Eligibility Review / Recertification
DSHS Home Page
 
Search     for:
DSHS Home    Acronyms    Alerts    Screens    WAC Number Index    WCCC

Eligibility Review / Recertification


Revised July 10, 2014



Purpose:

Eligibility Review/Recertification

 

Eligibility Review - Online Case Actions (ACES 3G)

 

Mid-Certification Review

 

Mid-Certification Review - Online Case Actions (ACES 3G)

 

 


ELIGIBILITY REVIEW/RECERTIFICATION


NOTE:

As a result of implementation of the Affordable Care Act (ACA), Family, Children, and Pregnancy Medical coverage groups with eligibility reviews/certifications ending November 30, 2013 through September 30, 2014 will need to submit their renewal applications in Healthplanfinder on or before their certification period end date to continue coverage. For further information, see EAZ Manual – Affordable Care Act (ACA) Transition Plan.


What is the eligibility review/recertification process?

 

How does ACES support the eligibility review process?

 

How are eligibility reviews scheduled?

 

How is the eligibility review type determined?

 

How often is an eligibility review required?

 

How are certification periods determined?

 

How does ACES indicate an eligibility review has been received?

 

How do I initiate an eligibility review?

 

How do I complete an eligibility review?

 

What is the SLAM indicator?

 

Can I initiate a review on a Spenddown Assistance Unit?

 

How do I complete an eligibility review on a Basic Food AU up to 45 days befoer the end of the certification period?  

 

How do I complete an eligibility review after deadline but before the first of the following month?

 

How do I complete an eligibility review after the first day of the month following the month the review was due?

 

What happens if an eligibility review is not initiated?

 

What happens if an eligibility review is initiated but not completed?

 

What happens to a TANF/SFA cash AU when an eligibility review has been received in DMS but not initiated or completed?

 

What happens to a Categorically Needy medical or Medicare Savings AU when an eligibility review has been received in DMS but not initiated or completed?

 

What happens to a GAX (G02) cash AU when an eligibility review has been received in DMS but not initiated or completed?

 


What is the eligibility review/recertification process?

 

·         The eligibility review/ recertification process is to determine if a client is still eligible to receive continued assistance. It is the procedure by which a user:

 

o    Initiates an eligibility review;

 

o    Enters any changes with required verification based on the household's current circumstances; and

 

o    Extends the certification period.

 

·         For more information, see the following EAZ Manual Chapters:

 

o    Eligibility Review/Food Assistance Recertifications – Process for Basic Food

 

o    Eligibility Reviews/ Food Assistance Recertifications - Requirements for Cash Assistance and Medical Programs

 

o    Eligibility Review Requirements for Cash Assistance and Medical Programs

 

How does ACES support the eligibility review process?

 

·         ACES supports the eligibility review process by:  

 

o    Scheduling appointments. See Scheduling Chapter.

 

o    Updating the Elig Rvw Recd field on MISC screen for TANF/SFA, FS, G01, G02 and any Categorically Needy (CN) medical program when a review has been received.

 

o    Tracking the initiation and completion of eligibility reviews.

 

o    Allowing entry of eligibility review information.

 

o    Initiating required interfaces and referrals.

 

o    Identifying required verifications.

 

o    Sending alerts and letters.

 

How is the eligibility review type determined?

 

·       For offices designated to use date/time specific eligibility review appointments, the eligibility review type is determined based on the valid value entered in the Next Review field on the MISC screen. There are five possible review types:

 

o    M = Mail Review Type

 

o    O = Office Review Type

 

o    T = Telephone Review Type

 

o    U = Unselected Review Type (Do not use)

 

o    Blank (system generated)

 

·         For offices designated to use the weekly eligibility review appointments:

 

o    Eligibility review types O = Office, T = Telephone, U = Unselected, and Blank may be entered and the system will send the LTR 013-03 (Weekly Appointment for Eligibility Review).


How are eligibility reviews scheduled?

 

·         Eligibility reviews are AUTO scheduled by ACES or manually scheduled by a user. See Scheduling Chapter.

           

How often is an eligibility review required?

 

·         For cash and medical programs, see EAZ Manual – WAC 388-434-0005 How often does the department review my eligibility for benefits?.

 

·         For Basic Food, see EAZ Manual – WAC 388-416-0005 How long can I get Basic Food?

