To add a person to a canceled case for medical only, code the cancellation Form 552 printout:

  • Item 2 - Except for newborns and filing unit members, enter a 4-digit date (month and year the Form 243 for the person to be added was completed, signed, and filed).
  • For newborns, enter the month and year (4-digit date) of the child's birth. For filing unit members, enter the 4-digit (MM/YY) the person was first eligible and required to be in the case.
  • Item 3 - Enter TA 39.
  • Item 32 - Enter the month and year of ending coverage as a 4-digit date. This date may not be later than the last month of the established 12-month period.
  • Item 33 - Enter TAR 36.
  • Items 60-76 - Enter the correct information for the person being added.
  • Item 77 - Enter the beginning medical eligibility date (MM/DD/YY) as a 6-digit date. Except for newborns and cash filing unit members, this date cannot be more than 3 months before the month of application or month the Form 243 was completed, signed, and filed.
  • Item 78 - or a Moms and Babies or All Kids Assist eligible person being added to the case, enter appropriate code.
  • Item 79 - Enter the correct information for the person being added.
  • Item 80 - For a Moms and Babies or All Kids Assist eligible person, enter the correct countable income code(s), as required (see WAG 27-80-01-f).

A MediPlan Card is produced if this is:

  • a Moms and Babies or All Kids Assist eligible person,
  • a Cash or Assist case, or
  • in spenddown met status for period requested.