When it is necessary to add a person to a canceled case for medical only, review the case.
A spenddown case does not have to have been in "MET" status or to have been a Regular medical case for the period requested.
An eligible person may be added to a canceled cash case that does not have extended medical coverage. The addition to the canceled case is for medical coverage, not for cash.
Example: Ms. D received TANF from 07/02 through 12/02. She gave birth to a baby girl 12/10/02. Ms. D asked for her case to be canceled effective 01/03 because she was moving to Iowa. The newborn was not added to the
case for 12/02.
During 03/03, the hospital contacted the Department about payment for hospital care provided to the newborn in 12/02. The newborn is eligible to be added to the canceled TANF case for medical coverage for 12/02.
The most recent application for the person being added -- Request for Financial Assistance - Medical Assistance - Food Stamps (Form 2378C), Mail-in Application for Medical Benefits (Form 2378H), Form 243C, or one of the Form 243 series -- must be
completed before adding the eligible person to the canceled case if the person was not a required filing unit member of a cash case.
For cash cases, no application is required for filing unit members. A written application is not required to provide medical to a newborn. The only information required to authorize medical only for the child is the child's name,
birthdate, relationship to payee, and sex.
Except for newborns and filing unit members in cash cases, medical eligibility cannot be approved for more than 3 months before the month of application or the month the Form 243C is completed, signed, and filed.
Example 1: A spenddown case is opened for 11/02 and closed for 11/02. An application to add a person is filed in 11/02. The person is ineligible for month of application but determined eligible for backdate period 08/02
- 10/02. Add the eligible person to the canceled case for 08/02 - 10/02.
Example 2: A spenddown case is opened for 08/02 and closed for 07/02. An application to add a person is filed in 11/02. The person is not eligible to be added to the canceled case because the month of
application/request is not within 3 months of the last month of enrollment.
Example 3: A spenddown case was opened 11/01 - 10/02. A child born 10/28/01 was not added to case. The newborn is determined All Kids Assist eligible. The newborn is eligible to be added to the canceled case from
10/28/01 - 10/31/01 only if the month was Medicaid eligible at the time of birth.
All nonfinancial and financial eligibility factors for the case in which the person is being added must be met for the period of medical coverage.
When adding a person to a canceled spenddown case, recalculate the spenddown amount. Document the new spenddown amount in the case record and enter it in ASDS. Send Notice of Changes During the Medical Assistance Enrollment Period or Eligibility
Period (Form 2434A) to notify client of the new spenddown amount.