 

How are certification periods determined?

 

·         See EAZ Manual Certification Periods.

 

·         See ACES Certification Period Chapter.

 

How does ACES indicate an eligibility review has been received?

 

·       ACES updates the Elig Rvw Rcvd field on the MISC screen with a [Y] – Yes the day after one of the following documents are scanned in DMS (Document Management System):

 

o   Application for Benefits (14-001)

 

o   Eligibility Review (14-078)

 

o   Eligibility Review for Long Term Care Benefits (14-416)

 

How do I initiate an eligibility review?

 

·         ACES does not automatically initiate eligibility reviews or allow workers to initiate eligibility reviews on Basic Food AUs more than 45 days before the end of the certification period.

 

·         ACES allows workers to intiate an eligibility review on Transitional Food Assistance (TFA) and Washington State Combined Application Program (WASHCAP) AUs any time during the certification period.

 

·         To initiate an eligibility review take the following steps:

  

1.      Select AMEN, Option N - Initiate Review, enter the [Client ID] for the head of household in the Client ID field, press <TRANSMIT>. 

 

2.      On the REVI screen, enter a [Y] in the SEL field next to each AU to be reviewed.

 

3.      Press <TRANSMIT> to return to AMEN.

 


NOTE:

The review type cannot be changed when the system has tentatively scheduled a review appointment.


NOTE:

When a review is initiated for a Cash or Basic Food AU, a review is also initiated for the following associated medical coverage groups: Categorically Needy (CN), S02 (SSI Related Categorically Needy), S03 (QMB), and S05 (SLMB).


How do I complete an eligibility review?

 

·         To complete an eligibility review take the following steps:

1.    From the AMEN, enter Option R - Interim/Hist Change in the Selection field.

 

o    Enter the [AUID or CLID] in the AUID or Client ID field for the head of household.

 

2.    Update the case with information reported during the review, and re-enter all required verification codes. See EAZ Manual – WAC 388-406-0030 Do I need to submit other information after I apply for benefits?

 

3.    Enter [Y] Yes in the Elig Rvw Complete field on the MISC screen.

 

4.    Commit the data.

 

·         ACES generates the following letters based on the type of AUs being recertified:

 

o   LTR 027-01 (Cash/Medical/Food Recertification),

 

o   LTR 027-04 (LTC Recertification) or

 

o   LTR 027-05 (WASHCAP Post Review).

What is the SLAM indicator?

 

·         The suspected of living above means (SLAM) indicator applies to Basic Food AUs only and must be updated on the MISC screen at application, re-open and eligibility review. 

 

·         In the SLAM Ind field, enter [Y] – Yes if you suspect the client(s) is living above their means. See <F2> help.

 

Can I initiate a review on a Spenddown Assistance Unit?

 

·         If the spenddown AU for which the review is due is in [A] – active status, a review may be initiated on the following types of AUs:

 

o    G99 (MN Alternate Living Facility W/Spenddown),

 

o    K99 (MN Family LTC W/Spenddown),

 

o    L99 (LTC MN W/Spenddown) or,

 

o    S99 (MN SSI Related W/Spenddown) the previous AU can be reopened.

 

·         If the AU is in [M] Spenddown status, an eligibility review can be initiated when the ongoing month is the month after the current base period end month.

 

How do I complete an eligibility review on a Basic Food AU up to 45 days before the end of the certification period?

 

·         If the AU is closed, reinstate both the ongoing and historical months. See Reinstatement. To ensure certification is set correctly, users should always process the oldest month first.

 

·         If the AU is active, take the following steps:

 

1.    Select AMEN, Option N – Initiate Review. Enter the [CLID] in the Client ID field for the head of household.

 

2.    The REVI screen displays and lists all AUs with the same head of household due for review.

3.    Enter [Y] – Yes in the SEL field next to each AU to be reviewed. Press <TRANSMIT>.

4.    Select AMEN, Option R – Interim Historical change.

5.    Update the case information as needed.

6.    Enter [Y] Yes in the Elig Rvw Complete field on the MISC screen.

7.    On the CAFI , MAFI or FSFI  screens, the REV Begin Date will be the month following the current certification period and the REV End Date will default based on program requirements.

