WAG 18-05-11-a: Change Case from Spenddown to Family Assist or FamilyCare Assist

  1. Complete Form 552:
    • Item 2 -Enter the current processing month and year.
    • Item 3 -Enter 31.
    • Item 25 -For Family Assist, enter code F.
    • Item 33 -Enter 57.
    • Item 44 -See WAG 27-44-00.
    • Item 77 -Enter the first day of the month in the enrollment period the case is eligible for Assist.
    • Item 80 -Delete:
      • 390 - indicator code and amount;
      • 392 - amount; and
      • 396 - date, if applicable.
  2. Document the action taken in the case record.
  3. Send Notice of Change During the Enrollment Period for Pregnant Women and Children (Form 23434D) to the family.