Eligibility Review / Recertification Process
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Eligibility Review / Recertification Process

Revised January 25, 2008

Purpose:

Separate Eligibility Reviews for TANF/SFA Cash and TANF Related Medical

What does “separate eligibility reviews” for TANF/SFA cash and TANF related medical mean?

What programs are affected by this review process?

What is the “eligibility review received” indicator?

What happens to AF F01 AUs with Office/Telephone Interviews if a review is not completed?

What happens to AF F01 & MA F04/F06/F07 AUs with Mail-in Reviews if a review is not completed?

Complete Eligibility Review

Completing Eligibility Review / Recertification After Monthly Issuance Runs in Month Review

Review Done After Monthly Issuance Runs (Deadline) but On or Before the Last Day of the Review Month

Review Form Received After First Day of the Month Following the Month the Review is Due

Eligibility Review Not Completed

Eligibility Review Not Initiated

Eligibility Review / Recertification Process

Cash and Food Assistance Cases

Medical Assistance Cases

Initiate Eligibility Review

Initiate Eligibility Review Process

Select AUs to be Reviewed

Schedule Review / Recertification Appointment

Mid-Certification Review

Who is required to complete a Mid-Certification Review?

What is the Mid-Certification Review?

When is a Mid-Certification Review?

Will the system match up the Mid-Certification Review cycle for related AU's?

When will the system not match up the Mid-Certification Review cycle for related AUs?

What happens when a related application is processed during the month a 022-07 (Mid-Certification Review) is due to be mailed?

What happens when a related application is approved after the 022-07 (Mid-Certification Review) is mailed to the client but prior to the report deadline?

How will I know if an AU is a Mid-Certification Reviewer?

How do I process a Mid-Certification Review no change report with verifications?

How do I process an incomplete Mid-Certification Review or a report with changes?

When is Letter 033-03 (Non-Receipt of Change Report Form) generated?

What happens at monthly issuance if the Mid-Certification Review is incomplete?

What happens at monthly issuance if the Mid-Certification Review has not been received?

Can an AU be manually closed for an incomplete Mid-Certification Review?

What do I do if an application is received after an AU closed for no Mid-Certification Review?

 

Separate Eligibility Reviews for TANF/SFA Cash and TANF Related Medical

  What does “separate eligibility reviews” for TANF/SFA cash and TANF related medical mean?

  • TANF/SFA cash AUs (F01) require an interview every 12 months whereas TANF related medical AUs (F04, F06, and F07) only require that an eligibility review form is received and processed. See WAC 388-434-0005.

  • ACES will indicate when an eligibility review has been received. This indicator assists to support the requirement of extending medical eligibility for TANF, F01, F04, F06, and F07 AUs when a review has been received but not completed.

What programs are affected by this review process?

  • The programs affected are TANF/SFA, F01, F04, F06 and F07.

What is the “eligibility review received” indicator?

  • When an eligibility review form (14-078), is received at DMS (Document Management System), it is scanned in and Barcode notifies ACES in overnight batch.

  • An indicator appears in the Elig Rvw Rcvd field on the (MISC) screen and displays a [Y] signifying the review has been received.

  • The eligibility review indicator will be updated to [Y] when any of the following documents are scanned in DMS:

    • Eligibility Review (14-078)

    • Eligibility Review for Family and Children’s Medical Benefits (13-698 or 22-08)

    • Online CSO Applications (excluding Child Care only)

    • Maternity and Medical Care Applications and Eligibility Review for Long Term Care Benefits (14-416) although there will be no functionality attached to the indicator, as these programs are not included in this process.

  • The only allowable valid values are [Y] and blank.

  • The Elig Rvw Rcvd field is updated on the (MISC) screen for all related AUs where the client ID is the head of household (HOH) and a review is due.

  • The Elig Rvw Rcvd field cannot be updated prior to the review month being the ongoing month.

  • The Elig Rvw Rcvd and review end dates will carry over to the spouted AUs with the exception of F02, F10, and when F07 trickles to F99.

  • The Elig Rvw Rcvd field can also be updated manually by the user.

What happens to AF F01 AUs with Office/Telephone Interviews if a review is not completed?

  • Letter 026-04 (Termination for No ER) generates in overnight batch on the day of the scheduled review.

  • If the eligibility review has been received but not completed:

  • If the eligibility review has not been received:

 

What happens to AF F01 & MA F04/F06/F07 AUs with Mail-in Reviews if a review is not completed?