 

8.    Commit the data.

 

·         Eligibility Reviews completed on Basic Food AUs up to 45 days prior to the end of the certification period and before monthly issuance in the month prior to the certification end date receive the following letters. These letters display the new certification period beginning the month following the current certification period:

 

o    LTR 027-01Cash/Medical/Food Recertification,

 

o    LTR 027-04 LTC Recertification, or

 

o    LTR 027-05 WASHCAP Post Review

 

How do I complete an eligibility review after deadline but before the first of the following month?

 

·         Reinstate both the ongoing and historical months. See Reinstatement. To ensure certification is set correctly, users should always process the oldest month first.

 

·         Once the AU is active, take the following steps:

 

1.    Select AMEN, Option N – Initiate Review. Enter the [CLID] in the Client ID field for the head of household.

 

2.    The REVI screen displays and lists all AUs with the same head of household due for review.

 

3.    Enter [Y] – Yes in the SEL field next to each AU to be reviewed. Press <TRANSMIT>.

 

4.    Select AMEN, Option R – Interim Historical change.

 

5.    Update the case information as needed.

 

6.    Enter [Y] Yes in the Elig Rvw Complete field on the MISC screen.

 

7.    On the CAFI , MAFI or FSFI screens, the REV Begin Date will be the same as the ongoing month and the REV End Date will default based on program requirements. For most cases, this means the certification period includes one extra month.

 

8.    Commit the data.

 

How do I complete an eligibility review after the first day of the month following the month the review was due?

 

·         When the review is received after the first day of the month following the month the review was due re-open benefits effective the date you determine they were eligible. See EAZ Manual – WAC 388-418-0020 How does the department determine the date a change affects my benefits?

 

·         When the review is not received until after the month it is due, the review should be handled as a new application.

 

o    See Screening – Re-Open.

 

o    Follow the steps in Interview.

 

What happens if an eligibility review is not initiated?

 

·            For reviews scheduled for date/time specific review appointments:

 

o    When an appointment has been scheduled through ACES, but the review is not initiated, Alert 312 – ER/Recert Sched on Previous Working day – Not Initiated is generated and displays the day after the appointment.

 

o    If the review is not initiated before deadline in the month it is due, ACES:

 

¨        Closes the AU with Reason Code 235 – Review Not Complete.

 

¨        Generates LTR 026-04 (Eligibility Review Termination), and Alert 351- AU TERMINATED/CLOSED OVERINIGHT.

 

·            For reviews scheduled using the weekly block of time method:

 

o    No Alerts will generate.

 

o    If the review is not initiated by the last business day of the week it is scheduled, LTR 026-04 generates the last system calendar day of the week.


EXAMPLE

ER is scheduled for the week of November 1, 2010 – November 5, 2010. The system is online Saturday November 6, 2010. If the review is not initiated by Saturday, LTR 026-04 is generated in batch the night of Saturday November 6, 2010. This gives the user one additional day to take action on the case before a letter is sent.


What happens if an eligibility review is initiated but not completed?

 

·         Basic Food AUs close at the end of the certification period.

 

·         Cash or medical AUs will not close and will remain active until they are manually closed.


NOTE:

If an eligibility review is initiated on a Cash or Medical AU and not completed, users need to set a tickler to manually close the AU if all needed verifications are not received.


What happens to a TANF/SFA cash AU when an eligibility review has been received in DMS but not initiated or completed?

 

·        If the eligibility review has been received in DMS but not initiated or completed:

 

o    At monthly issuance, the AU closes with Reason Code 235 – Review Not Complete unless the MISC screen has M – Mail Review Type in the Next Review field.

 

    If the MISC screen has M – Mail Review Type in the Next Review field, the AU will remain active with the expired certification period and Alert 110 – ER/RECERT PENDING generates in overnight batch.

What happens to a Categorically Needy medical or Medicare Savings AU when an eligibility review has been received in DMS but not initiated or completed?

·         If the eligibility review has been received in DMS but not initiated or completed in ACES:

 

o    The MISC screen for that AU displays a [Y] in the Elig Rvw Rcvd field.

 

o    At monthly issuance, the AU remains open with the current eligibility review end date.

 

o    Medical eligibility continues until the review is completed.

 

·         The following medical programs are included in this functionality:

 

o     G02  G03  I01  K01  L02 

 

S02  S03  S04  S05  S06  S08 


What happens to a GAX (G02) cash AU when an eligibility review has been received in DMS but not initiated or completed?

