WAG 06-08-03-f

new textBecause a different section of the law authorizes HFS to provide FamilyCare medical benefits to parents and caretaker relatives, HFS must provide backdated coverage to adults who request backdate and qualify under FamilyCare Share and Premium Level 1.

Only the All Kids unit can authorize FamilyCare benefits for months prior to the first regular roll month. Staff in the FCRCs will continue to approve eligible adults prospectively for FamilyCare Share and FamilyCare Premium Level 1 and send the cases to the All Kids unit for maintenance. Because children's Share and Premium benefits always begin prospectively, the backdated coverage for adults must be processed manually.

Eligible adults approved for Share or Premium Level 1 at or below 185% of the FPL may qualify for coverage beginning with up to three months prior to the month of application through the month prior to the first regular roll month. FamilyCare backdate is only available to adults who meet financial and nonfinancial eligibility requirements.

If monthly income is at or below the FamilyCare Assist level, set up an Assist case for the eligible months using a TA 10, TAR 75. Ineligible months will appear as unmet spenddown. If monthly income is over 185% of the FPL, the FCRC determines eligibility for spenddown. When the All Kids Unit is processing the application, they refer the adult to the FCRC for spenddown.

Unlike Prior Coverage for children, there is no limit to the number of times an adult can qualify for FamilyCare backdate. There is no time limit for an adult to request a FamilyCare backdate.

Children eligible for Share and Premium Level 1 do not qualify for FamilyCare backdate but may qualify for Prior Coverage (see PM 06-08-03-e).