  • If the eligibility review has been received but not completed:

    • Letter 026-04 (Termination for No ER) will NOT be generated.

    • At monthly issuance, the AUs will remain active.

    • The AU retains the same “Eligibility Review Received” and expired review end date values.

    • Alert 110 generates in overnight batch.

  • If the eligibility review has not been received:

    • Letter 026-04 (Termination for No ER) generates 15 days prior to the end of the month.

    • At monthly issuance the AU will close for Reason Code 235 – Review not Complete.

    • Alert 268 generates in overnight batch if the AU contains an active client who is pregnant.

    • Alert 269 generates in overnight batch if the AU contains an active child who is less than 1 year of age.

 

Complete Eligibility Review

  1. Enter Option [A] - Assistance Unit / Client - in the Selection field on the (WMEN). 

  2. <TRANSMIT> and ACES displays the (AMEN).

  3. Enter Option [R] - Interim / Hist Change in the Selection field on the (AMEN).

  4. Enter the [AUID or CLID] for the head of household selected for review, in the AU ID and Client ID field, whichever is appropriate.

  5. To go to a specific screen enter the [screen ID] in the Screen ID field.

  6. <TRANSMIT> and ACES displays the (REVI) which lists all AUs due for review with the same head of household.

  7. Enter [Y] in the SEL field next to each AU to be reviewed.

  8. <TRANSMIT> and ACES displays the specific screen indicated, or if no screen identifier is entered the head of household's (ADDR).

  9. Enter information as needed to update the case based on information reported during the review / recertification interview.

  10. Re-enter all required verification codes.  See EA-Z Manual - Applications - C. - Information Needed to Determine Eligibility - WAC 388-406-0030   

    1. During an eligibility review / recertification all eligibility factors relevant to that AU must be re-verified.

    2. ACES requires that the verification codes be reentered to confirm this has been done.

    3. The Elig Rvw Complete field on the (MISC) cannot be updated until all eligibility factors have been re-verified and the appropriate valid values are entered in the system.

  11. When all information has been updated in the case, and the eligibility review is complete, update the Elig Rvw Complete field on (MISC) by entering a [Y].

  12. Enter [DONE] in the Screen ID field in the upper right corner of the screen.

  13. To save the changes to the database, <TRANSMIT>.

    1. An eligibility recalculation is done based on information entered during the review process.

    2. Any changes in case status or benefit amounts will display on (ELIG), (CAFI), and / or (FSFI).

    3. Review the information, confirm benefits, and commit the data.

    4. ACES sends Letter 0027 - Recertification - or a change letter based on what has changed in the case.

 

Completing Eligibility Review / Recertification After Monthly Issuance Runs in Month Review

To complete an eligibility review, or recertification for cash and food assistance cases, in which the eligibility review / recertification is not completed until after monthly issuance runs for the month in which the review is due, follow this procedure.See  WAC 388-418-0020.

Review Done After Monthly Issuance Runs (Deadline) but On or Before the Last Day of the Review Month

Before the review can be completed, both the ongoing and historical month must be reinstated. To ensure the certification period is set correctly, workers should always process the oldest month first. See Reinstatement.

  1. Once the AU is active, enter Option N - Initiate Review in the Selection field on the AMEN.  You cannot enter a benefit month when entering Option N - Initiate Review. The review is always initiated in the ongoing month.

  2. Enter the [CLID for the head of household of the AU to be reviewed] in the Client ID field. When initiating a review you must enter the CLID not the AUID.

  3. <TRANSMIT> and ACES displays the REVI.

  4. The  REVI lists all AUs with the same head of household due for review.

  5. Enter [Y] in the SEL field next to each AU to be reviewed.

  6. <TRANSMIT> and ACES returns to the AMEN.

  7. Enter Option R - Interim Historical Change on the AMEN. Update case information as needed.

  8. Update the Elig Rvw Complete field on the MISC.

  9. On the CAFI, the REV BEGIN DATE will be the same as the ongoing month and the REV END DATE will default based on program requirements. For most cases, this means the certification period includes one extra month.

  10. Commit and finalize the data.

Follow this same process if the eligibility review / recertification is done on the first day of the month following the month in which the review is due.

