WAG 06-11-03-e: Application Process and Coding

PM 06-11-03-e

revised textMedical applications will be forwarded by the Division of DD to the FCRC or HFS All Kids Unit for processing. A cover letter and award letter will be attached to the application.

The HFS All Kids Unit is responsible for processing medical application for person under the age of 18 years old or younger. 

The FCRC is responsible for processing medical applications of persons age 19 through 21. A CAU determination is required on these cases.  If the person is 19 or older, and not receiving SSI, the medical assessment will be included with the application. This could be useful in determining disability. Refer to WAG 03-08-01.

For medical backdating refer to PM 17-02-05-a/WAG 17-02-05-a

Date of Application

Refer to PM 02-04-06 for applications received by DHS.

For applications received by the HFS All Kids Unit, the date of application is the date the application was signed.

DHS and All Kids Unit Responsibilities

DHS FCRC and HFS All Kids Unit will be responsible for processing medical applications. 

When eligibility for the waiver services is approved:

  • the DHS liaison will notify the FCRCs and All Kids of waiver approvals; and
  • code 335 HCBS is centrally entered,

When eligibility for the waiver services is terminated:

  • the DHS liaison will notify the FCRC of termination;
  • code 335 HCBS is centrally deleted; and
  • the FCRC must review eligibility for other medical programs when eligibility for the waiver program is terminated.

Changes on Waiver Children's Cases

When a case has an Item 80 Code 335 and TA 21, 22, 23, 44, 45, 81, 82 is entered or Item 80 Code 390 is added, a message will display. The message reads, "Case contains Waiver Child. Review PM 06-11-00."

When the case has an Item 80 Code 335 and TA 34 is processed to delete a waiver child, a message will display, "Recipient xxxxxxxxx receives waiver services. PM 06-11-00."

Contact the DHS liaison at 312-793-4131 before:

  • canceling a waiver child's medical assistance case;
  • deleting the child from the case; or
  • putting the child in spenddown.

Item 80 Code

revised textBeginning 10/15/08, HFS All Kids Unit will code all cases containing waiver children with Code 335 HCBS. This include cases that are maintained by the FCRC, also.  See WAG 27-80-02-c for coding instructions.

Cases approved for young adults, age 18-21, do not require Code 335 HCBS.