 

·         When the eligibility review has been received in DMS but not initiated or completed:

 

o    The MISC screen for that AU displays a Y in the Elig Rvw Rcvd field.

 

o    At monthly issuance the AU remains open.

 

o     Alert 110 – ER/ RECERT PENDING  generates.

 


MID–CERTIFICATION REVIEW

Who is required to complete a mid-certification review?

 

What is a mid-certification review?

 

When is a mid-certification review generated?

 

Will the system match up the mid-certification review cycle for related AUs?

 

When will the system not match up the mid-certification review cycle for related AUs?

 

What happens when a related application is processed during the month a LTR 022-07 (Mid-Certification Review) or LTR 022-11 (Mid Certification Review - Food Assistance Only) is due to be mailed?

 

What happens when a related application is approved after the LTR 022-07 (Mid-Certification Review) or LTR 022-11 (Mid Certification Review - Food Assistance Only) is mailed to the client but prior to the report deadline?

 

How will I know if an AU is a mid-certification reviewer?

 

How do I process a mid-certification review?

 

When is LTR 033-03 (Non-Receipt of Change Report Form) generated?

 

What happens at monthly issuance if the mid-certification review is incomplete?

 

What happens at monthly issuance if the mid-certification review has not been received?

 

Can an AU be manually closed for an incomplete mid-certification review?

 

What do I do if an application is received after an AU closed for no mid-certification review?

 


Who is required to complete a mid-certification review?

 

·         Most cash and Basic Food assistance units with certifications periods greater than 6 months are required to report changes on a mid-certification review. See EAZ Manual WAC 388-418-0011 What is a mid-certification review, and do I have to complete one in order to keep getting benefits?

 

·         The reporting requirements are the same for all assistance units (AUs) related by head of household (HOH) and are based on what types of benefits the household receives.

 

What is a mid-certification review?

 

·         Households related to a CASH AU: Clients who have a related cash AU will receive LTR 022-07 (Mid Certification Review) along with Attachment 14-467 (Mid-Certification Review). 

o    LTR 022-07 does not contain any case specific information. This letter informs clients how to complete their mid-certification review to continue receiving benefits.

 

o     Attachement 14-467 is not prefilled with any household information from ACES. See EAZ Manual WAC 388-418-005 How will I know what changes I must report?  

·          Food only households: Clients who are recipients of Basic Food and do  not have a related cash AU will receive LTR 022-11 (Mid-Certification Review - Food Assistance Only). 

o    LTR 022-11 is auto-populated with the following information;

  • Household Income
  • Household Members
  • Child Support Payments
  • Household Resources
  • Shelter Costs

o     Clients will return LTR 022-11 indicating if any circumstances have changed. See EAZ Manual WAC 388-418-005 How will I know what changes I must report?

 

o     ACES creates LTR 022-11 using static and conditional text to confirm circumstances and ask questions necessary to determine ongoing eligibility and benefits for the benefits clients receive. 

 

o     If a question is not relevant to the benefits a client receives, ACES will not add the question to the mid-certification review.

 

When is a mid-certification review generated?

 

·         ACES will auto-generate LTR 022-11 (Mid-Certification Review – Food Assistance Only) if the client is on Basic Food and has no related cash AUs or LTR 022-07 (Mid Certification Review) along with Attachment 14-467 (Mid-Certification Review) if the client has a related cash AU  the day after monthly issuance (deadline) in the 5th month from the begin date.

 

·         Both LTR 022-11 and LTR 022-07 are due back by the 10th day of the 6th month. 

 

Will the system match up the mid-certification review cycle for related AUs?

 

·         If cash or Basic Food is approved in different months and matching the cash end dates to the end date for Basic Food will give the cash a review end date of at least 6 months, the system will match up the mid-certification review cycle.

 

·         LTR 022-07 (Mid Certification Review) along with Attachment 14-467 (Mid-Certification Review) will be sent at the end of the 5th month of the Basic Food AU certification period to be completed and returned in the 6th month.

 

When will the system not match up the mid-certification review cycle for related AUs?

 

·         If matching the cash AU end date to the end date for Basic Food will give the cash a review date of less than 6 months, the system will not match up the 6-month review cycle.

