WAG 18-05-05

When a TANF or Family Assist case is no longer eligible due to earnings or child support, the entire family is eligible for extended medical (see PM 18-05-06). revised textIn all other situations, if the Last Medicaid Determination Date (LMDD) is within the last 12 months, all persons under 19 remain eligible for medical due to continuous eligibility policy (see PM 18-05-01). Take immediate action to make changes in eligibility for each person age 19 and over.

revised textFor each person under age 19, if the LMDD is more than 12 months ago, review eligibility for All Kids Share, Premium or Rebate. If they are ineligible because family income is over 300% of the FPL, put them in spenddown status.

revised textFor persons age 19 and over, review eligibility for FamilyCare Share, Premium or Rebate. If their income is over 185% of FPL and if they do not qualify for Rebate, put them in spenddown status.

revised textPersons with family income that is over 133% and up to 200% of the FPL may qualify for All Kids/FamilyCare Rebate (for information about the option to choose Rebate see PM 06-08-02-c):

  • If they have insurance and it covers both inpatient hospitalization and physician services, send the family the 2378KCB Rebate Form to determine eligibility for Rebate. If the form is returned within 10 days, and the person meets the nonfinancial requirements listed in PM 06-08-02-a, delete the person from the case and set up a Rebate case.
  • If the form is not returned within 10 days, or they do not have insurance that covers both inpatient hospitalization and physician services, and income is between: 
    • 133% and 150% of the FPL, delete the person from the case and set up an All Kids/FamilyCare Share case.
    • 150% and 185% of the FPL, delete the person age 19 and over from the case and set up a FamilyCare Premium Level 1 case.
    • 150% and 300% of the FPL, delete the person under age 19 from the case and set up an All Kids Premium Level 1 or Level 2 case.

NOTE: Adults and children can be on the same All Kids/FamilyCare Share, Premium Level 1 or Rebate Case.