EXAMPLE

Categorically Needy (CN) medical provides the broadest scope of medical coverage. Examples of CN medical programs: F04 (Categorically Needy), F06 (Categorically Needy (CN) for Children) and F07 (Children's Health Insurance Program (CHIP).

Medically Needy (MN) medical provides slightly less medical coverage than CN medical.  Example of MN medical: F99 (MN Children W/Spenddown).

A client applies for F04 medical for herself and child.  The system looks at the client’s income and resources to determine eligibility for F04 medical first. If eligible, the system approves the household for F04 medical. If not, then system reviews medical eligibility for the following programs in this order:

F06;

F07 (with premium) and lastly;

F99 (MN Children with Spenddown).

EXAMPLE

Trickle:

When an S02 medical AU is denied or closed due to excess earned income. ACES will trickle the medical coverage to S99 using the same AUID.

Sprout:

When a TANF/F01 cash AU is terminated for excess earned income, ACES closes the TANF AU and sprouts a new F02 medical extension AUID.

EXAMPLE

Mom is receiving F07 medical for her 2 children and paying a monthly premium. During her eligibility review she reports that her income has decreased.  When the worker updates her case and recalculates eligibility, the F07 AU with monthly premiums spawns back to an F06 AU with no monthly premium using the same AUID.

EXAMPLE

An application for TANF benefits is submitted on 5/7. During the interview on 5/12, the client withdraws their request for benefits.  When the pending TANF AU is denied with Reason Code 550 - Voluntary Withdrawal, ACES sprouts a pending F04 medical AU.

EXAMPLE

Today is 9/23. You close a TANF AU and do not waive adverse action. The paid through date in ACES is 10/31. Currently, only benefit months September and October are in the system so the medical extension AU is not created. When monthly issuance runs on 9/25 benefit month November displays in the system. When Month Begin occurs on 10/4, ACES automatically creates the MA extension AU which displays in ACES on 10/5.

EXAMPLE

Client active on Pregnancy TANF starts receiving unemployment benefits of $400 a month. When the updates are completed and eligibility recalculated, ACES closes the TANF AU with reason code 331 - Excess Net Income and sprouts an active P02 medical AU.  In this example the system jumped from the Family (F) - track to the Pregnancy (P) - track.

When a client active on G02 fails to complete an eligibility review and is closed with reason code 525 - No Eligibility Review Form, ACES sprouts an active S02 medical AU.  In this example the system jumped from the Disability Lifeline (G) - track to the SSI Related (S) - track.  

EXAMPLE

Mom receives F06 medical for one child with a certification period of 5/09 – 4/10. On 9/15/09, a second child is added to the AU. The 1st child has a CTCN of 5/09 – 4/10 and the 2nd child’s CTCN is 9/09 – 8/10.

During her eligibility review on 4/10/10, the client reported that her income had increased.  When the worker completed the review, the F06 AU stayed active for the 2nd child with a certification period extended out to 8/10, and an F07 AU sprouted for the 1st child with a new CTCN range and 12 month certification.