WAG 06-08-03-b

revised textEligibility for All Kids/FamilyCare Share, Premium, and Rebate is determined based on income expected to be received in the regular roll effective month.

Example: Eligibility is being determined on December 1st. Since the first regular roll month is January, eligibility is based on income expected to be received in January.

If the person is eligible for Moms & Babies, All Kids/FamilyCare Assist, or Spenddown met for the regular roll effective month, do not determine eligibility for All Kids/FamilyCare Share, Premium, and Rebate.

Example: Eligibility is being determined for the regular roll effective month of January. Income is above the Assist Standard for the 3 backdate months but is below the Assist Standard for January. Approve the case for Assist. Do not consider eligibility for Share, Premium, or Rebate.

If the person is eligible for Spenddown unmet for the regular roll effective month, determine eligibility for All Kids/FamilyCare Share, Premium, and Rebate.

Example: Eligibility is being determined for the regular roll effective month of February. Spenddown is met for December and January, but not for February. Determine eligibility for Share, Premium, and Rebate.

Assist Eligibility for Months Prior to the First Regular Roll Month

If income is at or below 133% of the FPL prior to the first regular roll month, and over 133% of the FPL for the first regular roll month, approve the child(ren) for Assist. Continuous eligibility policy applies for children (see PM 18-05-01).

The adult(s) will be approved for Share or Premium Level 1.  Split the adult(s) to a separate case and process the adult(s) using a TA 10, TAR 75 to approve the Assist coverage for the month(s) prior to the first regular roll month.

The TA 10, TAR 75 will authorize the Assist coverage from the earliest eligible month until the current effective month and then re-pends the application. If any spenddown months occur and the countable monthly income is below 185%, Share or Premium backdate may be manually authorized by the All Kids Unit if the adult requests it and is eligible (see PM 06-08-03-f).