WAG 02-05-04-c: Denying PE Coverage

PM 02-05-04-c.

IES Phase 2 Process

revised text(IES) There are denial reasons used by the system to deny CPE when an application new text or request for a child under 19 is registered and the child is not eligible for CPE:

  • Declared family income is above the income standard.
  • You have received Presumptive Eligibility within the last 12 months.
  • You did not give us enough information about your family's income.
  • You are not a U.S. citizen or an eligible alien.

(IES) Centrally generates Notice Regarding Your Application for Medical Benefits (Form 3818A) when a child is denied PE at registration. deleted text 

Legacy Process

(AIS) There are four denial Type Action Reasons used by the system to deny PE when an application for a child under 19 is registered and the child is not eligible for PE. Following are the TAR:

  • TAR D2 - Declared family income is above the income standard.
  • TAR D3 - You have received Presumptive Eligibility within the last 12 months.
  • TAR D4 - You did not give us enough information about your family's income.
  • TAR D5 - You are not a U.S. citizen or an eligible alien.

Centrally generates Notice Regarding Your Application for Medical Benefits (Form 3818A) when a child is denied PE at registration. There are two situations when AIS will prompt the worker to send a manual denial notice:

  • All children are denied PE but they are not all ineligible for PE for the same reason
  • A child is added to the application using the Add/Change/Delete system and the child is not eligible for PE.