PM 02-04-10 Medical Benefit Choice Preference

WAG 02-04-10

The Applicant's Choice of Category federal requirement mandates that an individual who is eligible for more than one medical benefit program have an opportunity to select their preferred program.

The medical benefit choice question in Application for Benefits Eligibility (ABE) and Integrated Eligibility System (IES) captures an individual's medical benefit choice preference. The question allows an applicant or customer to select if they would prefer the following:

  • Aid to the Aged, Blind and Disabled (AABD);
  • Family Care or ACA;
  • No Preference.

The medical eligibility determination sequence in IES will occur based on an individual's medical benefit choice preference.

IES will consider the preference selection to be built as a priority over other medical benefit program EDGs if the individual is eligible for more than one type of medical program. If No Preference is selected or if the individual is not eligible for their preferred medical program, IES will progress the EDG to the most beneficial medical program for the eligible individual.

During periods of continuous eligibility for children and pregnant women, medical program changes will not occur based on a medical benefit preference request; coverage will continue until redetermination.

Only a future medical benefit month may be changed due to a medical benefit program request for an individual currently receiving medical benefits. A previously certified month will not change.