WAG 25-08-02-b AABD Medical 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: Do not require ACID and ANQR inquiries when approving an application for persons who were enrolled for Medical 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 Family Community Resource Center).
  • Item 2 - Line through the previous entry and enter the 4-digit processing month and year that can be met.
  • Item 3 - Line through the previous entry and enter the correct TA (10, 11, or 12) for the new approval or restore action. Code 10 requires completion of either Item 41, Date of Death, or Item 42, Date Entered State Institution.
  • Items 5 & 6 - Complete.
  • Items 8-16 - Complete as needed.
  • Item 17 - Enter dashes.
  • Items 18-23 - Complete as needed.
  • Item 33 - Enter the TAR for opening the case.
  • Item 35 - Complete if required.
  • Item 39 - Enter Client Notice Code 00, 80, 91, or 92. (See WAG 17-02-00 for a complete Item 39 coding description.)
  • REMARKS - If the applicant included in the unit previously received benefits under a different case ID number, enter the former case ID number in REMARKS and the previously assigned RIN in Item 60. If the applicant received benefits under more than one former case ID number, enter all former case ID numbers.
  • If a temporary medical case was approved, and remains active at the time the Medical application is approved, enter that case number under REMARKS (see WAG 17-03-03). The temporary medical case is not centrally canceled unless the temporary medical case number is entered in this item.
  • Item 45 - For Medical clients (91, 92, 93) living in LTC facilities, enter a dash in the first position of Item 45, followed by the 4-digit agent code assigned to the facility or the correct exemption code (see WAG 22-01-04). Item 20 must be coded 13 or 15.
  • new textItem 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 an RPY. Enter the RIN (if assigned), SSN (if available), and last name immediately above the first name of the payee.
  • Enter the proper HIB and SMIB status indicator codes.
  • Enter the QMB/SLIB Code status indicator code (see WAG 27-60-09).
  • Items 61-70 - Complete as needed.
  • Items 71 & 72 - Enter dashes.
  • Items 73-76 - Complete as needed.
  • Item 77 - All Regular Medical 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).
  • For community spenddown cases: if spenddown is met (code 1 or 3) enter the month, day, and year met.
  • Item 79 - Complete if client has a TPL resource.
  • Item 80 - Enter the following codes that apply to the case situation:
  • 390 SPD

    Spenddown, non-group care. Enter under AMOUNT, the dollars and cents amount of the countable monthly income in excess of the case's MANG Standard.

    Enter under PERSONS, 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.
    391 SPDGC

    Spenddown -- LTC or SLF cases. Enter under AMOUNT, the dollars and cents amount of the countable monthly income. If the spenddown is due to excess assets only, enter 0.00 under AMOUNT.

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

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

    Enter under SUP. BY one of the following indicator codes:

    3 - Determination was made without diverting income.
    4 - Determination was made by diverting income.

    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 under AMOUNT the amount of nonexempt assets in excess of the case's asset limit. If none, enter zero. Before determining total assets, drop cents from each individual nonexempt asset.
    395 GCARE

    Non-Spenddown -- LTC or SLF credit. Enter under AMOUNT, the dollars and cents figure of the LTC or SLF credit obligation spenddown. Do not make entries under PERSONS or TOTAL COST.

    Enter under SUP. BY one of the following indicator codes:

    3 - Determination was made without diverting income.
    4 - Determination was made by diverting income.

    A 392 AST entry is also required in Item 80.
    396 E SPD Spenddown met ending day - Enter under PERSONS the last date (MM/YY) spenddown is met.
    398 BRLTC Beginning Restriction for Long Term Care - Enter under PERSONS, as required, the beginning date (MM/YY) of the penalty period for LTC, SLF, and DoA services.
    399 ERLTC Ending Restriction for Long Term Care - Enter under PERSONS, as required, the last date (MM/YY) of the penalty period for LTC, SLF, and DoA services.
    158 CI

    Countable Income Medical (Excluding QMB Only, SLIB Only, and QI-1 Only) - Use only when code 16, 17, 18, or 20 is entered in Item 20.

    For all community Medical (Regular and Spenddown cases), enter under AMOUNT the amount of monthly countable income. If there is no countable income, enter 0.00. Enter under PERSONS the 2-digit number to report the number of persons included in the MANG Standard.

    When code 20 is entered in Item 20, enter under SUP. BY one of the following indicator codes:

    3 - Determination was made without diverting income.
    4 - Determination was made by diverting income.

    Entry of code 158 CI is required for approvals, REDEs, and when changes in Item 90 are processed (excluding changes in Item 90 codes 554, 636, 638, 640, 641, 643, 644, 648, 654, 657, 658, 659, 660, 661, 663, 670, 671, 672, and 700).
    674 PAT Enter this code if a person in a spenddown case is on a waiting list for a transplant.
    684 EIT Enter this code for cases with exempt irrevocable trusts. Enter under PERSONS, the 4-digit date (mm/yy) of the referral to BOC - TRS.

    Item 90 - Enter nonexempt income to be budgeted.

  • Item 91 - Complete, as required.