- [new text] ACM Screens
- All Kids Generic
- All Kids Specific
- [new text] ACM Type Action (TA) 62
- [new text] Take Actions in the Correct Order
- Why is this Important?
All Kids Generic
The All Kids Generic screen appears when an income calculation is more than 133% of the FPL. The following questions must be answered:
- For a child under 1, was the mother Medicaid eligible at the time of the child's birth? Y/N
(Worker) Enter the basic number of the case being created:
- Has anyone been canceled for All Kids Share/Premium/Rebate?
- Does anyone have insurance now or in the last 3 months?
- Does anyone have state administered insurance?
- Has a completed Rebate form been received?
All Kids Specific
This screen appears when questions 1, 2, or 3 from the All Kids Generic screen are answered Yes. For each active person on the case, ACM asks the following questions:
- Canceled Y/N
- Date (MMYY)
- Code 178 (Y/N)
- Indicator (1/2)
- Code 186 (Y/N)
- State Admin Ins (Y/N)
To answer the question for Codes 178 and 186, review the clearances for the family to determine if a previous U or W basic number case is present. Codes 178 and 186 may appear in screen 2 of ACID in the Needs section.
Answering Y to code 178 prompts ACM to approve for Share or Premium. However, for Premium, overnight processing will change the approval to an 'enrolled' case. The family will receive an invoice from HFS stating the amount of premiums the family must pay before benefits will start.
ACM Type Action (TA) 62
TA 62 appears as Option 14 for ACM. Use TA 62 option to change eligibility to All Kids/FamilyCare Share, Premium and Rebate when continuous eligibility has ended on the Assist case and income exceeds 133% of the FPL.
TA 62 transfers eligible persons from the existing Assist case to the new U or W case. Indicate with an X the person who is the case name for the new case. Enter a Y next to the name of each person to approve for the TA 62. Enter the appropriate Item 73 code for each person. Any household member who is not included in the new case will lose eligibility when the system closes the existing Assist case. For this reason, the following types of cases cannot be transferred using TA 62:
- Cases containing a newborn who is eligible for medical benefits up to one year;
- Cases containing a pregnant person;
- Cases containing children whose Last Medical Determination Date (LMDD) is within the last 12 months;
- Cases in Spenddown;
- Cases containing SNAP; and
- Cases in Family Assist or medical extension (item 25 of Form 552 is F or X).
If the household is eligible for All Kids/FamilyCare Share, Premium Levels 1-8, or Rebate, ACM will prompt staff to enter a basic number beginning with U for Rebate and W for Share/Premium. If adults are on the case, and income is greater than 185% of the FPL, staff are prompted to put the adults in spenddown. (Adults are eligible for Rebate with income up to 200% FPL.) Use the appropriate existing basic number or assign a new basic number from the supply of basic numbers provided to each FCRC.
If no one is eligible for TA 62 after completing the new All Kids specific screens, ACM will return to the Spenddown screen.
TA 62 is similar to a Quick Reinstatement (TA 12, TAR 98) action. TA 62 uses case information from the Client Database from the previous day. For this reason, it may require more than one transaction occurring on two different days to complete the TA 62 process. Staff may have to delete certain family members who should not transfer to the new case the day before processing the TA 62. Open an Assist or Moms & Babies case for the deleted family members if they remain eligible. For example, newborns remain eligible until they reach age 1 (see PM 18-05-01-b); 18 year old children are usually eligible on a case by themselves (see PM 15-06-01-k).
TA 62 is also similar to a case transfer (TA 40). Once the TA 62 is complete, the Assist case will show XFERRED OUT REGULAR in ACID to the new case ID number.
Important: If a case contains family members who are to split into different cases follow the steps below.
- Delete the persons who will be split off into their own case. Suppress the central notice and send a manual notice if appropriate.
- Open a case in IPACS for the deleted persons.
- Delete the persons who are no longer eligible. Enter 00 in item 39 to generate a central Form 157C.
- The next day, use TA 62 to transfer the remaining members to the new case. Persons not selected for the TA 62 will drop off the existing case and won't appear on the new case. For this reason, only those people who are eligible for Share, Premium Levels 1 through 8, or Rebate should be active on the case when the TA 62 is started.
Once the transaction is complete, send a Notice 2434KC Notice of Change Regarding Eligibility for Medical Benefits for each Share, Premium Level 1, or Rebate approval. HFS will centrally send the 360KC on all Premium Level 2-8 approvals.
Take Actions in the Correct Order
When moving a person from one case to another, delete the customer from the first case before adding the customer to the new case.
Example 1: The family's income increased and is now over the limit for Assist. The children remain eligible for Assist until renewal and the parents are eligible for Premium Level 1.
- First, delete the parents from the Assist case;
- Then authorize coverage for the parents on the Premium Level 1 case.
Example 2: Children go to live with their father instead of their mother. Both the mother and father have other children on Assist cases.
- First, delete the children from mother's case.
- Then add them to the father's case.
Why is this Important?
Transactions go to MMIS in the order they are received (even when completed on the same day). Taking the actions in the wrong order causes coverage to drop from MMIS requiring staff to send form 2958 to the Exception Processing Unit (EPU) to add coverage back to MMIS.