Processing Alternatives (PAL) - Medical
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Processing Alternatives (PAL) - Medical


Revised November 6, 2013



Purpose: This category contains instructions for processing cases when ACES must be modified to ensure correct benefits are issued. Use these processing alternative processes when there is a system error or when a policy change is effective before ACES has been programmed to correctly handle the case. If you need further assistance, contact ITD Customer Support at 360-664-4560.

F07 17-Year Old Student Earned Income Disregard (PR 4837)

Married couple both eligible for Medicare in S05/S06 loop (PR 5866)

Medical Calculation W02 Denied With 301 - No Spouse Deduction (PR 3230)

F09 - Over Resources with Applicants Under age 19 and age 19 or Older (PR 5788)

S03 medical for an applicant with a non–applying spouse trickles to S05 and denies for Reason Code 301 – Exceeds Income Standard when the net income is under the 2 person standard. (PR 208323)

How to open MCS for TANF recipient with financial responsibility code RC – Recipient of Cash Only

 


F07 17 Year Old Student Earned Income Disregard (PR 4837)

Situation:

 

The earned income disregard for students age 17 and under is not being applied to F07 cases, which may result in the AU trickling to F99 in error.

 

Workaround:

 

Code the student's earned income type ON - Other Noncountable Income on the EARN screen.

 


Married couple both eligible for Medicare in S05/S06 loop (PR 5866)

When one spouse in a married couple receives SSI and both are eligible for Medicare, and active on S05 (SLMB), ACES trickles to S06 (Qualified Individual) if their combined other income exceeds the S05 standard. The system then looks at the S06 AU, notices the couple is active on medical and then goes back to an S05 AU. This loop of going back and forth from S05 to S06 will continue indefinitely. If an AU is caught in this type of loop situation, a data-fix needs to be done by contacting the ITD Central Support Help desk at (360) 664-4560.

 

To avoid this AU looping situation, the user needs to follow the recommended procedure listed below.

 

To process the case:

 

Open a separate S03 AU for each spouse.

 

Based on income the S03 (QMB) AU will trickle to a S05 AU program.

 


Medical Calculation W02 Denied With 301 - No Spouse Deduction (PR 3230)

Program and Medical Coverage Group: W02

 

No spousal Earned Income deductions are given in the computation for a W02 AU when the AU contains a non-applying spouse with earnings. W02 income allocation and deeming should follow the same rules as a GA-U and W01.

 

To process the case:

 

1.    User must manually calculate the correct net income and use that figure on the EARN for the spouse.

 

2.    If Basic Food is involved, user must code two EARN.

 

o    One for the W02 AU using the workaround and income type MA (Other MA Countable) to be budgeted against the W02 and

 

o    One using the actual gross income and income type FS (other FS countable to budget against the Basic Food.

 

3.   If the client becomes eligible for W01, the workaround is no longer necessary and the EARN with the MA and FS income types should be deleted and a new EARN completed using the correct gross income and the EI income type.

 


F09 - Over Resources with Applicants Under age 19 and age 19 or Older (PR 5788)

Situation

 

When an F09 AU contains an applicant(s) under the age of 19 and an applicant(s) age 19 or older in the same AU and the household has excess resources:

 

Currently, the system correctly denies the applicant 19 years or older in the first month for over resources and approves F09 for the child under 19. In the second and ongoing months, the system reads the adult member as active, ignores the resources as for a recipient, and incorrectly approves the adult applicant 19 years or older.

 

To process the case:

 

1.    Screen in 2 separate F09 AU's; one for the person(s) age 19 or older and one for the person(s) under the age of 19.

 

2.    This will allow the system to correctly ignore the resources and approve the F09 for the person(s) under age 19 and to consider the resources and deny the AU for the person(s) age 19 or older.

 


EXAMPLE

Household consists of Mom, Dad and two children. The Dad and one child have emergent medical need and apply for F09. Dad is 21 years old. The child with the emergent need is 2 years old. Household is over resources.


 Establish two F09 AU's
F09 for Dad F09 for Child
IP - Mom IP - Mom
PN - Dad IP - Dad
SC - Child PN - Child
SC - Child SC - Child
 

S03 MEDICAL FOR AN APPLICANT WITH A NON–APPLYING SPOUSE TRICKLES TO S05 AND DENIES FOR REASON CODE 301 – EXCEEDS INCOME STANDARD WHEN THE NET INCOME IS UNDER THE 2 PERSON STANDARD. (PR 208323)

Situation:

When an S03/S05 applicant has a non-applying spouse and the UNER screen indicates the applicant received SSI and is eligible for the Pickle disregard in the APPL/BEN fields, and the net income is below the 2 person standard, the AU denies for Reason Code 301 – Exceeds Income Standard.

Workaround:

Remove the disregard information at the bottom of the clients UNER screen.

 


How to open MCS for TANF recipient with financial responsibility code RC – Recipient of Cash Only

  Situation:

 

A TANF recipient with financial responsibility code RC – Recipient of Cash Only has been approved for MCS.  When finalizing the MCS AU, worker receives edit 0585 – CLIENT CANNOT RECEIVE BENEFITS FROM TWO AU'S, REVIEW CLIENT STATUS

 

To process this case:

 

Contact Customer Support at 360-664-4560 for instructions on how to process the case. 

 

Modification Date: November 6, 2013