- Adding Newborns
- Spenddown Cases
- Adding Newborn to Canceled Medical Case
- [new text] IES Phase 2 Action When Child Reaches Age 1
- If the mother is part of the benefit unit at the time of birth, add the newborn right away for medical when notified of the birth. This can be from any source including but not limited to:
- the mother/father; or
- the medical provider (including AKAAs, MCOs and hospital vendors); or
- receipt of Record of Birth (Form 2636); or
- receipt of Medical Coverage Request for Newborns (Form 2761).
- When the newborn is added to the case, a medical card is automatically generated for the newborn.
- If the client provides the needed proofs before the child is one year old, delete code 3 from Item 78 and enter a dash.
- If the client hasn't completed Form 243C and provided the needed proofs when the child is one year old and it is more than 12 months from the Last Medicaid Determination Date (LMDD), send Form 157 and delete the child from the Assist or Moms & Babies case.
Note: In Phase 2, when adding a deemed newborn in IES it is important to indicate on the newborn screen whether a written request was already received. This will prevent IES from requesting another 243C when the child turns a year old.
- If the newborn is the only child in the case and it is more than 12 months from the LMDD, cancel the Assist or Moms & Babies case. Enter the following reason on Form 157:
Your infant's 12 months of medical benefits has ended. You have not applied for ongoing medical coverage.
For inactive spenddown cases, if the spenddown case is in canceled not met status, see WAG 18-03-10 and WAG 18-05-07.
Adding Newborn to Canceled Medical Case
- (FCRC) When adding a newborn to a canceled Family Health Plans case, determine if the case is eligible for the addition.
- Case must meet all nonfinancial and financial eligibility factors for the period of medical coverage being requested.
- Case must not have been canceled for more than 24 months.
- (FCRC) When the newborn is added to a canceled spenddown case, refigure the spenddown amount.
- Document the new spenddown amount in the case record and enter it in ASDS.
- Send Notice of Changes During the Medical Assistance Enrollment Period or Eligibility Period (Form 2434A), (with Form 458SPA/SPB attached, if needed), to notify the client of the new spenddown amount.
NOTE: Case does not have to be in met status for the period requested.
Example: A spenddown case was open 08/02 - 07/03. A child born 08/31/02 was not added to case. The newborn is determined Moms and Babies eligible. Add the newborn to the canceled case for 08/31/02 - 07/31/03.
- (FCRC) If case is eligible for the addition, see WAG 18-03-03 to add a newborn to the case.
- (System) Sends a Medical card if the newborn is eligible for Assist, Moms and Babies, or is in Family Health Spenddown met status for the period requested.
- (FCRC) Send Request for Correction/Addition of MMIS Medical Eligibility File (Form 2958) to Exception Processing Unit (EPU) to cover any other month(s) of medical eligibility in the backdated period.
- File copy of Form 2958 in case record.
- (EPU) Sends Medical Eligibility Change/Correction (Form 1313D) to the FCRC.
- (FCRC) Send client Notice of Decision to Add a Person to a Medical Assistance Case (Form 1934A) within 45 days from the date of the written application. The date of the written application is the date the application is received in the correct Family Community Resource Center.
IES Phase 2 Action When Child Reaches Age 1
A batch action trigger is generated after cutoff the month before the newborn turns a year old. If IES data shows that a signed request has already been received, and the newborn's SSN or proof of application for an SSN has been provided, the batch action will rerun eligibility to determine eligibility for another All Kids program.
- Example 1: Baby Billy will turn a year old on July 10th. The batch action is triggered after cut off in June. IES data shows that a 243C request has been received for Billy and his SSN is recorded. Countable family income is under at the All Kids Share level for his EDG size. At cut-off in July he will be certified for the All Kids Share program effective August, the first month after his first birthday.
If IES data shows that a signed request has not been received, or an SSN or proof of application for the SSN has not yet been provided, a request for information will be generated.
- Example 2: Baby Sharee will turn a year old on December 1st. The batch action is triggered after cut off in November. IES data does not show that a 243C request has been received, nor has an SSN or proof of application been provided for Sharee. A VCL (Form 267) is generated and mailed to the client with Form 243C. The VCL requests Sharee's SSN (or proof of application), and instructs the client to complete, sign and return the 243C request.
- If a response to the VCL is not received, Sharee's medical benefits will be systemically terminated at cut off in December effective for January. Note: In this situation if the worker certifies another change action after the VCL due date and before the cut off, the system will recognize that there is an overdue VCL for Sharee and terminate benefits effective January at that time.