PM 06-08-09-c

revised text(FCRC/All Kids Unit) If the family is eligible for All Kids Premium, approve the case. The system puts the case in enrolled status, whether or not the premiums have been paid.

Once the case is enrolled, HFS BFO sends the family a bill for the first month's premium and any unpaid premiums.

  • If the family's first month's premium and all unpaid premiums are paid within 30 days, the system changes the case from enrolled to active (TA 31/TAR 71) for the current effective month when the premiums are paid. Form 360KC approval is centrally generated at that time. The 12-month eligibility period stays the same.
  • If the family's first month's premium and all unpaid premiums are not paid within 30 days, the system changes the case from enrolled to canceled (TA 22/TAR 06). Form 360KC denial is centrally generated at that time.

Example 1: The J family's case was canceled due to nonpayment of premiums effective 12/10. They reapply and eligibility is determined for 04/11. They have paid their unpaid premiums.

When the worker completes the approval action, the system puts the case in enrolled status. No notice of decision on the application is sent.

Example 2: The B family's All Kids Premium case was canceled effective 09/11. They pay their unpaid premiums on 09/01/11 (Indicator Code 2 in Item 80). When they reapply, complete Screen K3 as follows:

Eff. Date of Cancel (MM/YYYY) 09/2011
Code 178 in Item 80? (Y/N) Y
If yes, Indicator (1 or 2) 2

They are determined eligible for All Kids Premium on 10/30/11 (current effective month 12/11). When the DHS FCRC or HFS All Kids Unit approves the case, the system enrolls the case effective 12/11.

HFS BFO sends the family a bill for the first month's premium. On 11/19/11, the family pays their first month's premium. The system changes the case from enrolled to active effective 01/12 and sends Form 360KC. The family will receive benefits from 01/12 through 11/13.

Example 3: Same as Example 2, except the family does not pay their first month's premium. On approximately 11/30/11, the system changes the case from enrolled to canceled and sends Form 360KC.