Review Form Received After First Day of the Month Following the Month the Review is Due

Do not reinstate the AU in this situation. When the review is not received until after the month it is due, the review should be handled as a new application. Reopen benefits effective the date you determined they were eligible. See Screening - ACES.ONLINE, Re-Open.See  WAC 388-418-0020.

 

Eligibility Review Not Completed

  • Verification factors not completed during the review process will be shown on an (ERRO), which displays screen names, and AU / Client pointers that must be reviewed.

  • If ACES finds any missing verification, the (VERF) will be displayed.

  • Verifications are tracked by AU. A separate (VERF) will be shown for each related AU with missing verifications.

  • ACES will not allow you to indicate an eligibility review is complete, unless all required verification codes have been reentered.

  • Enter any missing verification codes on the appropriate data screens.

  • When the client must provide information to complete the review do not update the ELIG RVW COMPLETE field on the (VERF) until all verification is received and eligibility for assistance has been reestablished.

  • When there is missing verification, ACES generates Letter 0023-01, Missing Verification for Interview.  See Letters.
     

Eligibility Review Not Initiated

When an appointment has been scheduled through ACES, but the review is not initiated, the day after the appointment the user gets Alert 312 - ER / Recert Sched on Previous Working Day - Not Initiated.

If the review is not initiated before monthly issuance runs for the month in which the review is due the case will:

  1. Close for Reason Code 235 - Failure to Recert,

  2. Be sent Letter 0026 - Termination for No ER, and

  3. Generate Alert 351 - AU Terminated / Closed Overnight
     

Eligibility Review / Recertification Process

  1. The on-line eligibility review / recertification (ER / RC) process is the procedure by which the user:

    1. Initiates an eligibility review;

    2. Enters any changes with required verification based on the household's current circumstances; and

    3. Extends the certification period

  2. ACES supports the eligibility review process by:

    1. Scheduling appointment  See Scheduling - Schedule an Eligibility Review / Recertification Appointment for A Client.

    2. Tracking the initiation and completion of eligibility review

    3. Allowing on-line entry of eligibility review information

    4. Initiating required interfaces and referral

    5. Identifying required verifications

    6. Sending alerts and notices

  3. The eligibility review / recertification type is determined based on the valid value entered in the NEXT REVIEW field on the (MISC).   For eligibility review / recertifications there are three possible review types.

  • M = Mail-in Review (not valid for cash and / or food assistance cases)

  • O = Office Review 

  • T = Telephone Review 

  1. At the time a new application is finalized the review type defaults to [O], Office Review.  The review type can be changed.


NOTE: The review type cannot be changed when the system has tentatively scheduled a review appointment.

See WAC 388-434-0005, WAC 388-434-0010 , and WAC 388-416-0010 through WAC 388-416-0035.  

 

Cash and Food Assistance Cases

  1. The SLAM indicator is used to indicate whether or not a client is suspected of living above their means.  Each CSO and Region determines criteria for the SLAM profile.

    At each eligibility review the SLAM indicator on the (MISC) must be updated. The user gets a soft edit and then an error on the (ERRO) if trying to commit data and the SLAM indicator is not updated.

  2. If the review is not initiated and completed prior to the date monthly issuance runs (deadline) the case closes at the end of month that the review was due with Reason Code 235 - Failure to Recert.

  3. If the review is initiated but not completed the AU will:

    1. For a food assistance AU, the case will close at the end of the certification period.

    2. For a cash or medical AU, the case will NOT close. Users should not initiate the review until they are sure all information has been received or unless user generated alerts are set to track the case and ensure it is closed prior to monthly issuance if the required information is not received.

  4. When the AU is closed prior to the date monthly issuance runs (deadline) no benefit will be issued for the ongoing month.

  5. To do the review after monthly issuance runs for the month in which the review is due the AU must first be reinstated.  See Reinstatement.

See WAC 388-434-0005 and WAC 388-434-0010. 

Medical Assistance Cases

  1. When a recertification is due on a medical assistance unit ACES sends Letter 0022 - Redetermination for Cash / Medical (Non- LTC Recipients), and a DSHS 14-078 (X) Eligibility Review form.

  2. If the assistance unit on which the review is due was in active (A) status and is C99, F99, G99, K99, L99, P99 or S99 the previous AU can be reopened.

  3. If the AU is in (M) status, a new AU must be screened for the next base period.

See WAC 388-416-0010 through WAC 388-416-0035.  

