PM 17-01-02

New InformationSee Medical Morsel regarding:  Case Progression and When to Approve Applicant for AABD dated 04/11/2014

  1. (FCRC) Consider eligibility for all programs where potential eligibility exists, in the order of the more liberal program (category) first. This is called case progression. If the applicant states in writing that they do not want to apply for a particular program(s), do not determine eligibility for that program(s).

    NOTE: If the applicant is not eligible for the first program, but is for another program, use the original application date to determine eligibility and the effective date. 

    For SNAP, always determine eligibility for SNAP benefits unless the applicant states in writing they do not want them, or the application is: 

    • a Mail-In Application for Medical Benefits, or an All Kids, FamilyCare and Moms & Babies Health Insurance application;
    • an abbreviated reapplication for a spenddown case;
    • an application for medical requesting payment for long term care services; or
    • an application for QMB Only or SLIB Only.
  2. (FCRC) Determine which category is correct for the applicant, based on the information contained on the application. Register the application for that category.
    • Case Progression

      Consider eligibility in the following order: 

      • TANF or AABD Cash
      • RRA
      • text deleted
      • Family Assist
    • If not eligible for any of these programs, proceed as follows based on the status of each applicant:
      • For Pregnant Women:
        • Moms and Babies
        • Family Health Spenddown
      • For Adults not Aged, Blind, Disabled or Pregnant:
        • FamilyCare Assist
        • FamilyCare Share/Rebate
        • FamilyCare Premium/Rebate
        • Family Health Spenddown
      • For Children:
        • All Kids Assist
        • Family Health Spenddown, met for current processing month
        • All Kids Share/Rebate
        • All Kids Premium Level 1/Rebate
        • All Kids Premium Level 2 through 8
        • Family Health Spenddown, met for a month other than the current processing month
          NOTE: Always determine eligibility for Share or Premium before determining eligibility in unmet spenddown status for the current processing month.
      • For Aged, Blind, or Disabled Adults:
        • AABD Medical without a spenddown
        • AABD Medical with a spenddown
        • QMB Only
        • SLIB Only
        • QI-1 Only
  3. (FCRC) Determine eligibility.

    Approve the application for the program that the client is eligible for. 

    1. If the client requests cash and medical, first determine eligibility under the TANF or AABD Program. Also, determine eligibility for QMB benefits.
    2. text deletedDo not make a TANF or Medical determination or send a denial notice, when the youngest child is age 19 or older. Since the applicants do not meet the nonfinancial factor of having a dependent child, a TANF or Medical determination is not required.
    3. When a family is determined eligible to receive under more than one category of assistance (e.g., AABD Medical and one of the Family Health Plans), the applicant does not have to complete a 2nd application. Save the Final CAF in Content Management for all cases, including the primary case and any secondary cases. Cross-reference the case ID numbers on CAF Screen 32A, General Write-up.
    4. If a Mail-in Application for Medical Benefits (Form 2378H), or an Application for Medical - Short Form (Form 2431), is filed, make a determination of eligibility for Medical and QMB benefits.
    5. If an application for only medical assistance is filed and payment for long term care services is requested, make a determination of eligibility for Medical and QMB.
    6. If the application is filed for QMB only, make a determination for QMB. If an applicant is income ineligible for QMB, determine eligibility for SLIB.
    7. If an application is denied because of the client's failure or refusal to cooperate in determining initial eligibility, determine eligibility for all other programs for which the client may be eligible. Deny the application under the program that the client refused or failed to cooperate with.

      Example 1: If the client fails or refuses to cooperate with developing a Responsibility and Services Plan, or fails an interview appointment, deny TANF and determine eligibility for medical benefits.

      Example 2: If the client fails or refuses to cooperate with a request that is not necessary to determine QMB or SLIB eligibility (e.g., the client failed to appear for the application interview or to provide verification of non-questionable income or assets), deny AABD Medical and determine eligibility for QMB Only and SLIB Only.

  4. (FCRC) If the application is registered under one category and is ineligible under that category, but is eligible for other benefits, change the category through AIS or IPACS using TA 62, Change of Category.
    • AIS
      • At the bottom of the financial or nonfinancial screen that shows the denial reason for the case, information about the next program determination is displayed. AIS determines all programs that the case may qualify for, and displays these categories. The next category to be determined is highlighted. AIS also determines if this is the last determination to be made. The caseworker can override this entry.
      • AIS may display a warning that "this is not a final determination" and the sequence of program determinations is displayed. AIS also displays the function keys which allow you to change categories, or deny applications as part of case progression.
        • Step 1. In Option 7 of AIS, on the Change I.D. Screen, enter the original AID (or assistance) requested by the client (e.g., a cash, medical, SNAP request is entered on the screen as follows: C, M, F).
        • Step 2. Enter the new AID request (C, M and/or F) on the Change I.D. screen.
        • Step 3. On the Change I.D. Screen, enter the former case ID number (category, FCRC number, group, basic) originally registered and the new category and group number for the new category determination. The system assigns the basic number for the new category determination.

          NOTE: If a previous number exists for the new category, enter it in this field. 

