WAG 18-03-08: Adding Other Persons for Medical Only (Assist, Moms and Babies)

PM 18-03-08.

IES Phase 2 Process

  1. revised text (Customer) Completes Request for Medical Benefits for Another Family Member(s) (Form 243A-C) to add a person to an Assist or Moms and Babies case.
  2. revised text (FCRC/All Kids Unit) Process the request in IES within 42 days to ensure timely notification of the decision by the 45th day.
  3. revised text (IES) Sends the client Notice of Decision (Form 360C) within 45 days of the request date.

Example: Mr. R has an active All Kids Assist case in IES for his son whose existing certification period is Jan through Dec. Effective Sept, his daughter is added to the case. The daughter has countable income under MAGI (see PM 15-06-01-h) that will bring both children to the All Kids Share level. The son stays in Assist through Dec, and the daughter is added for the remainder of the cert period (through Dec.) for Share. January benefits for both children will be based on REDE information.

Example: Ms. S has an active case for 2 children ages 8 and 10 on All Kids Assist. Ms. S requests medical coverage for her 6 year old child who moved in with her. Ms. S completes and signs form 243A-C for her 6 year old child. The 6 year old child has income from Social Security but is not expected to be required to file an income tax return, so the child's income is not counted. The 6 year old qualifies to be included in the All Kids Assist case with her siblings.

Example: Mr. F has an active All Kids Assist case for his son age 14. Mr. F requests medical coverage for his daughter age 9 who moved in with him. The daughter receives unearned income of $650 and is expected to be required to file a tax return. The daughter's income must be counted for presumptive eligibility and for ongoing medical coverage it must be verified and counted. The daughter's income is not counted against the son's current case.

Legacy Process

  1. (Customer) Completes Request for Medical Benefits for Another Family Member(s) (Form 243C) to add a person to an Assist or Moms and Babies case.
  2. (FCRC) If medical coverage is approved for non-continuous months before the month the completed Form 243 was received, enter the first day of the month as the beginning medical eligibility date in Item 77 of Form 552.
  3. (FCRC) Send Request for Correction/Addition of MMIS Medical Eligibility File (Form 2958) to EPU to cover any other month(s) of medical eligibility in the backdated period.
  4. (FCRC) Send the client Notice of Decision to Add a Person to a Medical Assistance Case (Form 1934A) within 45 days of the application date.