PM 06-25-03

Processing Applications

Medical coverage may not start prior to November 1, 2012.

Approvals

Use TAR 81 to approve a CountyCare case.

Enter code 80 in Item 39 to suppress the central notice when approving a CountyCare case. Cook County Health and Hospitals System (CCHHS) sends the approval notice for each case approved. CCHHS also sends a welcome packet and member ID card to each person approved for CountyCare.

No medical card is generated on a CountyCare case.

The approval notice serves as evidence of the person's date of approval, Recipient Identification Number (RIN) and date of birth. A note to CCHHS providers is included on the notice instructing them to contact MEDI to confirm eligibility when services are provided.

Stroger FCRC keeps and maintains the CountyCare cases.  Transfer regular medical cases to the appropriate FCRC.

Automated Intake System

For office 197 only, option 8 includes a new question on the Case Cooperation Screen:

Is this a Cook County waiver application? (Y/N):

Answer Y to authorize a CountyCare case. Answer N to authorize a Family Health Plans case. There are system edits in place for CountyCare cases that will permit one or two single adults to be approved when no children are in the household.

Example 1: Mr. D, age 43, requests CountyCare for himself and AABD for his wife who receives SSI. CCHHS submits a CountyCare application for Mr. D using the Web Benefits application system and assists Mrs. D with an application for AABD using Form 2378H. Stroger FCRC processes both applications. Upon approval, Stroger keeps the CountyCare case and transfers the AABD case to the appropriate FCRC.

Example 2: Mrs. E, age 63, requests CountyCare for herself and her husband who is age 66. CCHHS submits a CountyCare for Mrs. E and assists Mr. E with an application for AABD on Form 2378H. Stroger FCRC processes both applications. Upon approval, Stroger keeps the CountyCare case and transfers the AABD case to the appropriate FCRC.

Example 3: Mr. F, age 38, requests CountyCare for himself. CCHHS submitted the electronic application for CountyCare. Stroger staff discover Mr. F is not eligible for CountyCare because he was approved by the Social Security Administration last week for SSDI, and his income as at or below 100% of the FPL. Deny the CountyCare application (no notice is sent). Reregister the application for AABD using the original application date and process as appropriate.

Example 4: Ms. G's income is less than 133% of the FPL however, she has an active AABD spenddown case in unmet status. Ms. G requests CountyCare for herself. CCHHS submits the electronic application for CountyCare. Stroger FCRC finds the active unmet spenddown case is located in the Roseland FCRC in Cook County. Stroger FCRC staff contact Roseland FCRC to coordinate the closing of the unmet spenddown case per client request, then approves the CountyCare case.

Example 5: Mr. H, age 46 received RRA medical coverage until 2 months ago when he reached his 8 month limit. He lives alone and requests CountyCare. CCHHS submits a CountyCare application for Mr. H. Stroger FCRC processes the CountyCare application and keeps the case for on going maintenance.

Denials

A Form 360C Notice of Decision is generated centrally for denials. Refer to WAG 27-03-01-q for denial reasons.