PM 06-25-04
Change Case from ACA Adult to Family Health Plans (FHP)
There are times when a parent or caretaker relative is no longer eligible for medical under FHP.
This occurs when:
- the only eligible child(ren) moves out of the home; or
- the only eligible child turns 18.
Example 1: Mary, age 67, has two grandchildren living in the home. Since Mary is over the age of 64, she is not eligible for ACA Adult. Due to minor children living in the home she may be eligible for FHP. If Mary is not eligible for FHP, review for AABD.
Example 2: Sue, age 35, is currently in the ACA Adult eligibility group. She reported that her minor child moved into the home. Sue is no longer eligible for ACA Adult. Review eligibility for FHP. If Sue is not eligible for FHP, review for AABD.
Example 3: An ACA Adult reports a newborn. The newborn is potentially eligible for Moms and Babies because the mother was receiving Medicaid under ACA Adult. Review PM 06-09-01. If they are eligible for FHP, change the case level coding as described above.
Change Case from FHP to ACA Adult
There are times when a parent or caretaker relative is no longer eligible for medical under FHP. This occurs when:
- the only eligible child(ren) moves out of the home; or
- the only eligible child turns 18.
Example 4: Mr. Smith is enrolled in the AABD Spenddown. His spenddown is $302 each month. Mr. Smith's income is below 138% of the FPL. Mr. Smith requested to be enrolled in the ACA Adult Program. A new application is not required.
Change Case from AABD to ACA Adult
Individuals enrolled in AABD Spenddown whose income is over 100% FPL but not more than 138% of the FPL may be eligible for ACA Adult.
Example 5: Mr. Smith is enrolled in the AABD Spenddown. His spenddown is $302 each month. Mr. Smith's income is below 138% of the FPL. Mr. Smith requested to be enrolled in the ACA Adult Program. A new application is not required.
