WAG 01-06-02-b: Medical

 IES Phase 2 Process

1. (FCRC) Approve or deny the application through the Integrated Eligibility System (IES).
2. (FCRC) Using IES, generate and mail form IL444-0360C Notice of Decision either:
   1. Centrally if the worker runs eligibility and certifies case; or
   2. Locally by:
      1. Running eligibility and certifying the case;
      2. selecting the Correspondence module in Left Navigation; and
      3. clicking the Local Print button.
3. (IES) Sends form IL444-360C Notice of Decision the day after the nightly batch job.
4. (FCRC) Generates and mails form IL-444 360C Notice of Decision if local print is chosen.
5. (FCRC) Reprints notices using the correspondence module in left navigation in IES.

Features of Systematically Generated Form IL444-0360C Notice of Decision

The IL444-360C Notice Of Decision has 5 sections.  IES will generate the following fragments as appropriate:

1. Summary Section provides information on:
   1. notice date;
   2. date of application or date of change;
   3. What action is being taken;
   4. the policy citation for the action;
   5. information on how to use their LINK card (if applicable); and
   6. information on how to use Manage My Case in ABE.
2. Cash Section - see WAG 01-06-02-a.
3. Medical Section provides information on:
   1. who is eligible for medical assistance;
   2. what type of medical assistance each individual is eligible for;
   3. detailed information on medical assistance program requirements for each type of medical assistance being approved;
   4. medical backdate information;
   5. common services provided under the medical assistance program;
   6. any copayment requirements by program; and
   7. the calculation(s) used to determine each type of medical assistance each approved individual is eligible for.
4. SNAP Section - see WAG 01-06-02-d.
5. Additional Information Section provides information on:
   1. reporting requirements;
   2. rights and responsibilities;
   3. appeal rights;
   4. Manage My Case; and
   5. when an approved representative is named, information on approved representative policy.

 Legacy System Process (ACM and IPACS)

1. (FCRC) Approve or deny the application through the Integrated Eligibility System (IES). 
2. (System) Sends (or syncs) the approval or denial data from IES to the Client Data Base.
3. (System) Within 2 workdays of when an application is approved or denied, automatically issues and sends Form 360C.
4. (FCRC) Completes and mails Notice of Decision on Application for Medical Assistance - Regular MANG (Form 458), when a decision is made to approve or deny an initial application as regular Medical via IPACS; or
5. (FCRC) Complete and mail a Notice of Decision on Application for Medical Assistance - MANG Long Term Care (HFS 458LTC), when a decision is made to:
   • authorize a nursing home (NH) or supportive living facility (SLF) Medical case with or without a spend down, or
   • deny the application and a central notice is not wanted.
   1. Enter code 80 in Item 39. Send a Nursing Home/Supportive Living Facility Resource Calculation (HFS 2500) with the notice.

      NOTE: For a community case at application, or for backdated months that are before the case became NH or SLF, use HFS 458LTC to notify the client of the application decision and the change in case status. Send HFS 2500 with the notice.

6. (FCRC) Complete and mail a Notice of Limited Approval of Medical Assistance Application (Form 458D), when:
   • a All Kids Assist/Moms and Babies case is not eligible for the month of decision or any backdated month, and
   • spenddown exists for each month eligibility exists.
7. (FCRC) Complete and mail a Notice of Decision on Applications for Payment of Medicare Premiums, Deductibles and Coinsurance (Form 458M), to inform AABD Medical applicants of:
   • eligibility/ineligibility for Medicare cost-sharing benefits as a QMB, or
   • payment of Medicare Part B SMIB premiums as an SLIB.
8. (FCRC) Complete and mail a Notice of Decision on Application (MANG) for a MediPlan Card (Form 458SP), with Form 458SPA/SPB attached, if needed, to inform an applicant they are eligible for spenddown enrollment.