 

·         The cash AU will receive a separate mid-certification review.

 

·         The user has the option of initiating a review on the Basic Food AU which will match up the mid-certification review cycle to the newly opened cash AU.

 

What happens when a related application is processed during the month a LTR 022-07 (Mid-Certification Review) or LTR 022-11 (Mid Certification Review - Food Assistance Only) is due to be mailed?

 

·         Processing the related application will be considered a completed mid-certification review and no LTR 022-07 or LTR 022-11 will be mailed.

 

What happens when a related application is approved after the LTR 022-07 (Mid-Certification Review) or LTR 022-11 (Mid Certification Review - Food Assistance Only) is mailed to the client but prior to the report deadline?

 

·         The system will consider the mid-certification review as complete and automatically update the Report Cmplt field on the MISC  screen to <C> (Complete) to prevent the termination of the related AU.

 

How will I know if an AU is a mid-certification reviewer?

 

·         Mid-certification reviewers are identified on the STAT screen in the Rpt Stat field. This field appears on the STAT screen if the AU is a mid-certification reviewer (indicator ‘S’) or a quarterly reporter (indicator ‘Q’). See <F1> Help.

 

·         The Rpt Stat field always appear on the CAFI, MAFI, and/or FSFI screens. See <F1> Help.

 

·         The exempt reason field on the CAFI, MAFI, and/or FSFI screen is automatically updated by ACES to identify the reason an AU is a non-reporter. See <F1> Help.

 

How do I process a mid-certification review?

 

·         For information on required verifications for the mid-certification review, see Clarifying Information in the EAZ Manual – WAC 388-418-0011 What is a mid-certification review and do I have to complete one in order to keep getting benefits?

 

·         To process a mid-certification review in Online Case Actions (3G) see Mid-Certification Review - Online Case Actions (ACES 3G) How do I complete a Mid-Certification review?

 

·         To process a mid-certification review in ACES, take the following steps:

 

1.    From AMEN, access the AU via Option R – Interim/Hist Change.

 

2.    If changes have been reported, enter the information as required on the appropriate screens.

 

3.    On the MISC screen, enter date in the Date Report Recd field and update the Report Cmplt field with the appropriate code. See <F1> Help.

 

o    When mid-certification review is processed through Option R – Interim/Hist Change, the MISC screen will need to be updated for each AU separately.

 

o    When a returned mid-certification review is processed as incomplete, ACES generates LTR 023-02 (General Request for Information or Action) to request more information from the client.

 

4.    Enter [DONE] in the Screen ID field in the upper right corner, update the NARR screen and <TRANSMIT>.

 

When is LTR 033-03 (Non-Receipt of the Change Report Form) generated?

 

·         LTR 033-03 serves as 10-day Notice and the Termination Letter. It generates on or about the 18th day of the 6th month if the MISC screen Report Cmplt field displays the following valid values:

 

o    S - Report Sent Not Returned

 

o    I - Report Returned Incomplete

 

o    W - Report Ret Incomplete-Missing WAGE/Income Verification

 

What happens at monthly issuance if the mid-certification review is incomplete?

 

·         If the Report Cmplt field on MISC screen indicates the report is still incomplete at monthly issuance of the 6th month:

 

o    TANF/SFA and Basic Food close at monthly issuance for Reason Code 142 – Incomplete mid-certification review.

 

What happens at monthly issuance if the mid-certification review has not been received?

 

·         TANF/SFA and Basic Food AUs close for Reason Code 141 – Mid-certification review not returned.

 

Can an AU be manually closed for an incomplete mid-certification review?

 

·         Yes, an AU can be manually closed for Reason Code 542 – Incomplete mid-certification review.

 

·         When an AU is closed for Reason Code 542, the AU does not trickle or sprout.

 

What do I do if an application is received after an AU closed for no mid-certification review?

 

·         When a client submits a new application after their case closed for failing to return a mid certification review (Reason code 141 or 142) the client has the choice of either completing the application, or withdrawing the application and completing the mid-certification review. See EAZ Manual – WAC 388-418-0011 What is a mid-certification review, and do I have to complete one in order to keep receiving benefits?

 

 

·         For more information, refer to CSD Procedure Handbook,  Mid-Certification reviews.

Modification Date: July 10, 2014