A person becomes ineligible for ACA Adult in the following circumstances:
- reaches age 65; or
- is enrolled in Medicare; or
- is a parent or caretaker relative of a child living in the home; or
- has income that exceeds 138% of the FPL; or
- No longer meets the financial and nonfinancial eligibility criteria.
There is no spenddown for persons in ACA Adult.
ACA Adults are not eligible for extended medical.
ACA Adult Case Edits in IPACS and ACM
Effective 4/4/17, new edits are in place in ACM and IPACS that will prevent staff from taking certain actions on ACA Adult cases when there is someone on the case no longer eligible for the ACA Adult eligibility group due to age or Medicare.
When an ACA Adult case has Medicare or is under age 19 or age 65 or older, the following Type Actions (TA) will be blocked by an edit:
- TA 12/98- quick reinstatement;
- TA 30- REDE;
- TA 31- change action; and
- TA 34- additions.
When an ACA Adult case has Spenddown codes 390/392 in Item 80, the following Type Actions (TA) will be blocked by an edit:
- TA 12/98- quick reinstatement; and
- TA 30- REDE
The following Type Actions (TA) will be allowed so that the cases can be updated:
- TA 34- deletions to remove the individual due to Medicare or age
- TA 31/42-address change
- TA 31 to remove spenddown
When a spouse moves out of the home of an active ACA Adult case, delete the spouse using TAR 07, suppress the central notice if the spouse is eligible for his/her own ACA Adult case.