WAG 18-03-08.

IES Phase 2 Process

A written request is required to add a person (other than a newborn new textborn to a Medicaid eligible mother) to an Assist or Moms and Babies case.

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When a written request is received to add a person, review medical eligibility for the 3-month period before the month of the request.

If eligible, backdate medical for the person from the first day of the 3rd month before the month the written request is received.

The client does not have to prove medical need to qualify for backdate. Always start medical coverage on the first day of the month the person is eligible for backdate. See PM 17-02-05-a to backdate medical coverage.

new text Under Modified Adjusted Gross Income (MAGI) budgeting methodology, IES determines each child's eligibility based on their individual circumstances.  A child who is being added to an existing medical case may qualify for a different All Kids program that that of his/her siblings.

For all additions other than deemed newborns, form 243A-C Request for Medical Benefits for Another Household Member is required and asks for the person's income, tax filer and relationship information. When a request to add a child to an existing medical case is received, proof of the child's own countable income is required. Do not re-verify countable parental or sibling income, only verify the child's own income if such income is reported.

Due to continuous eligibility, any child who is active in the medical case would not be moved to a higher cost program based on the new household information. Coverage for children added shall continue for the remainder of the original 12-month eligibility period.

Legacy Process

A written request is required to add a person (other than a newborn) to an Assist or Moms and Babies case.

Send the client a written notice of approval or denial within 45 calendar days of the written request.

When a written request is received to add a person, review medical eligibility for the 3-month period before the month of the request.

If eligible, backdate medical for the person from the first day of the 3rd month before the month the written request is received.

The client does not have to prove medical need to qualify for backdate. Always start medical coverage on the first day of the month the person is eligible for backdate. See PM 17-02-05-a to backdate medical coverage.