Healthcare for Workers with Disabilities – HWD (S08)
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Healthcare for Workers with Disabilities – HWD (S08)


Revised June 26, 2014



Who is eligible to receive S08 medical?

How long is the S08 certification period?

How is S08 opened?

How do I screen S08 medical?

How do I complete an interview on a pending S08 AU?

How do I Process Application Months on a pending S08 AU?

How do I finalize a pending S08 AU?

How do I process Retro Medical for an S08 AU?

What happens if the S08 premium is not paid for an active S08 AU?


Who is eligible to receive S08 medical?

 

·       Individuals who meet the criteria in the following WAC/EAZ Manual sections may be eligible for S08 medical coverage:

 

o   WAC 182-511-1000 Healthcare for workers with disabilities (HWD) – Program description

 

o   WAC 182-511-1050 Healthcare for workers with disabilities (HWD) – Program requirements

 

 

·       S08 eligible clients also meet Medically Needy SSI-related eligibility requirements and have a choice between receiving coverage under the MN program or the S08 program.  See EA-Z Manual SSI-Related Medical/HWD – Clarifying Information – Program Choice - HWD Or Other Medical Programs

 

·       Once eligibility for S08 medical has been established, recipients must pay a monthly premium to maintain eligibility for this program.

 

How long is the S08 certification period?

 

·       The S08 medical program is certified for 12 months.

 

·       A person who experiences a job loss can choose to continue S08 coverage through the original twelve months of eligibility, if both the following requirements are met:

 

o   The job loss results from an involuntary dismissal or health crisis.

 

o   The person continues to pay the monthly premium.

 

·       For information on retroactive S08 coverage, see  WAC 182-511-1100 - Healthcare for workers with disabilities (HWD) - Retroactive coverage.

 

 

How is S08 opened?

 

·       Designated staff in HCS and Regional CSD offices are responsible for the administration of the S08 (HWD) program.  These are the only workers who can process S08 cases.

 

How do I screen S08 medical?

 

To screen an S08 AU, take the following steps:

 

1.     From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.

 

2.     On the Applicant page, enter the head of household’s Name, Residential and Mailing Addresses.  Continue with the screening process until you reach the Programs page.

 

3.     On the Programs page:

 

o   Click the checkbox next to Medical in the Programs section.

 

o   Click the checkbox next to Disabled in the Program Determination Criteria section. 

 

4.     Continue with the screening process until you reach the Finalize page.

 

o   The system defaults to the S02 program in this situation.

 

5.     On the Finalize page, click the Specify Program button. 

 

6.     On the Finalize – Program Details page:

 

o   From the Program drop-down list, select Medical Assistance (MA).

 

o   From the Medical Coverage Group drop-down list, select Healthcare for Workers with Disabilities (S08).

 

o   Based on the client’s situation, select either Disabled (D) or Blind (B) from the Program Type drop-down list.

 

o   Click the Next button to return to the Finalize page and complete the screening process.  See Screening a Client.

 

How do I complete an Interview on a pending S08 AU?

 

·       All HWD S08 AUs must be completed in ACES 3G Online Case Actions.

 

·       To initiate and complete an interview take the following steps:

 

1.     Go to the Case Actions page (see How do I access Case Actions?).

 

2.     In the Pending Applications section, click the Start Interview link.

 

3.     On the Pending Applications page:

 

o   Check Begin Intake to initiate interview on the pending S08 AU.

 

o   Continue through the interview process by using the Navigation pane. 

 

o   For more information on navigating, see How do I navigate in Case Actions?

 

4.     On the AU ID page enter a date in the Client Chosen HWD Begin date field:

 

o   If the client has not chosen a begin date leave this field blank.

 

o   The S08 AU remains in pending status until a Client Begin Date is entered even if the user has gone thru finalize.

 

5.     When all interview questions are complete, click Review on the Navigation pane. This takes you to the Review page.

 

6.     If there are no Errors on the Review summary, click Eligibility on the Navigation pane. This takes you to the Eligibility page.

 

7.     On the Eligibility page, a Details  link may display to the right of any AUs where there are changes. Click the Details  link.

 

o   Review the Eligibility Details.

 

o   If all looks correct, click Confirm Benefits.

 

8.     The Eligibility page displays, click the Commit Changes button.

 

9.     A window appears saying Session committed successfully. Click OK.

 

10. To exit the Case Actions page, click the Close button.

 

How do I Process Application Months on a pending S08 AU?

 

·       If the household has no other AUs active and there are no adjustments necessary in the prior months, it is not necessary to go into each application month to process.

 

·       If there are existing active cases for this household in ACES, under Process Application Months, any months prior to the ongoing month display .

 

o   Click on each month that displays  and start at step 5 of How do I complete an interview on a pending S08 AU? to process each application month.

 

How do I Finalize a Pending S08 AU?

 

·       In order to bring an S08 AU to active status users need to go into Start Interview and enter a Client Chosen Begin date on the AUID page. See step 5 of How do I complete an interview on a pending S08 AU?

 

·       If a date has not been entered in the Client Chosen Begin date field on the AUID page, the AU remains in pending status even when users complete finalize.

 

·       To finalize a pending S08 AU take the following steps:

 

1.     Go to the Case Actions page. See How do I access Case Actions?

 

2.     From the Case Actions page, in the Finalize Applications section click the Finalize link for the pending AU.

 

3.     For each pending month:

 

o   On the Eligibility page click the Details  link, this takes you to the Eligibility Details page.

 

o   On the Eligibility Details page, verify the benefit information then click the Confirm Benefits button for each pending month.   When all months are confirmed, the Eligibility page displays.

 

o   On the Eligibility page, click the Commit Changes button.

 

How do I process Retro Medical for an S08 AU?

 

·       To process retro medical for an S08 AU see:

 

o   How do I initiate Retro Medical?

 

o   How do I process the Retro medical? and

 

o   How do I finalize Retro medical benefits?  in the Retroactive Medical section.

 

·       After finalizing the retro period for an S08 AU, the AU remains in pending status.

 

·       The system sends Office of Financial Recovery (OFR) the AU information for the retro base period and sends the premium notices to the client.

 

·       If the client pays the premiums for all or some of the retro months, OFR sends notification to the system and the pending retro months for months paid are AUTO opened.

 

·       If Retro month premiums are not paid within 120 days from the billing date the retro pending AUs are AUTO denied.

 

What happens if the S08 premium is not paid for an active S08 AU?

 

·       Barcode Tickler HW01-S99 SPENDDOWN GREATER THAN HWD PREMIUM OFFER HWD COVERAGE generates to the user of record when a client is approved for an S99 AU and the system finds they meet S08 employment requirements.

 

·       Barcode Tickler HW02-CLIENT HAS REACHED 90 DAYS OF NON-PAYMENT OF PREMIUM FEES generates when a client has not paid their premiums for 90 days. This tickler advises the user of record that the client is nearing HWD termination and sanction for non-payment of premiums.

 

·       Barcode Tickler HW03- DELINQUENT PAYMENT RECEIVED – REINSTATE AU generates to the user of record for reinstatement of the AU, when OFR notifies ACES that an S08 client has made a delinquent premium payment on or before the last day of the 4th month of delinquent payment months.

 

·       See EA-Z Manual HWD - Healthcare for Workers with Disabilities - Worker Responsibilities – Initial Premium Amount and WAC 182-511-1250 Healthcare for Workers with disabilities (HWD) - Premium payments for information on entering the initial premium amount.

Modification Date: June 26, 2014