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continuous eligibility for categorically needy childrens medical

Revised March 11, 2008

Who is eligible to receive Categorically Needy (CN) Childrens Medical? What CN Medical Coverage Groups are tracked? How is CN Childrens continuous medical eligibility tracked in ACES? How does ACES automatically authorize CN coverage? When will the system not automatically trickle/sprout to continuous medical coverage? How are CN continuous children identified from regular F06 clients? How is the certification date set when there are multiple children on the F06 AU? What happens when Add-A-Person is completed? What is the Eligibility Review process for CN continuous clients on F06? What happens if the F06 review is not completed? How can I close an AU that was opened in error and should not be tracked? How do I access the CTCN screen? What information is displayed on the CTCN screen?

Who is eligible to receive Categorically Needy (CN) Childrens Medical? Children who have been determined eligible for CN medical are eligible to receive a full 12 months of CN medical coverage regardless of changes in the circumstances or the household the child is associated with. See EAZ Manual: WAC 388-505-0210 Children's medical eligibility , WAC 388-416-0015 Certification periods for categorically needy (CN) medical and state children's health insurance program (SCHIP) , WAC 388-418-0025 Effect of changes on medical program eligibility. What CN Medical Coverage Groups are tracked? ACES will individually track a child's certification in the following CN medical coverage groups: C01 - Copes/Categorical Needy Home Services F01 - Temporary Assistance for Needy Families Cash CN F02 - CN 12-Month Extension F03 - CN 4-Month Extension F04 - Categorically Needy F05 - Newborns F06 - Categorically Needy Children's F10 - Categorically Needy/Family Medical G01 - GA Regular - Only Federally Qualified G02 - GA Cash, B, D, X I01 - Inpatient Psychiatric K01 - Family Long Term Care L01 - SSI Long Term Care L02 - CN SSI Related Long Term Care P02 - Categorically Needy Pregnancy R01 - Refugee Medical R02 - Refugee Extension R03 - Refugee Categorically Needy S01 - SSI Categorically Needy Each recipient child in the above medical coverage groups will be tracked for a 12-month potential continuous range. This will be based on the begin date of the certification period. The potential range end date is the child's begin date plus 11 months, it is not based on the number of months the client received coverage. A child will retain this CN eligibility regardless of the assistance unit the child is associated with at any point during the most recent 12-month certification. How is CN Childrens continuous medical eligibility tracked in ACES? The system will automatically track a child's 12-month continuous CN Medicaid coverage based on the begin date of the AUs certification period. The Children's Tracking CN Medicaid CTCN screen will track a child's CN Medicaid date ranges. How does ACES automatically authorize CN coverage? At a child's termination or denial, the system will look at the start date of their most recent period of CN certification. If the elapsed time is less than 12 months, continuous eligibility rules will apply. When an assistance unit in one of the following CN medical coverage groups closes, children under 19 years of age will automatically trickle to CN continuous F06 medical coverage for the remainder of twelve months continuous coverage: F01 - AFDC Cash CN F02 - CN 12-Month Extension F03 - CN 4-Month Extension F04 - Categorically Needy F06 - Categorically Needy Children's F10 - Categorically Needy/Family Medical G01 - R - GA Regular (Children on GAU cash under age 19) G02 - GA Cash, B, D, X P02 - Categorically Needy Pregnancy R01 - Refugee Medical R02 - Refugee Extension R03 - Refugee Categorically Needy The system will allow children receiving continuous CN Medicaid eligibility to jump (trickle/sprout) from one medical track to another after the current trickle/sprout logic is applied.

EXAMPLE When a child is terminated from R01 and R02 is opened, when the R02 closes and the child is not eligible for any other CN coverage, the system will AUTO open F06 continuous CN coverage for the child for the remainder of the 12 month period.

