WAG 02-05-04

Children under the age of 19 are presumptively eligible (PE) for medical benefits when an application is received if:

  • declared family income is equal to or less than 200% of the FPL;
  • the child did not start receiving PE coverage (including MPE) within one of the last 12 months; and
  • the worker has no knowledge that the child does not meet citizenship/ immigration requirements.

text revisedThis includes applications registered for all Family Health Plans as well as TANF and AABD.

During the PE period, the child receives the same medical benefits as children receiving Family Assist or All Kids Assist. There are no copays or premiums during the PE period. Also, no MediPlan or All Kids ID Care is issued.

Gross family income is used to determine PE eligibility. The normal deductions, such as the earned income deduction or child care, are not allowed. The system uses regular income-averaging to determine monthly income.