WAG 18-05-01: Continuous Medicaid Eligibility for Persons Under Age 19

PM 18-05-01

(Examples are Updated for IES Phase 2)

revised textExample 1: The A family applies for medical benefits on 08/03/16 and is approved for FamilyCare and All Kids Assist. Their certification period is August 2016 through July 2017. Each person in the case under age 19 is eligible for All Kids Assist  through 07/31/17.

revised textExample 2: Ms. B, age 17, receives All Kids Assist for herself and her daughter, Barbara. Both Ms. B and her daughter are eligible for All Kids Assist for 12 months since both are under age 19.

revised textExample 3: The C family applied for medical benefits on 08/03/16 for their their daughter, Karen, age 12. Family income is over the All Kids Premium Level 2 standard and Karen is approved for Family Health Spenddown due to a hospital bill.

Karen is not automatically eligible for 12 months because she is only eligible for medical benefits because she met her spenddown.

revised textExample 4: Mr. and Mrs. D, age 25 and 26, apply for benefits on 10/01/16 for themselves and their 3 year old daughter. They request backdating for July, August and September.

The family's income is below the All Kids Assist Standard for 07/16. The daughter is eligible for All Kids Assist from 07/01/16 through 09/30/17, regardless of changes in income.

revised textExample 5: Ms. E receives All Kids Assist for her son, Jack, age 8. She also receives SNAP for herself and Jack. The Medical and SNAP case is certified through 12/16. On 11/01/16, a Medical Benefits Redetermination notice (Form 2381A) is mailed to Ms. E informing her that Jack will continue to qualify for All Kids Assist after December based on earned income data received electronically. The notice advises her to report any change in the number of people in her household or income changes within 10 days. Also included with Form 2381A, is the SNAP Redetermination (Form 1893). Ms. E does not respond to the REDE notice, so the All Kids Assist EDG is auto-REDE'd with a new certification period of 01/17 through 12/17; and SNAP benefits expire after 12/16.

On 01/03/17, Ms. E completes the SNAP REDE and provides pay verification that shows she started a new job with increased income in October. Her verified income is at the All Kids Share level. Because the income from the new job was not listed on Form 2381A, and Ms. E did not report the income change as required, Jack is not eligible for continued eligibility for All Kids Assist because he was incorrectly determined eligible in the first place. Jack is certified for All Kids Share for the remainder of the certification period that ends 12/17.