 

Initiate Eligibility Review

Process

  1. Enter Option [A] - Assistance Unit / Client in the Selection field on the (WMEN). 

  2. <TRANSMIT> and the (AMEN) displays.

  3. Enter option [N] - Initiate Review -, in the Selection field on the (AMEN).

  4. Enter the [CLID for the head of household of the AU to be reviewed] in the CLIENT ID field. When initiating a review you must enter the CLID not the AUID.

  5. You cannot enter a benefit month when entering Option [N] - Initiate Review. The review is always initiated in the ongoing month.

  6. <TRANSMIT>.

Select AUs to be Reviewed

When initiate a review is done for a cash or food assistance AU, a review will also be initiated for an associated medical coverage group

  • F04, TANF related Categorically Needy;

  • F06, Children's Medical;

  • F08, Undocumented Alien Children's Medical;

  • H01, General Assistance Legal Guardian;

  • S02, SSI Related Categorically Needy;

  • S03, QMB; and

  • S05, SLMB.

  1. ACES displays the (REVI).

  2. The (REVI)  lists all AUs with the same head of household due for review.

  3. Enter [Y] in the SEL field next to each AU to be reviewed.

  4. <TRANSMIT> and ACES returns to the (AMEN).

    Selecting an AU on the (REVI) tells ACES to

    • Update the REVIEW BEGIN DATE,

    • Start tracking the eligibility review completion time, and

    • Identify the data that needs to be re-verified.
       

Schedule Review / Recertification Appointment

See Scheduling - Schedule Review / Recertification Appointment for a Client.

 

Mid-Certification Review

Who is required to to complete a Mid-Certification Review?

What is the Mid-Certification Review?

  • The Mid-Certification Review (Mid-Certification Review Form 022-07) is a letter that is auto populated with client information.

  • Clients are required to return the report indicating if any circumstances have changed. See EAZ Manual Reporting Requirements WAC 388-418-0005 How will I know what changes I must report?

  • ACES creates the Mid-Certification Review using static and conditional text to confirm circumstances and ask questions necessary to determine ongoing eligibility and benefits for the benefits clients receive.

  • If a question is not relevant to the benefits a client receives, ACES will not add the question to the Mid-Certification Review.

When is a Mid-Certification Review Generated?

  • The Mid-Certification Review is auto generated the day after monthly issuance (deadline) in the 5th month from the begin date.

  • The Mid-Certification Review is due back by the 10th day of the 6th month.

Will the system match up the Mid-Certification Review cycle for related AU's?

  • If cash, family related medical or Basic Food is approved in different months and matching the cash or family medical end dates to the end date for Basic Food will give the cash or family medical a review end date of at least 6 months, the system will match up the  Mid-Certification Review cycle.

  • A single report will be sent at the end of the 5th month of the Basic Food AU certification period to be completed and returned in the 6th month).

When will the system not match up the Mid-Certification Review cycle for related AU's?

  • If matching the cash or family related medical AU end dates to the end date for Basic Food will give the cash or family medical a review date of less than 6 months, the system will not match up the 6-month review cycle.

  • The cash/family medical AU will receive a separate Mid-Certification Review.

  • The user has the option of initiating a review on the Basic Food AU which will match up the Mid-Certification Review cycle to the newly opened cash or family medical AU.

What happens when a related application is processed during the month a 022-07 Mid-Certification is due to mailed?

  • Processing the related application will be considered a completed Mid-Certification Review and no Letter 022-07 will be mailed.

What happens when a related application is approved after the 022-07 Mid-Certification Review is mailed to the client but prior to the report deadline?

  • The system will consider the Mid-Certification Review as complete and automatically update the Report Cmplt field on the MISC  screen to <C> (Complete) to prevent the termination of the related AU.

How will I know if an AU is a Mid-Certification Reviewer?

  • Mid-Certification Reviewers are identified on the STAT screen in the Rpt Stat field. This field will only appear on the STAT  screen if the AU is a Mid-Certification Reviewer (indicator ‘S’) or a quarterly reporter (indicator ‘Q’). See <F1> Help.

  • The Rpt Stat field will always appear on theCAFI,  MAFI, and/or  FSFI screens. See <F1> Help.

  • The exempt reason field on theCAFI,MAFI, and/orFSFI screen will be automatically updated by ACES to identify the reason an AU is a non-reporter. See <F1> Help.

How do I process a Mid-Certification Review no change report with verifications?

