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

PM 18-05-01

(Examples are Updated for IES Phase 2)

Example 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.

Example 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.

new text

Example 3: 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.

Example 4: 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.

new text

Note: Continuous Eligibility does not apply when the Head of Household is reported deceased by an acceptable type of verification.

Correcting Continuous Eligibility when the child was incorrectly determined eligible in the first place.


What is an Eligibility Override?

Eligibility overrides are used to update information about the EDG after running eligibility. Information such as the Begin Date, End Date, Amount and EDG Status can be updated from the Exception Details page. Once an Eligibility Override has been completed for a month, re-running certification won't update eligibility for the month. If a change happens that impacts the month for which an override was completed, another Eligibility Override is required. It is critical that you ensure the information is entered correctly prior to requesting an Eligibility Override. A flag on the Eligibility Summary page indicates if there was an override.

Who Can Complete an Eligibility Override?

Caseworkers request the Eligibility Override and a Manager with the Override Request Coordinator role approves or rejects the Eligibility Override.

What is the Process?

Step 1: Worker Requests An Override

Request an Eligibility Override: Worker notices a discrepancy and navigates to the Exception Details page and enters override details to request an eligibility override.

An alert automatically goes to the team manager. If the team manager does not have access to functionality or is out of the office, create a manual alert to another manager as instructed by the LOA/PSA as follows:

From Left Navigation select Alerts/Reminders, then select Create Manual Alert

In the Override Reason field, begin the explanation with "Override Request" in order to clearly name the task.

The caseworker should include their name in the task/alert Override Reason field so that the manager can easily identify who created the request and follow up.

Flag the Alert as High Priority

Step 2: Manager Reviews the Case

Manager reviews the case to confirm all information is entered correctly and an override is needed. If the eligibility error is a known issue, enter the Problem Number and JIRA Number from the Go-Live Instructions page as part of the Supervisor Comments field. If this is a new issue, call the USC and add the incident Number.

Step 3: Manager Approve/Reject Override

After reviewing the override request, the manager approves or rejects the override on the Exception Details page.

Step 4: Certify the Case

For FCRCs, the manager who approves the override should certify the case. For AKU, the manager should create a manual Alert/Reminder informing the caseworker of the override decision in order for the worker to complete Eligibility on the case.