PM 06-08-09-b.

(FCRC/All Kids Unit) revised textIf the family is eligible for All Kids Share, approve the case.

  • If the premiums have been paid (code 178 with indicator 2 in Item 80), the computer system approves the case in the normal manner.
  • If the premiums are unpaid (code 178 with indicator 1 in Item 80), the computer system enrolls, rather than approve, the case. Enrolled cases do not receive benefits. A Notice of Decision on Application for Health Benefits (Form 360KC) is not sent. A case is enrolled by the system so the HFS Bureau of Fiscal Operations (BFO) can send the family a bill for the unpaid premiums.

revised textExample 1: The H family's case was canceled due to nonpayment of premiums effective 01/11. The family pays their premiums and reapplies in 02/11. Eligibility is determined for 03/11. The family is now eligible for All Kids Share. When the worker submits the approval action, the system will approve the case and send a notice of decision on the application.

Example 2: The I family's case was canceled due to nonpayment of premiums effective 02/11. The family reapplies in 04/11 and eligibility is determined for 05/11. The premiums are unpaid. When the worker submits the action to approve the case, the system will put the case in enrolled status and no notice of decision on the application is sent. HFS's BFO sends the family a bill for the overdue premiums.

An enrolled case can be identified by looking at the CASE STAT in ACID which will show ENROLLED PREMIUM (OR SHARE) CASE. A message appears in Item 93 on Form 552 generated as a result of the enrollment. Item 93 will say ENROLLED PREMIUM (OR SHARE) CASE.

  • If the family pays the premiums within 30 days, the system changes the case from enrolled to active (TA 31/TAR 71) for the current effective month when the premiums are paid. A Form 360KC approval is centrally generated at that time. The 12-month eligibility stays the same.
  • If the family does not pay the premiums within 30 days, the system changes the case from enrolled to canceled (TA 22/TAR 06). A Form 360KC denial is centrally generated.

Example 3: The B family's All Kids Premium case was canceled effective 08/11. When they reapply, complete Screen K3 as follows:

Eff. Date of Cancel (MM/YYYY) 08/2011
Code 178 in Item 80? (Y/N) Y
If yes, Indicator (1 or 2) 1

They are determined eligible for All Kids Share on 09/30/11 (current effective month 11/11). The family has unpaid premiums (Indicator 1 in Item 80). When the DHS Family Community Resource Center/HFS All Kids Unit approves the case, the system puts the case in enrolled status effective 11/11.

HFS BFO sends the family a bill. On 10/19/11, the family pays their unpaid premiums. The system changes the case from enrolled to active effective 12/11 (current effective month) and sends Form 360KC. The family will receive benefits for 12/11 through 10/12.

Example 4: Same as Example 1, except that the family does not pay their premiums within 30 days. On approximately 10/31/11, the system changes the case from enrolled to canceled and sends Form 360KC.