  • Mid-Certification Reviews returned with no reported changes and all required verifications are processed in aces.online using the 6 Month No Change Report function. This function can be accessed in two ways:

  1. From the Welcome Back page in aces.online, use the Quick Navigation section to do the following:

    • Enter a Client ID number in the Enter an ID box.

    • From the Select a Page drop down box, click on the 6 Month No Change Report option.

    OR

    • From the ClientSummary page, select the Case Maintenance link and then click 6 Month No Change Report.

  2. When the 6 Month No Change Report option is selected, a pop-up page, ACES Update, appears and lists all AUs that the client is the HOH for and that have a Mid-Certification Review due.

  3. If there are no related AUs with a Mid-Certification Review due or the client is not a Mid-Certification Reviewer, the error message “No related AUs qualify to process for Simplified Review” will appear.

  4. The date field defaults to the current date. A new date can be entered in the space provided or selected from the calendar.

  5. Once completed, click on the “Save” button for the system to process the entered date.

  6. A second pop-up page appears with links to Additional Functions View Case Narrative and Take me to Letters List.

  • This process automatically updates the Date Report Rec’d and Report Complt fields on theMISC screen in ACES.

  • The ACES narrative is automatically updated with one of the following entries:

    • Cases that include a Food Assistance AU: “Mid-Certification Review form received. Client states circumstances have not changed. Case processed and finalized. Letter 0010-01 sent for Basic Food.”

    • Cases that don’t include a Food Assistance AU: “Mid-Certification Review form received. Client states circumstances have not changed. Case processed and finalized.”

  • ACES generates one LTR 010-01 (No Change in Benefit) for all related AUs. However, relevant data from all the related AUs is combined and displays as a pending letter separately for each AU.

How do I process an incomplete Mid-Certification Review or a report with changes?

  1. FromAMEN, access the AU via Option R – Interim/Hist Change.

  2. If changes have been reported, enter the information as required on the appropriate screens.

  3. On theMISC screen, enter date in the Date Report Recd field and update the Report Cmplt field with the appropriate code. See <F1> Help.

    • When Mid-Certification Review is processed through Option R – Interim/Hist Change, theMISC screen will need to be updated for each AU separately.

    • When a returned Mid-Certification Review is processed as incomplete, ACES generates LTR 023-02 (General Request for Information or Action) to request more information from the client.

  4. Enter [DONE] in the Screen ID field in the upper right corner, update theNARR screen and <TRANSMIT>.

When is Letter 033-03 (Non-Receipt of the Change Report Form) generated?

  • LTR 033-03 serves as 10-day Notice and the Termination Letter. It is generated on or about the 18th of the month in the 6th month if theMISC screen Report Cmplt field displays the following valid values:

    • S - Report Sent Not Returned

    • I - Report Returned Incomplete

    • W - Report Ret Incomplete/No Wage Verification

What happens at monthly issuance if the Mid-Certification Review is incomplete?

If the Report Cmplt field onMISC screen indicates the report is still incomplete at monthly issuance of the 6th month the report will be process differently for different programs.

What happens at monthly issuance if the Mid-Certification has not been received?

  • TANF/SFA, Basic Food, GA and medical AUs will close for Reason Code 141 – Mid-Certification Review not returned.

Can an AU be manually closed for an incomplete Mid-Certification Review?

  • Yes, an AU can be manually closed for Reason Code 542 – Incomplete 6-month report.

  • When an AU is closed for Reason Code 542, the AU will not trickle or sprout.

What do I do if an application is received after an AU closed for no Mid-Certification Review?

When a client submits a new application after their case closed for failing to return a 6-month report (Reason code 141 or 142) the client has the choice of either completing the application, or withdrawing the application and completing the 6-month report. See EAZ Manual, Change of Circumstance, Reporting Changes for more information.

When you receive a new application in this situation, take the following steps:

  1. Screen a new AU for the application. See Screening a Client.

    • Do not re-open the AU that closed for reason 141 or 142, you will need to use this AU if the client chooses to complete the 6-month report.

  2. Contact the client to offer them the choice of withdrawing this application and completing the six-month report or completing the application process.

  3. If the client chooses to complete the application:

  4. If the client chooses to withdraw the application and complete the 6-month report, take the following steps only when you have all the necessary information/verification to complete the 6-month report:

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Modification Date: January 25, 2008
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