WAG 06-11-01-d: Central Processing of a MFTD Waiver Request

PM 06-11-01-d

DHS CENTRAL OFFICE 238 RESPONSIBILITIES

Contact CO 238 with questions about the MFTD Waiver process. See WAG 25-05-03 for CO 238 contact information.

Pending MFTD Waiver

1. DSCC sends "General Information for a Waiver Application" to CO 238 to notify the Department that a MFTD waiver is pending for a child.
2. CO 238 notifies DSCC whether or not the child is already active for medical assistance.
3. If the child does not have a medical case, DSCC provides a signed medical application, or confirmation that the family has applied through ABE to CO 238.
4. If the child is not receiving SSI or SSA based on disability, CO 238 completes a referral to the Client Assessment Unit (CAU) with medical documents provided by DSCC. 
5. CO 238 notifies HFS BPAS if all Medicaid eligibility factors are met except for consideration of parental income.
6. If the child's parent has an active or pending TANF case, CO 238 notifies the FCRC that a MFTD waiver is pending.

Denied MFTD Waiver

1. CO 238 denies their medical application if the child:
   • does not meet nonfinancial requirements for medical assistance; or
   • is financially ineligible due to his or her own income.
2. DHS denies the waiver application if:
   • the child's medical application is denied for the above reasons; or 
   • the child does not meet federal Medicaid immigration status; or 
   • the child is not considered disabled according to SSA standards.
3. HFS BPAS denies the waiver application if the child is not at risk for institutionalization due to his or her medical condition.
4. If ineligible for the waiver, CO 238 determines medical eligibility according to regular Medicaid financial policy (considers parental income). If ineligible for medical assistance, CO 238 denies the medical application. If eligible, the application is approved and transferred to the FCRC.

Approved MFTD Waiver

1. When HFS BPAS notifies CO 238 that a child has been determined medically eligible for the MFTD waiver, Office 238;
   1. processes child's medical application if it is pending in CO 238; or
   2. removes child from a medical assistance case at the FCRC, and sets up new CO 238 case for child, unless the child is in an active TANF or DCFS case;
2. Adds child back to FCRC SNAP unit if deleted from medical/SNAP case;
3. Adds Item 80 Code 335 and Item 90 Code 540 to CO 238 case;
4. Adds Item 80 Code 331 to the TANF case of an adult who is caring for a child approved for the MFTD waiver, adjusts the TANF counter(s) if needed and sends Form 4335 (see WAG 03-06-01-e); and enters code 4 in Item 73 for the first adult in the TANF case (see WAG 21-01-04-b); 
5. Adds Item 80 Code 331 as an informational code to a waiver child's TANF child-only case;
6. Notifies FCRC of any action taken on a case at their office; and
7. Completes annual redeterminations of medical eligibility for the child's case under CO 238.

Terminated MFTD Waiver

1. DSCC notifies CO 238 when a child no longer qualifies for waiver services.
2. If the child has died or has moved out of state, CO 238 cancels the child's medical assistance, and takes action for the child on cases maintained at the FCRC. CO 238 notifies the FCRC if the child is deleted from a SNAP household, or when a TANF child-only case is canceled.
3. If the child has moved out of state, CO 238 notifies the FCRC if follow up action may be needed on a related family case.
4. If the child remains nonfinancially eligible for medical assistance, CO 238 determines eligibility using regular financial policy (considers parental income). If financially ineligible, the CO 238 case is canceled. If eligible, the case is transferred to the appropriate FCRC.
5. CO 238 removes Item 80 Code 331 from the child's and/or parent's TANF case, sends Form 4335 and notifies the FCRC administrator by email. See WAG 03-06-01-e.