PM 18-03-02

NOTE: See WAG 25-07-09-a to complete Form 552 to add a newborn.

  1. (Caretaker Relative) Completes Request for Assistance for Additional Family Member (Form 243) and returns to caseworker.
  2. (FCRC) Enter the date received on Form 243. Date stamp forms received by mail.
  3. (FCRC) If proof is needed, complete 2 copies of Instructions to Recipient (Form 1721).
    1. Send the original to the caretaker relative.
    2. File a copy in the case record.
  4. (FCRC) Set a 30 calendar day control for receipt of proofs.
  5. (FCRC) Approve cash benefits from date the signed Form 243 is received in the FCRC, or date of initial eligibility after the date of the written request.

    Exception: When a signed Form 243 is received for a newborn who was just deleted from unit, the initial date of eligibility is the first day of the fiscal month the newborn was deleted, not the date Form 243 was received. 

  6. (FCRC) See WAG 25-07-10 to start benefits. Process separate actions for any changes in income, deletions, etc. that cause a reduction from the previous month's benefit amount. Use the TA and TAR codes that generate the correct central notice of reduction for the 2nd action.
  7. (FCRC) Inform the caretaker relative of their responsibility to cooperate in obtaining support and their right to claim good cause for noncooperation (see PM 24-02-00 and WAG 24-02-00).
  8. (FCRC) Complete Form 2355 for a responsible relative not subject to the child support referral process.
  9. (FCRC) The client must apply for an SSN for the newborn (see WAG 03-11-01-a). Complete Requirement to Apply for SSN (Form 3168) for each child unless the client made application for an SSN via the Enumeration at Birth program or the child already has a verified SSN.
  10. (FCRC) Complete ACID and ANQR inquiries for all children, other than newborns. Determine if the child receives benefits under another program and if the child was assigned an RIN.
  11. (FCRC) Issue a Temporary MediPlan Card for the newborn through the expected date of the centrally issued MediPlan Card.
  12. (FCRC) Begin medical up to 3 months before the month Form 243 is signed, but no earlier than the date of birth.
    1. Record the type of eligibility for the backdated period, in the case record.
    2. To cover any other month(s) of medical eligibility in the backdated period, send Request for Correction/Addition of MMIS Medical Eligibility File (Form 2958) to Exception Processing Unit (EPU).
  13. (FCRC) Decide which program is correct for the newborn, upon receipt of Form 243 and the necessary verifications.

    If necessary, assign a new case number and complete Form 552. Record all actions on revised text the Form 514 in ACM and save to Content Management. 

  14. (FCRC) Continue to include the newborn in the case for medical only, if the client fails to provide the necessary proofs and apply for an SSN.
  15. (FCRC) Send the client Notice of Decision on Request for a Financial Assistance Increase/Special Authorization (Form 1934) within 45 days of the date of the written request.
  16. (FCRC) Before deleting the child from case at age one, review eligibility for all other medical programs. If you requested needed proofs at time of the addition, don't request them again. Record all actions on Form 514 add text in ACM.
  17. (FCRC) File Form 243 deleted textin the case record.  Save Form 514 in ACM to Content Management.