- HFS Medical Cards are Issued When:
- Replacing an HFS Medical Card
- Customer Automated Voice Response System (AVRS)
HFS Medical Cards (Form 469) are centrally generated for each case eligible for medical assistance under the following categories: 01/02/03/04, 00/90, 91/92/93/94, 98 and P3/P4/P6. A person who receives Rebate does not receive a medical card. Two or more medical cards may be sent when all eligible persons in the case cannot be listed on one card due to the the number of persons in the case.
The medical cards do not contain beginning and end dates; therefore, they do not guarantee eligibility or payment for medical services for a specified time period.
Medical providers must always verify a person's eligibility prior to providing medical services whether or not the client is able to present a medical card. If the client does not have their HFS Medical Card, but has another form of identification and can provide their medical card ID number (also called Recipient Identification Number or RIN), or can give their social security number and date of birth, providers can verify eligibility electronically or through the provider Automated Voice Response System (AVRS).
HFS Medical Cards are Issued When:
- a medical case is approved,
- a person(s) is added to or deleted from the medical case,
- a REDE or renewal is processed,
- a person's name or date of birth is corrected on a medical case, and
- a duplicate card is processed at the client's request.
||Type Actions for which a medical card is generated:
||TAR - Reason
||Approve and cancel
- 45, 47, 49 - MPE approval
- 81 -postpartum woman or deceased or adopted child
- B9 -noncitizen pregnant woman
- F2 - IHW approval when woman was not on prior medical case
- C3 & C4 - IHW renewal
||any except TAR 98 - all reapplications other than 'quick reinstatements'
||Resumption with a new payee
||REDEs & renewals
||Change or correction of information
- when the name is changed or corrected for a person on a medical case, or for the payee of a medical case; or when the REDE date in Item 30 is changed
- 71 - when premiums are paid on an enrolled All Kids Share or Premium case and the system changes the case from enrolled to active status
||Change in unit members
||Actions on a canceled case
||36 - used to add a person for medical to a canceled or medical extension case
||Transfer-in of active case
||only when a payee's name is changed or corrected
||Transfer between category 04 & 06 or 94 & 96
||only when a person is added or deleted from the case with this TA
||Replace medical card
||TAR 03 or with no TAR - used to replace a card
Replacing an HFS Medical Card
When a client reports that their HFS Medical Card is lost or was not received, staff can issue a replacement using TA 55 in the same way that monthly medical cards were replaced (see WAG 22-02-01). Clients may request a replacement by contacting their DHS or HFS worker, or by calling the DHS Customer Help Line or the HFS Health Benefits Hotline.
It is important to let clients know that, if they are eligible for HFS covered medical services, medical providers can provide services to them even if they do not have their medical card with them.
Customer Automated Voice Response System (AVRS)
The HFS Medical Card contains a toll-free number (1-855-828-4995) for clients to call to verify their own, or a family member's, eligibility. The number connects to an Automated Voice Response System. Clients will need to enter the 9-digit HFS Medical Card identification number (also know as the RIN number) of the person for whom they are checking eligibility.
Since HFS Medical Cards do not guarantee eligibility for a specific time period, customers may need to verify their eligibility for services prior to seeing a provider or filling a prescription. This is especially important for spenddown clients who are used to receiving a medical card only for periods in which spenddown is met. They will have to rely more on notices of decision and notices of spenddown met.