WAG 15-05-02-b: Active Cases in FS Quarterly Reporting

1. Add up the wages listed on the Report Form (Form 43/43CF) and compare to the current amount.
2. If the wages are the same, no action is required.
3. If the wages have changed, review the question on Form 43/43CF, "Do you think that there will be a change in any of the above answers within any of the next 3 months?".
   • If the client circled "no" or left the Item blank, assume that the wages listed by the client will continue.
   • If the client circled "yes", contact the client and ask if the amount earned is expected to stay the same. (Same hourly wage? Same number of hours?)
   • If the person says the wages are expected to stay the same, use the last calendar month's wages as the amount to be received in the future month.
   • If the person says the wages are expected to change or they have not received any wages yet, figure the amount of wages expected to be received by asking them:
     • the hourly wage,
     • the number of hours expected to work, and
     • the number of pays expected.

FamilyCare/All Kids Assist Cases

1. From wages listed on Form 43/43CF, determine if countable income has gone down.
   1. If the change in income is not expected to continue, no action is needed for Medical.
   2. If the change in income is expected to continue:
      • Complete Form 2383A or figure through ACM.
      • Update Item 80 and Item 90 codes on Form 552.
      • Review eligibility for Family Assist and Cash.
2. Determine if countable income has gone up.
   1. If the change in income is not expected to continue, no action is needed.
   2. If the change in income is expected to continue, compare the new income to the income standard by completing Form 2383A or ACM MANG Actual Screens for persons age 19 and over. Also complete Form 2383A or the ACM MANG Actual Screens if the Last Medicaid Determination Date is more than 12 months in the past:
      • If the case remains Assist, update Item 80 and Item 90 codes on Form 552.
      • If the case is now Spenddown, change the case status for the current submittal month, and update Item 80 and Item 90 codes on Form 552.
        • Figure All Kids Assist and Moms and Babies eligibility for all potentially eligible persons and code Form 552.
        • If All Kids Assist or Moms and Babies eligible, code Item 78 with a P or B.
        • Send the client Notice of Changes During the Medical Assistance Enrollment Period or Eligibility Period (Form 2434A) (with Form 458SPA/SPB attached, if needed) or Notice of Change During the Enrollment Period for Pregnant Women and for Children (Form 2434D).
        • Write in the case record that the case is now spenddown.
   3. If income increases over the All Kids Assist income standard, do not put a person under age 19 in spenddown status until the effective month that is 13 months after the Last Medicaid Determination Date.

Example: Last Medicaid Determination Date is 11/02 for a All Kids Assist case. If income increases over the All Kids Assist standard, do not change the case to a Family Health Spenddown case until 12/03.

Spenddown Cases in Met Status

1. From wages reported on Form 43/43C, determine if countable income has gone down.
   1. If the change in income is not expected to continue, no action is needed.
   2. If the change in income is expected to continue, complete Form 2383A or ACM MANG Actual Screens.
      • If the case remains spenddown, update Item 80 and Item 90 codes on Form 552.
      • If the case is now Family Assist, FamilyCare Assist Regular, All Kids Assist, or Moms and Babies, submit Form 552 coded with TA 31/TAR 57 for the current submittal month.
        • Code medical eligibility for the first day of the month in which the income fell below the Family Assist, FamilyCare Assist, or All Kids Assist standard
        • If All Kids Assist or Moms and Babies eligible, code Item 78 with a P or B.
        • Update Item 80 and Item 90 codes on Form 552.
        • Send Form 2434A or Form 2434D to the client.
        • Write in the case record that the case is now Family Assist, FamilyCare Assist, All Kids Assist, or Moms and Babies.
2. Determine if countable income has gone up.
   1. If the change in income is not expected to continue, no action is needed.
   2. If the change in income is expected to continue, compare the new income to the MANG standard by completing Form 2383A or ACM MANG Actual Screens.
      • Refigure spenddown amount for future months and update ASDS.
      • Send Form 2434A (with Form 458SPA/SPB attached, if needed) to the client.
   3. If the case is no longer in spenddown met status due to the increased income, change the case to unmet status for the current submittal month.
      • Update Item 80 and Item 90 codes on Form 552.
      • Send Notice of Determination of Monthly Spenddown Met/Unmet (Form 458SP-1) for each month spenddown is no longer met.
   4. If the case remains in spenddown met status for the period and the client was sent a notice, update Item 80 and Item 90 codes on Form 552.

Spenddown Cases in Unmet Status

1. From wages reported on Form 43/43C, determine if countable income has gone down.
   1. If the change in income is not expected to continue, complete Form 2383A or ACM MANG Actual Screens.
      • Send Form 2434A (with Form 458SPA/SPB attached, if needed) to the client.
      • If the client has not previously brought in medical costs for the month of the decrease, take no further action.
      • If the client has medical costs for the month of the decrease, use ASDS to refigure spenddown, to see if it will now be met for the month.
        • If spenddown is met, submit a TA 55 to issue a MediPlan Card.
        • Send Form 458SP-1 to the client.
   2. If the change in income is expected to continue, complete Form 2383A or ACM MANG Actual Screens.
      • If the client has medical costs for the months of the decrease, use ASDS to refigure spenddown to see if spenddown is now met.
      • If the case remains Spenddown, update Item 80 and Item 90 on Form 552.
      • If spenddown is met, submit a TA 55 or a TA 31.
        • Send the client Form 458SP-1.
      • If the case status is now Family Assist, FamilyCare Assist, All Kids Assist, or Moms and Babies, submit a TA 31 for the current submittal month.
        • Code medical eligibility for the first day of the month in which the income fell below the Family Assist, FamilyCare Assist, or All Kids Assist standard.
        • If All Kids Assist or Moms and Babies eligible, code Item 78 with a P or B.
        • Update Item 80 and Item 90 codes on Form 552.
        • Send Form 2434A (with Form 458SPA/SPB attached, if needed) or Form 2434D to the client.
        • Write in the case record that the case is now Family Assist, FamilyCare Assist, All Kids Assist, or Moms and Babies.
2. Determine if countable income has gone up.
   1. If the change in income is not expected to continue, do not update Form 552.
      • Complete Form 2383A or ACM MANG Actual Screens.
      • Send Form 2434A (with Form 458SPA/SPB attached, if needed).
   2. If the change in income is expected to continue, complete Form 2383A or ACM MANG Actual Screens.
      • Update Item 80 and Item 90 on Form 552.
      • Send the client Form 2434A (with Form 458SPA/SPB attached, if needed).