        • Step 4. Enter on the AIS Miscellaneous Entry Screen the denial TAR for the original category (or program) determination. Press the return key.
        • Step 5. TA 62 and the denial TAR are displayed on the AIS Actions to Be Taken Screen. The denial reason message for every TAR entered in Item 33 is printed on the Form 360C when the final disposition is made.
      • A Form 360C is not centrally sent at the time a TA 62 is processed. The category and denial TAR entered with TA 62 is retained in AIS. The information is passed to the central system when a final disposition is made on the case using TA 11 or 12 for an approval or TA 05 for a denial.
      • When the final disposition is made, Form 360C is centrally sent notifying the client of the approval, and the denial reason for each program (or category) determination that was made. If the applicant is ineligible for all programs, Form 360C notifies the client of the denial reason for each program determination.
    • IPACS
      • To perform case progression via IPACS, a separate TA 62 must be processed for each program determination. The system requires a denial TAR in Item 33 of Form 552 when processing a TA 62, but the TAR(s) is not retained and passed through for the final notice. The EW does the case progression manually. Since the denial reasons are not passed, the EW completes and sends a locally issued notice with the case progression denials and final disposition.
        • Step 1. Change the category through IPACS, by completing a blank Form 552 or a copy of the Form 552 as follows:
          • Item 1 -Enter the entire case ID number (category, Family Community Resource Center, group, basic) originally registered at the bottom of Item 1, and enter the entire new case ID number at the top of Item 1. If a copy of the Form 552 is used, cross out the original number and enter the entire new case ID number at the top of Item 1.
          • Item 2 -Enter the month, day, and year using the original application date.
          • Item 3 -Enter TA 62.
          • Items 5 and 6 -Complete.
          • Items 8-10 -Complete.
          • Item 33 -Enter the correct denial TAR.
          • Item 39 -Enter 80 for Medical or 90 for Cash.
        • Step 2. When the final disposition is made, complete and send Form 360 to the client. In Section *D** of Form 360I advise the client of the denial reason for each program determination that was made. If more than one category is approved, complete and send the correct pages and sections of Form 360 series notifying the client of the programs that have been approved.
        • Step 3. Make copies of the pages and sections of the Form 360 series sent to the client for the case record(s). See WAG 26-02-01 for detailed instructions for completing the Form 360 series.
    • The denial TARs used with TA 62 processed through AIS or IPACS appear on the:
      • Transaction Summary Report produced daily,
      • Final summary page printed by the AIS, and
      • Action Taken Notice Screen.
    • Example: CASE PROGRESSION AND CENTRALLY ISSUED COMBINED NOTICES PROCESSED IN AIS

      Based on the information contained on the application a family initially applies for TANF and SNAP, and is determined ineligible for TANF. Determine eligibility for Medical assistance using the original application date.

      The client is approved for Medical assistance and SNAP. One Form 360C is centrally sent, advising the client of approval of Medical assistance and SNAP benefits and the reason for ineligibility for TANF. Establish one case record. 

      1. (EW) After the applicant is determined ineligible in nonfinancial, go to Option 7 and enter M, F, and the former 06 case I.D. number. Then enter M, F, and the category and group number (94/00) for the new category determination.
      2. (EW) Enter the appropriate cash denial TAR on the Miscellaneous Entry Screen for the TANF denial. TA 62 with the appropriate TAR, is displayed on the Actions To Be Taken Screen.
      3. (AIS) Registers a Category 94 case.
      4. (EW)  Determine eligibility for medical assistance.
      5. (EW) Once eligibility for medical assistance is determined, processes a TA 11 (approval) of medical assistance.
      6. (AIS) Centrally sends one Form 360C notifying the client of the denial reason for TANF and the approval of medical assistance and SNAP.
  5. (AIS/EW) Use TA 05/TAR 42 to deny a Family Health Spenddown case or AABD Medical case if spenddown has not been met for at least one month of the enrollment period.

Identification of Teen Parent Service (TPS) Case

(System) A TPS case is centrally identified upon approval at intake.

A case is identified as TPS if it meets the following criteria:

  • An 04 or 06 case in which the grantee is:
    • age 11 through 19 years and 9 months; and
    • coded 01, 02 or 25 in Item 62, or
    • coded G in Item 28, or
    • coded with an EDD date in Item 60; and
    • coded A, B, C, D, E, F, or dash in Item 71.
  • An 04 or 06 case in which a child on the case is:
    • age 11 through 18 years and 3 months; and
    • coded 6 in Item 69 or
    • coded with an EDD date in Item 60; and
    • coded A, B, C, D, E, F, or dash in Item 71.

When a case is identified at Intake approval as TPS:

  • A message in AIS/IPACS alerts staff that the case has been identified as TPS and must be transferred to the appropriate TPS worker and/or site.
  • A batch exception message is produced by the system. The message says:

TPS case. Transfer it, if appropriate, to the TPS site or worker that handles TPS cases.

When appropriate, send cases identified as TPS to the appropriate site where TPS staff will:

  • transfer the case into the TPS site;
  • code the case to identify it as a TPS case;
  • be responsible for the ongoing casework on the case;
  • monitor completion of the Responsibility and Services Plan (RSP);
  • report the client's progress on their RSP via the Change/Progress Report (Form 2151A); and
  • send the case back to the appropriate Family Community Resource Center when the case is no longer identified as a TPS case.

See PM 14-12-00 and WAG 14-12-00 for specific details concerning TPS cases.