WAG 17-01-04: Written Decision

PM 17-01-04.

(FCRC) When making a decision on an application, decide whether to provide the applicant with a:

  • centrally issued Notice of Decision on Application for Cash, Medical, and/or Food Stamps (Form 360C);
  • centrally issued Notice of Decision on Application for Health Benefits (Form 360KC);
  • locally issued Notice of Decision on Application for Cash, Medical, and/or Food Stamps - Local (Form 360 series);
  • locally issued Notice of Decision on Application for Health Benefits (Form 360KC);
  • locally issued Backdate Supplement To Notice of Decision on Application for Assistance (Form 360B);
  • locally issued Notice of Decision on Application for Medical Assistance - MANG Non Spenddown (Form 458);
  • locally issued Notice of Limited Approval of Medical Assistance Application (Form 458D);
  • locally issued Notice of Decision on Application for Medical Assistance - MANG Revised textNursing Home/Supportive Living Facility (Form Revised text458LTC);
  • locally issued Notice of Decision on Application for Payment of Medicare Premiums, Deductibles and Coinsurance (Form 458M); and/or
  • locally issued Notice of Decision on Application (MANG) For A MediPlan Card (Form 458SP).

See WAG 25-02-06 for charts entitled Disposition Notices to Applicants. These charts show when to send Form 360C, Form 360, and other approval/denial notices.

Also see WAG 01-06-00 for more information about client notices and WAG 26-02-01-a for instructions for completing the Form 360 series.

(System) When coded not to suppress, sends Form 360C for:

  • TANF applications approved/denied through AIS;
  • TANF, AABD Medical, FamilyCare Assist, All Kids Assist, Moms and Babies (not spenddown or long term care) approved/denied through AIS;
  • Medical Long Term Care applications denied through AIS;
  • GA applications approved/denied through AIS;
  • FS applications approved/denied through AIS, ACM, or IPACS;
  • AABD Cash applications approved through IPACS; and
  • AABD Cash applications denied through AIS.

NOTE: Mails Form 360C centrally when Item 39 is coded 00 on Form 552 or on the proper AIS screen.

(System) For TANF cases, completes and sends budget calcs, Approval TANF/Food Stamp Computation (Form 553I), and if needed, an Attachment to Worksheet for Computation of Grant/Food Stamps (Form 553GC), with Form 360C when income is budgeted for the first regular payment month.

(System) For AABD Cash cases, completes and sends an AABD/Food Stamp Computation (Form 4050C), with Form 360C.

(System) Dates and mails Form 360C no later than 2 workdays after the date the action is transmitted.

(System) Does not send copies of Form 360C to the Family Community Resource Center. Sends the FCRC a daily list entitled IM Change Notices Issued Centrally/Intake Notices Issued Centrally. At the top of the list, shows the mailing date of each notice.

(EW) If AIS is down or inaccessible when determining financial eligibility, complete the following worksheets as needed:

  • Food Stamp Eligibility Worksheet (Form 683A);
  • Food Stamp Calculation Sheet (Form 683B);
  • Revised textAABD MANG Computation Sheet - Community Case (Form 2382A);
  • Revised textNursing Home/Supportive Living Facility Calculation (Form 2500);
  • AABD Revised textCash Computation (Form 2382);
  • TANF Cash Computation (Form 2383C);
  • Supplement to Form 2383C, TANF Cash Computation (Form 2383B);
  • Assist/Moms and Babies Computation Sheet (Form 2383A);
  • Category 94R Worksheet (Form 2595).

NOTE: Do not send copies of Form 683A, Form 683B, Form 2382, Form 2382A, Form 2383C, Form 2383A, Form 2383B, or Form 2595 to the customer.