WAG 25-08-01-b: Family Health Plans Approvals

Before approving, complete an ANQR inquiry for each person listed on the application. If there is a matching record, complete an ACID inquiry for each matched case number. If anyone is included or had been included in a Cash, Medical, or SNAP Only case in the past 2 years, get the RIN from the ACID inquiry and enter it in Item 60.

NOTE: ACID and ANQR inquiries are not required when approving an application for persons who received Family Health Spenddown within the last 4 months.

(EW) To approve a pending application in IPACS, complete the Form 552 used to register the application or complete a blank Form 552:

  • Item 1 - Enter the complete case ID number. If there is a double entry due to a transfer of the application before approval, erase the bottom entry (number assigned by the sending office).
  • Item 2 - Enter the 4-digit current processing month (MM/YY) of the approval.
  • Item 3 - Enter the correct TA (10, 11, or 12). Code 10 requires completion of Item 41, Ending Medical Eligibility Date/Date of Death (see WAG 04-02-02-b).
  • Items 5 & 6 - Complete.
  • Items 8-10 - Complete, as needed.
  • Item 11 - Enter a dash.
  • Item 12 - Family Health Plans - Enter a dash.
  • deleted text
  • Items 13-15 - Complete as needed.
  • Item 16 - Enter a dash.
  • deleted text
  • Items 18-23 - Complete as needed.
  • Item 28 - Complete if case is adult-only, or child-only.
  • Item 33 - Enter the TAR for the reason for opening the case.
  • Item 35 - Complete, if required.
  • Item 39 - Enter code 00, 80, 91, or 92 (see WAG 17-02-00 for a complete Item 39 coding description).
  • REMARKS - If any client included in the unit previously received benefits under a different case ID number, enter the former number in REMARKS. If a temporary medical case was approved and is active at the time the Medical case is approved, enter the number of the temporary medical case in REMARKS (see WAG 17-03-03). The temporary medical case is not canceled unless the T case number is entered in REMARKS.
  • Item 53 - Enter the county of residence.  The county of residence is the 3 digit code corresponding to the office number of the FCRC located in the household's county of residence.
  • Item 60 - Enter any previously assigned RIN for each person included in the unit. Enter the RIN (if assigned), SSN, and last name immediately above the first name of the person previously assigned an RIN.
  • Enter any previously assigned RIN for a payee (RPY or TEMP) not included in the unit. Enter the RIN (if assigned), SSN (if available), and last name immediately above the first name of the payee.
  • Enter the correct QMB status indicator code (see WAG 27-60-09).
  • Items 61 & 62 - Complete as needed.
  • Item 63 - Enter mother/father status codes for all Family Health Plans cases. Update Item 63 when Item 62 is changed, or an Adjudication of Paternity (Form 3148) is received, or a member is added or deleted.
  • Items 64-70 - Complete as needed.
  • Items 71 & 72 - Enter dashes.
  • Items 73-75 - Complete as needed.
  • Item 77 - All non-spenddown cases: Enter the first day (6-digit month, day, and year) of the earliest month of medical eligibility. This may be as early as 3 months before the month of application if both nonfinancial and financial eligibility factors are met (see PM 17-02-05-a).
  • All Spenddown cases: Enter the 6-digit spenddown met date (MM/DD/YY) if spenddown is met (code 1).
  • Item 79 - Complete if client has a TPL resource.
  • Item 80 - Enter the spenddown codes that apply to the case situation:
390 SPD

Spenddown, non-group care. Enter under AMOUNT, the spenddown amount in dollars and cents.

Enter under PERSON, the spenddown status indicator code that applies:

  1. Spenddown met - split-bill
  2. Spenddown not met
  3. Spenddown met - carryover

A 392 AST entry is required in Item 80.When the FCRC enters a date in Item 77, the system automatically enters the month and year from Item 77 under TOTAL COST.
392 AST Enter for all spenddown cases the amount of nonexempt assets in excess of the case's asset limit. If none, enter zeros. Before determining total assets, drop cents from each individual nonexempt asset.
396 SPD Spenddown met ending date. Under PERSONS, enter the last date (MM/YY) spenddown is met.
158 CI Countable Income - Under AMOUNT, enter the amount of monthly countable income. If there is no countable income, enter 0.00. Under PERSONS, enter the 2-digit number to report the number of persons included in the Standard.Enter for All Kids Assist or Moms and Babies case when Item 20 is coded 16.Entry of code 158 CI is required for approvals, REDEs and when changes in Item 90 are processed (excluding changes in Item 90 codes 550, 554, 556, 560, 599, 602, 636, 638, 639, 644, 645, 648, 654, 657, 658, 659, 660, 661, 662, 663, and 700).
159 CI

Countable Income. Use only when Item 78 is coded P.

Under AMOUNT, enter the amount of monthly countable income. If there is no countable income, enter 0.00. Under PERSONS, enter the 2-digit number to report the number of persons included in the Standard.

When there is more than one person eligible, and eligibility has been determined separately, enter the countable income of the pregnant woman. If there is no pregnant woman, enter the countable income for the oldest eligible child.

Entry of code 159 CI is required for approvals, REDEs, and changes.
  • For cases that include a Refugee(s) or Entrant(s) in the unit, enter code 328 DU. Under PERSONS, enter the earliest month and year any Refugee(s)/Entrant(s) in the unit entered the United States. This entry is not required for the Repatriate Program.
  • Example: If the month and year the Refugee(s) or Entrants(s) entered the United States is July 1, 2002, enter 07/02 under PERSONS.
  • Item 90 - Enter nonexempt income codes and amounts.
  • Item 91 - Complete as required.