WAG 17-01-02: Processing the Application

PM 17-01-02

See Medical Morsel regarding: Case Progression and When to Approve Applicant for AABD dated 04/11/2014

  1. (FCRC) Consider eligibility for all programs where potential eligibility exists, in the order of the more liberal program (category) first. This is called case progression. If the applicant states in writing that they do not want to apply for a particular program(s), do not determine eligibility for that program(s).

NOTE: If the applicant is not eligible for the first program, but is for another program, use the original application date to determine eligibility and the effective date.

For SNAP, always determine eligibility for SNAP benefits unless the applicant states in writing they do not want them, or the application is:

    • a Mail-In Application for Medical Benefits, or an All Kids, FamilyCare and Moms & Babies Health Insurance Application;
    • an abbreviated reapplication for a spenddown case;
    • an application for medical requesting payment for long term care services; or
    • an application for QMB Only or SLIB Only.
  1. (FCRC) Determine which category is correct for the applicant, based on the information contained on the application. Register the application for that category. 

Case Progression

  • Consider eligibility in the following order:
    • TANF or AABD Cash
    • RRA
    • Family Assist
  • If not eligible for any of the programs above, proceed as follows based on the status for each applicant:
    • For Pregnant Women:
      • Moms and Babies
      • Family Health Spenddown
    • For Adults not Aged, Blind, Disabled or Pregnant:
      • FamilyCare Assist
      • Family Health Spenddown
    • For Children:
    • All Kids Assist
    • Family Health Spenddown, met for current processing month
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    • Family Health Spenddown, met for a month other than the current processing month
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    • For Aged, Blind or Disabled Adults:
      • AABD Medical without a Spenddown
      • AABD Medical with a spenddown
      • QMB Only
      • SLIB Only
      • QI-1 Only
  1. (FCRC) Determine eligibility.

Approve the application for the program that the client is eligible for.

  1. If the client requests cash and medical, first determine eligibility under the TANF or AABD program. Also, determine eligibility for QMB benefits.
  2. Do not make a TANF or Medical determination or send a denial notice, when the youngest child is age 19 or older. Since the applicants do not meet the financial factor of having a dependent child, a TANF or  Medical determination is not required.
  3. When a family is determined eligible to receive under more than one category of assistance (e.g., AABD Medical and one of the Family Health Plans), the applicant does not have to complete a 2nd application. Save the Final CAF in Content Management for all cases, including the primary case and any secondary cases. Cross-reference the case ID numbers on CAF Screen 32A, General Write-up.
  4. If a Mail-In Application for Medical Benefits (Form 2378H), or an Application for Medical - Short Form (Form 2431), is filed, make a determination for Medical and QMB benefits.
  5. If an application for only medical assistance is filed and payment for long term care services is requested, make a determination of eligibility for Medical and QMB .
  6. If the application is filed for QMB only, make a determination for QMB. If an applicant is income eligible for QMB, determine eligibility for SLIB.
  7. If an application is denied because of the client's failure or refusal to cooperate in determining initial eligibility for all other programs for which the client may be eligible. Deny the application under the program that the client refused or failed to cooperate with.

Example 1: If the client fails or refuses to cooperate with developing a Responsibility and Services Plan, or fails an interview appointment, deny TANF and determine eligibility for medical benefits.

Example 2: If the client fails or refuses to cooperate with a request that is not necessary to determine QMB or SLIB eligibility (e.g., the client failed to appear for the application interview or to provide verification of non-questionable income or assets), deny AABD Medical and determine eligibility for QMB Only and SLIB Only.

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  • When the final disposition is made, Form 360C is centrally sent notifying the client of the approval, and the denial reason for each program (category) determination that was made. If the applicant is ineligible for all programs, Form 360C notifies the client of the denial reason for each program determination.
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CASE PROGRESSION AND CENTRALLY ISSUED COMBINED NOTICES

Based on the information contained on the application a family initially applying for TANF, Medical and SNAP and determined ineligible for TANF may still qualify for Medical. Determine eligibility for Medical Assistance using the original application date.

The client is approved for Medical assistance and SNAP. One Form 360C is centrally sent, advising the client of approval of Medical assistance and SNAP benefits and the reason for ineligibility for TANF. Establish one case record.

Identification of Teen Parent Service (TPS) Case

(System) A TPS case is centrally identified upon approval at intake.

A case is identified as TPS if it meets the following criteria:

  • A case in which the grantee is:
    • age 11 through 19 years and 9 months; and
    • has a minor child under 1 year of age; or
    • has an EDD.
  • A case in which a child on the case is:
    • age 11 through 18 years and 3 months; and
    • has a minor child under 1 year of age; or
    • has an EDD

When a case is identified at approval as TPS, transfer the case into the TPS site where the TPS staff will:

  • be responsible for the ongoing casework on the case;
  • monitor completion of the Responsibility and Services Plan (RSP);
  • report the client's progress on their RSP via the Change/Progress Report (Forms 2151A); and
  • send the case back to the appropriate Family Community Resource Center when the case is no longer identified as a TPS case.

See PM 14-12-00 and WAG 14-12-00 for specific details concerning TPS cases.