PM 06-05-03: Deciding Eligibility

WAG 06-05-03.

IES will process the case using case progression.

IES will determine if all other nonfinancial factors are met except for citizenship or immigration status, and providing a SSN.

IES will compare income (and for AABD Medical, resources) to the correct standard.

Backdate medical benefits for each month the client provides written proof they had an emergency medical condition and received medical services, including the month of application and up to 3 months medical backdating if medical services were received during the prior 3 months. Approve emergency medical only for the person who received the emergency medical care.

Approve a noncitizen New text who does not meet the federal qualifying Medicaid criteria who meet all requirements for Assist, except for citizenship/immigration status and a Social Security Number.

A noncitizen pregnant woman who does not meet immigration requirements should be approved for Family Assist, FamilyCare Assist or Moms and Babies (PM 06-09) if she meets the eligibility requirements. Do not approve a pregnant woman for emergency medical.

Always establish a separate case for a person eligible for emergency medical. Do not put Revised texta noncitizen not meeting immigration status in the same case with a person receiving ongoing medical benefits.

Example: An application is filed 9/07/17 for Revised texta noncitizen who does not meet the federal qualifying Medicaid criteria with 3 children who are also Revised textnoncitizens who does not meet the federal qualifying Medicaid criteria. He is temporarily unemployed because of a broken leg from a 8/07/17 car accident. He plans to return to work in October. He meets income and nonfinancial requirements of FamilyCare Assist, except for citizenship/immigration status and providing an SSN.

The broken leg is a serious impairment of a body part. Use the FamilyCare All Kids Assist Standard for a family of 4. The father is eligible for emergency medical coverage. Set up a case for him. The children may qualify for All Kids Assist on a separate case.