PM 18-05-05

new textIES Phase 2

new textDetermination for Extended Medical

When the worker reruns eligibility and the family is financially ineligible for TANF, or a parent or caretaker relative who received FamilyCare has income that increases above the Family Assist standard (when it was previously at or below the Family Assist standard), the system will determine if the family qualifies for extended medical per PM 18-05-06

new textFamilies that Don't Qualify for Extended Medical

new textIf the family is not eligible for extended medical:

  1. For children under age 19:
    1. If the certification period has not ended, the child receives All Kids Assist for the remainder of the 12 month certification period.
    2. If the certification period has ended, IES will determine eligibility for All Kids Share or Premium. Medical benefits are canceled if income is more than the All Kids Premium Level 2 standard (318% of the FPL), and the child does not qualify for another program.
  2. For adults age 19 and over, IES will determine eligibility for other medical programs. Medical benefits are canceled if income exceeds the FamilyCare Assist Standard and the adult does not qualify for another program. 

Example 1: Ms. Zee received TANF and medical benefits with her 2 children since December 2016. On 06/07/17, Ms. Zee reports that she has a new job. Due to her increased earned income she no longer qualifies for TANF. When her income is entered into Data Collection and her eligibility is rerun, the system determines that the family qualifies for extended medical.

Example 2: Ms. Aye receives FamilyCare and All Kids Assist with her 2 children. Countable monthly income is $1,800. The last month of their certification period is 06/2017. On 01/07/17, Ms. Aye reports that she has a new job and countable income is now $2,900, which is above the All Kids Assist, and the FamilyCare Assist Standard for 3. The updated income is entered into IES.

The family does not qualify for extended medical because income was not at or below the Family Assist level for 3 of the last 6 months. Since the current certification period is not ending, the children continue to receive All Kids Assist until the end of the certification period. Medical benefits are canceled for Ms. Aye and she is referred to the Marketplace.

Example 3: Mr. Bee and his child receives FamilyCare and All Kids Assist. Countable income is $1,200. The last month of their certification period is 06/2017. On 06/01/17 in response to the REDE, Mr. Bee reports that he has a new job and countable income is now $2,500, which is above the Assist standard for 2.

The family does not qualify for extended medical because income was not at or below the Family Assist level for 3 of the last 6 months. Since the certification period is ending, when the REDE is certified in IES with the updated income amount, the child is determined eligible for All Kids Premium Level 1. And, Mr. Bee's medical benefits are canceled and he is referred to the Marketplace.

new textLegacy System prior to IES Phase 2

TANF

  1. Determine eligibility for extended medical (see WAG 18-05-06).
  2. If not eligible for extended medical, SWAP the case.
  3. If income is less than the All Kids/FamilyCare Assist Standard, update Items 30, 80 and 90.
  4. For children (persons under age 19), if income exceeds the All Kids Assist Standard:
    1. If the LMDD is within 12 months, enter a code in Item 78 so that the child receives All Kids Assist for the remainder of the 12 month period. Do not update Item 30.
    2. If the LMDD is not within 12 months, review eligibility for All Kids Share or Premium. Cancel medical benefits if income is more than 318% of the FPL.
  5. For adults (persons age 19 and over), cancel medical benefits if income exceeds the FamilyCare Assist Standard. 

Family Assist

  1. Determine eligibility for extended medical (see WAG 18-05-06).
  2. If not eligible for extended medical, change Item 25 to a dash (-).
  3. If income is less than the All Kids/FamilyCare Assist Standard, update Items 30, 80, and 90.
  4. For children (persons under age 19), if income exceeds the All Kids Assist Standard 
    1. If the LMDD is within 12 months, enter a code in Item 78 so that the child receives All Kids Assist for the remainder of the 12 month period. Do not update Item 30.
    2. If the LMDD is not within 12 months, review eligibility for All Kids Share or Premium. Cancel medical benefits if income is more than 318% of the FPL.
  5. For adults (persons age 19 and over), cancel medical benefits if income exceeds the FamilyCare Assist Standard.

FamilyCare/All Kids Assist

  1. For children (persons under age 19):
    1. If the LMDD is within 12 months, enter a code in Item 78 so that the child receives All Kids Assist for the remainder of the 12 month period. Do not update Item 30.
    2. If the LMDD is not within 12 months review eligibility for All Kids Share or Premium. Cancel medical benefits if income is more than 318% of the FPL.
  2. For adults (persons age 19 and over), cancel medical benefits if income exceeds the FamilyCare Assist Standard.

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