When will the system not automatically trickle/sprout to continuous medical coverage? The system will not auto trickle/sprout a child to the F06 program when the child is removed from the AU or the AU closes for any of the following reason codes: RC 200 - Undocumented Children and Non-Qualified Alien Medical Ineligibility RC 201 - Living Arrangement Cash/Medical Assistance RC 202 - Citizenship/Alien Status RC 203 - Receiving SSI RC 210 - Failed Residency Requirement RC 220 - Failed Age Requirement - Medical RC 225 - Now Receiving SSI RC 244 - Death RC 248 - HOH Not Eligible RC 293 - Failed Age Requirement for Cash Related Medical RC 535 - Error in Initial Eligibility - Removed Continuous Tracking for Child RC 550 - Voluntary Withdrawal RC 551 - Whereabouts Unknown RC 561 - Screened in Error (Admin use only) RC 566 - Refused to Cooperate with the Application Process RC 569 - Child Accepted into Foster Care RC 572 - User Voided Application (Admin use only) RC 577 - Missed Application Deadline (Admin use only) RC 587 - Already Eligible for Program in Different AU (Admin use only) RC 599 - Other - For User Generation Only (Eliminated w/ Re-determination) How are CN continuous children identified from regular F06 clients? The STAT and ELIG screens will display a [Y] as the indicator in the CC - Continuous Coverage field to identify an F06 child eligible due to CN Medicaid 12-month tracking. The CC column displays on the F06 medical coverage groups and shares the same location as the OP - Optional Children field used for the F07 children with premiums. This field will also be displayed in aces.online on the Assistance Unit >> Household Member page. How is the certification date set when there are multiple children on the F06 AU? When there are multiple children on the F06 AU with different continuous ranges, the AU certification end date is set to the earliest of the continuous end dates. When there is not an associated F07 AU, only the child reaching their certification period end date first will receive an eligibility review for the F06. What happens when Add-A-Person is completed? When a child is added to one of the tracked medical coverage groups and becomes an active recipient, the begin date of the tracking is the begin date on the new certification period for that child. A new potential continuous range will be created for the added client(s) only. Each added recipient child gets a complete 12-month potential range, and the original AUs certification end date does not impact this. See EAZ Manual Twelve Month Continuous Eligibility for Children under #7. Add-A-Person Examples 1 and 2 that include initiating a review. What is the Eligibility Review process for CN continuous clients on F06? An eligibility review will be sent for F06 AUs when there is no associated active F07 or F99. The batch process that sends reviews for AUs works the same for continuous children on F06 AUs. See the Eligibility Review/Recertification Process Chapter. There is one exception, if the client's financial responsibility code is [SC] - Child of SSI Related Parents/Child used to determine household size on an Active F07 AU with the same HOH, the review will be suppressed. The eligibility review should not be initiated before deadline in the calendar month prior to the month in which the review is due. If reviews are initiated early, the certification period will be incorrect. Example F06 certification end date is 03/07. The review month is 03/07 so a review should not be initiated prior to monthly issuance (deadline) in February (02/24/07). If a review is initiated early on this F06, say on 02/15/07, which is before monthly issuance and which is more than one month before the review month of 03/07, the system will only create a one month certification period.       If the F06 AU is reviewed and stays F06, all recipient children will get a new 'potential continuous range' using the new certification period and will become regular F06 with no continuous indicator. What happens if the F06 review is not completed? If the review is not completed (either because there is a related F07 and no review sent, or the client doesn't send in the required information), the client(s) who's continuous range is ending will be closed out of the F06 AU. ACES then resets the ending certification date to the next earliest date for any remaining children. If a related F07 AU exists, with same Head of Household (HOH), the child's financial responsibility code on the F07 will change from [SC] - Child of SSI Related Parents/Child used to determine household size to [RE] - Recipient. If the client that is getting closed out of the F06 AU is the HOH, they will stay Active [A] status but their financial responsibility code will change to [IP] - Ineligible Person. How can I close an AU that was opened in error and should not be tracked? Reason Code 535 - Error in Initial Eligibility - Removed Continuous Tracking for Child can be used to manually close a CN Medicaid AU that was opened in error. When the AU is closed with Reason Code 535 - Error in Initial Eligibility - Removed Continuous Tracking for Child, the system will remove the most recent AU segment being tracked. Reason Code 535 can be entered in the ongoing month only. Users will need to add mandatory freeform text giving the reason for termination as the Reason Code 535 will not add any text to the Letter 006-01 (Termination for AU) or Letter 006-08 (General Termination of Benefits for an Individual).

NOTE: Do not historically close children from any CN Medicaid program except in cases of death or confirmed out of state residence.

How do I access the CTCN screen? The CTCN screen can be accessed in the following ways: From the AMEN screen, select Option [2] Childrens Tracking CN and enter the Client ID. From the CLLI screen, enter a [Y] in Select column next to the client and press <F13>. From the Welcome Back page in aces.online, use the Quick Navigation section to do the following: Enter a Client ID number in the Enter an ID box. From the Select a Page drop down box, click on the Childrens Tracking CN Medicaid option. From the Client >> Summary page, the Childrens Tracking CN Medicaid option will be included in all client level inquiry pages under Details submenu. What information is displayed on the CTCN screen? This screen displays the CN Medicaid AU, Potential Continuous Date Range and the Date this Range was removed by using Reason Code 535 - Error in Initial Eligibility - Removed Continuous Tracking for Child. CN MEDICAID AU - The AU number under which the client is receiving, or has received CN Medicaid Coverage and has been tracked by the system will be displayed. POTENTIAL CONTINUOUS RANGE - The range start date plus 11 months calculates the range end date. Continuous range is 12 months regardless of the original AU certification period. REMOVED - The date Reason Code 535 was used, the CN Medicaid range is no longer tracked and will not be considered for continuous coverage. The CTCN screen is an Inquiry screen only and not part of the data collection screen flow. No fast path or remarks are allowed on the screen. Paging is allowed when more data exists and the most current tracked period will appear at the top of the list.

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Modification Date: March 11, 2008

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