalize. See Finalize Application chapter.
How are shared cases between CSOs 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. | ||
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Children’s Medically Needy Program – F99
How long is the F99 certification period?
How do I authorize spenddown for an F99 AU in M Status?
How do I enter spenddown medical expenses for an F99 AU in M status?
· Children under the age of nineteen are eligible for Medically Needy (MN) medical assistance when they meet citizenship immigrant status, social security number requirements and have income over 250% of the Federal Poverty Level (FPL).
· See EAZ Manual – WAC 388-505-0210 – Children’s healthcare programs.
How long is the F99 certification period?
· F99 AUs default to a six-month certification period but can be shortened to three-month certification periods.
· See EAZ Manual – WAC 388-519-0110 Spenddown of excess income for the medically needy program.
1. While pending, the AU remains an F04, F06, F07 or F09 and is processed through Interview and Process Application Months.
2. The F04, F06, F07 or F09 AU that is denied due to income in excess of 250% FPL trickles to an F99 in M – Pending Spenddown status during Option Q – Finalize Application.
How do I authorize spenddown for an F99 AU in M status?
· To authorize spenddown on an F99 AU in M status, follow the instructions in Spenddown Processing.
How do I enter spenddown medical expenses for an F99 AU in M status?
· To enter medical expenses to meet the client’s spenddown liability on an F99 AU in M status, follow the instructions in Spenddown – Enter Spenddown Medical Expenses.
· After updating the medical expenses, you must authorize the spenddown again by choosing Option V – Spenddown Authorization.
· See EAZ Manual – WAC 388-519-0110 Spenddown of excess income for the medically needy program. | ||
