continuous eligibility for categorically needy children's medical
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continuous eligibility for categorically needy children's medical


Revised June 20, 2014



NOTE:

As a result of implementation of the Affordable Care Act (ACA), effective with applications received on or after 10/01/2013 this medical program is no longer valid. Any current active AUs with this medical coverage type will continue through the AUs current certification period. Clients would then need to apply for medical through the healthplanfinder.


Who is eligible to receive Categorically Needy (CN) Children’s Medical?

 

What CN Medical Coverage Groups are tracked?

 

How is CN Children’s continuous medical eligibility tracked in ACES?

 

When does ACES automatically authorize F06 CN coverage?

 

When does ACES automatically authorize F07 CN coverage?

 

When  won’t the system  automatically trickle/sprout to continuous medical coverage?

 

How are  children who are continuously CN eligible identified from regular F06 clients?

 

How is the certification date set when there are multiple children on the F06 AU?

 

What happens to a child’s continuous range 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) Children’s 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.

 

·         For more information see the following WACs::

 

o        WAC 182-505-0210 Washington Apple Health - Eligibility for children.

 

o        WAC 182-504-0015 Washington Apple Health - Certification periods for categorically needy (CN) programs.

 

o         WAC 182-504-0125 Washington Apple Health - Effect of reported changes.

 

What CN Medical Coverage Groups are tracked?

 

·         ACES tracks each child's certification in the following CN medical coverage groups:

 

C01 - COPES/Categorical Needy Home Services
F01 - Temporary Assistance for Needy Families Cash CN (Prior to 10/2013)
F02 - CN 12-Month Extension
F03 - CN 4-Month Extension
F04 - Categorically Needy
F05 - Newborns
F06 - Categorically Needy Children's

F07 - Children’s Health Insurance Program (CHIP)
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

P04 - Non-Citizen Pregnancy
R01 - Refugee Medical (Prior to 10/2013)
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 Children’s 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.

 

 When does ACES automatically authorize F06 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.

 

·         Children under 19 years of age will automatically trickle to CN continuous F06 medical coverage for the remainder of twelve months continuous coverage when an assistance unit in one of the following CN medical coverage groups closes:

 

F01 - AFDC Cash CN (Prior to 10/2013)
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 GA cash under age 19)
G02 - GA Cash, B, D, X
P02 - Categorically Needy Pregnancy

P04 - Non-Citizen Pregnancy
R01 - Refugee Medical (Prior to 10/2013)
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 does ACES automatically authorize F07 CN coverage?

 

·         When a child is closed off an F07 AU that does not result in continuous eligibility, the system will continue to track continuous F07 eligibility. If the child is reopened on medical during the 12 month tracking period, and the household’s income exceeds 200% of the FPL, the F06 AU will trickle to an active F07 AU.

 

When won’t the system 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 children who are continuously CN eligible 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 or F07 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 to a child’s continuous range 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 their own complete 12-month potential range, and the original AUs certification end date does not impact this.

 

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 03/08. The review month is 03/08 so a review should not be initiated prior to monthly issuance (deadline) in February (02/24/08). If a review is initiated early on this F06, say on 02/15/08, which is before monthly issuance and which is more than one month before the review month of 03/08, 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 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:

 

1.      From the AMEN screen, in the Selection field, enter [2] - Children’s Tracking CN and enter the [Client ID] in the Client ID field.

 

2.      From the CLLI screen, enter a [Y] in Select column next to the client and press <F13>.

 

3.      From the Welcome Back page in aces.online, use the Quick Navigation section to do the following:

 

o        Enter a [Client ID number] in the Enter an ID box.

 

o        From the Select a Page drop down box, click on the Children's Tracking CN Medicaid option.

 

4.      From the Client >> Summary page, the Children's 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, Premium Tier Level and End Date, and the Date this Range was removed by using Reason Code 535 - Error in Initial Eligibility - Removed Continuous Tracking for Child.

 

o        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.

 

o        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.

 

o        PREM TIER LEVEL and END DT – The premium Tier level an F07 recipient is “locked” into and the date the Tier level will end. 

 

o        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.

 

Modification Date: June 20, 2014