PM 06-08-05

IES Phase 2 Process

The family must sign a Request for Medical Benefits for Another Family Member(s) (Form 243A-C) to have a child added to an All Kids Share or All Kids Premium case deleted text. This also applies to newborns. The family can also request prior coverage to cover the newborn up to 2 weeks prior to the date the request was signed.

When there is no reported change in income and the household is not due or overdue for a REDE, proof of household income is not required if the increase in the EDG size resulting from the addition causes the siblings to qualify for a less costly medical program. See PM 18-05-10.

revised text(IES) When the child is added to the case by the FCRC or the All Kids Unit, Notice of Decision deleted text (Form 360C) is centrally generated notifying the family of the approval.

deleted text (IES) If the child is not eligible to be added to the case, Notice of Decision (Form 360C) is centrally generated notifying the family of the denial.

revised text Example 1: The R family receives Share. On 12/14/16, the worker receives Form 243A-C requesting medical coverage for the newborn. The newborn was not counted in the family size because the worker was unaware of the pregnancy until the baby's birth was reported. The newborn does not have countable income under MAGI budgeting. See PM 15-06-01-h. Approve the newborn's request for medical coverage if eligible. The children on the case are eligible for All Kids Assist due to the increase in the EDG size. Proof of household income is not required unless Ms. R reported a change in household income or is due or overdue for a REDE.  The newborn can qualify for up to a 3 month backdate or back to the date of birth whichever is later under All Kids Assist.

revised text Example 2: The P family receives Share for their son. On 12/15/16, Mr. P brings in Form 243A-C to request medical coverage for his daughter. Mr. P asks that eligibility for Assist be determined because of the change in family size.

Mr. P does not report a change in income. Income listed in IES indicates that the children are eligible for Assist beginning 12/16. Certify the results in IES for Assist for both children effective 12/16.

revised text Example 3: The Q family receives Share for their son. On 12/16/16, the All Kids Unit receives Form 243A-C to request medical coverage for their daughter and asks that eligibility be reviewed due to the change in family size.

The daughter is expected to be required to file a tax return based on her own income. The MAGI calculation puts the children in Premium Level 1. Certify the daughter in Premium Level 1. Leave the son in the Share case until the next renewal due to continuous eligibility.

revised text Example 4: The S family receives Premium Level 1 for their daughter. On 11/10/16, the FCRC receives Form 243A-C to request medical coverage for their son. The son does not have any countable income under MAGI.  However, the increase in EDG size is not enough to qualify for Share.  Add the son to the Premium case effective 12/16. The premium increases from $15 to $20 effective 12/16.

Refer to PM 06-08-03-e for information about prior coverage when adding a child to an All Kids Share or Premium case.

Legacy Process

The family must sign a Request for Medical Benefits for Another Family Member(s) (Form 243C) to have a family member added to an All Kids Share or Premium case. This also applies to newborns.

(System) When the child is added to the case by the FCRC or the All Kids Unit, Notice of Decision for Addition of a Family Member (Form 3718) is centrally generated notifying the family of the approval.

(FCRC/All Kids Unit) If the person is not eligible to be added to the case, send a manual Form 3718.

Example 1: The R family receives Share. On 12/13/07, the worker receives Form 243C requesting to add Ms. R's newborn to the Share case. Add the newborn to the Share case effective 01/08. Do not review income unless Ms. R asks to be considered for Assist or Moms & Babies. If Ms. R wants her child to be considered for Assist or Moms & Babies, she must provide current verification of income.

The family can request prior coverage to cover the newborn from 11/29/02 (2 weeks prior to the date the request was signed).

Example 2: The P family receives Share for their son. On 10/06/07, Mr. P brings in Form 243C to add his daughter to the Share case. Mr. P asks that eligibility for Assist be determined because of the change in family size.

Current verification of income indicates that the family is eligible for Assist beginning 09/07. Cancel the Share case and set up an Assist case for both children effective 09/07.

Example 3: The Q family receives Share for their son. On 11/12/07, the All Kids Unit receives Form 243C to add their daughter to the case and asks that eligibility be reviewed due to the change in family size.

Current verification of income indicates that family income falls in the Premium Level 1 range. Leave the case as a Share case until the next renewal.

Example 4: The S family receives Premium Level 1 for their daughter. On 11/04/07, the FCRC receives Form 243C to add Ms. S's son to the Premium case. Add the son to the Premium case effective 12/07. The premium increases from $15 to $20 effective 12/07.

Refer to PM 06-08-03-e for information about prior coverage when adding a child to an All Kids Share or Premium case.

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