family medical
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family 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of the Affordable Care Act (ACA), effective with applications received on or after 10/01/2013 this medical program is no longer valid.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.


TANF Categorically Needy Medical (F01) (Invalid 10/01/13)

 

Categorically Needy Family Medical (F04)

 

Family Medical Project (F20) (Invalid 1/01/2002)  

 


TANF CATEGORICALLY NEEDY MEDICAL (F01) (Invalid 10/01/13)

NOTE: Effective with benefit month 10/13, Temporary Assistance for Needy Families (TANF) AU will only issue cash assistance.

Who is eligible to receive F01 medical?

When is a TANF recipient not eligible to receive F01 medical?

How do I open F01 medical?


Who is eligible to receive F01 medical?

 

·         Clients active on a Temporary Assistance for Needy Families (TANF) AU with a Financial Responsibility code of RE (Recipient) receive F01 (TANF Categorically Needy) medical coverage in addition to TANF cash benefits. For instructions on opening a TANF/F01 AU see (TANF) - Temporary Assistance for Needy Families.

 

·         Clients active on a TANF AU with a Financial Responsibility code of RM (Cash ineligible person receiving medical only) receive F01 medical, but are not eligible to receive TANF cash benefits for themselves. See  Disqualified/Sanctioned AU or Client for examples of situations where a client would be assigned Financial Responsibility code RM.

 

·         Clients active on a TANF AU with a Financial Responsibility code of RN (Cash sanctioned receiving medical only) receive F01 medical, but do not receive TANF cash assistance for themselves. See Disqualified/Sanctioned AU or Client for examples of situations where a client would be assigned Financial Responsibility code RN.

 

·         Clients who are eligible to receive both a TANF cash benefit and F01 medical, but who do not wish to receive the cash benefit, should be opened on F04 (TANF-related Categorically Needy) medical.

 

When is a TANF recipient not eligible to receive F01 medical?

 

·         TANF recipients who fail to cooperate with the Division of Child Support (DCS) are not eligible to receive TANF-related medical assistance, but may still receive a reduced TANF cash benefit. These clients will have a Financial Responsibility code of RC (Recipient of Cash Only).

 

·         For more information on DCS cooperation requirements and sanction penalties for failing to cooperate, see Disqualified/Sanctioned Assistance Unit/Individual, Non-Cooperation, Division of Child Support and EA-Z Manual - Child Support WAC 388-422-0010.

 

·         TANF recipients who do not cooperate with the Third Party Liability (TPL) process are not eligible to receive any medical assistance, but may still receive a TANF cash benefit. These clients will have a Financial Responsibility code of RC.

 

·         For more information on TPL cooperation requirements and sanction penalties for failing to cooperate, see Disqualified/Sanctioned Assistance Unit/Individual, Non-Cooperation, Third Party Liability and EA-Z Manual - Third Party Liability - WAC 388-505-0540.

 

How do I open F01 medical?

 

·         Eligible clients automatically receive F01 medical when they are opened on a TANF AU.  

 

·         See Temporary Assistance For Needy Families (TANF)  for instructions on opening a TANF case.

 


Categorically Needy Family Medical (F04)

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 F04 medical after 10/01/13?

 

Who is eligible to receive F04 medical up until 9/30/13?

 

Can an adult be eligible for F04 if the household’s income exceeds F04 standards?

 

How long is the F04 certification period?

 

How do I screen F04 medical?

 

How do I process a pending F04 AU?

 


Who is eligible to receive F04 medical after 10/01/13? 

 

·         Households that were receiving TANF related medical (F01) as of 9/30/13 were opened on a F04 AU.

 

·         Active F04 medical AUs will continue through current certification period.

o        All active F04 medical AUs are not impacted by financial eligibility changes, such as income or resource changes.

o        F04 AUs will no longer sprout to a transitional medical AU.

·         Any new requests for family related medical will be referred to the healthplanfinder. The F04 program is no longer an option during screening for applications dated 10/01/13 or later.

 

Who is eligible to receive F04 medical up until 9/30/13? 

 

·         Families that meet all TANF eligibility requirements, including income and resources, but choose not to receive a TANF cash benefit may receive F04 medical.

 

·         A person may receive F04 medical benefits if that person is not eligible for or receiving TANF cash benefits, see EAZ Manual – Medical Assistance Programs - Family medical Programs.

 

·         See EAZ Manual – Medical Assistance Programs - Family Medical Programs .

 

·         F04 should be the program of choice when the household contains both adults and children who are applying for medical.  For households where the only applicants are children, see Children’s Medical.

 

Can an adult be eligible for F04 if the household’s income exceeds F04 standards?

 

·         Adults may be eligible for F04 as a separate Medical Assistance Unit (MAU) when certain conditions exist.

 

·         See WAC 182-506-0010 Medical assistance units (MAU) for MAGI-based Washington Apple Health programs and Sneede vs. Kizer Medical for those conditions and instructions concerning financial responsibility and the establishment of separate MAUs as required by the Sneede V. Kizer Ninth Circuit Court decision.

 

How long is the F04 certification period?

 

·         The F04 medical program is certified for 12 months.

 

·         Changes during the certification period that affect a client’s eligibility for F04 medical should be processed according to Change of Circumstance and   WAC 182-504-0125 Effect of changes on medical program eligibility.

 

How do I screen F04 medical?

 

To screen an F04 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:

 

o        Enter the head of household’s Name, Residential and Mailing Addresses.

 

o        Click the AREP/Payee checkbox if you will be entering an Authorized Representative or Payee to the case.  For instructions to add an Authorized Representative, syou Authorized Representatives. 

 

o        Click the Next button.

 

3.      Continue with the screening process until you reach the Programs page. 

        See Screening  a Client for additional information.

 

4.      On the Programs page:

 

o        Click the checkbox next to Medical.

 

o        Click the Next button.

 

5.      Continue the screening process until you reach the Finalize page.

 

o        See Screening - aces.online, Screening a Client for additional information on completing screening.

 

6.      On the Finalize page:

 

o        Click the checkbox next to the F04 program.

 

o        Enter the application date.

 

o        Click the Commit button to commit the screening data.

 

How do I process a pending F04 AU?

 

To process a pending F04 AU take the following steps:

 

1.      From the AMEN, access the pending AU via Option O – Interview.

 

2.      On the STAT screen, enter [PN] – Applicant in the Finl Resp field for each applicant.

 

o        See Sneede vs. Kizer Medical for instructions on coding the STAT screen when Sneede vs. Kizer rules apply to the AU.

 

o        See WAC 188-506-0010 Medical assistance units (MAU) for MAGI-based Washington Apple Health programs for information on who must be included in the AU.

 

3.      Complete the interview following the instructions in the Interview chapter. 

 

4.      After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.

 

5.      After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the F04 eligibility determination.

 

o        If the AU exceeds the F04 income or resource standards, it may trickle to Categorically Needy Children’s Medical (F06), the State Children’s Health Insurance Program - SCHIP (F07), or the Children’s Medically Needy (F99) program during finalize.

 

o        See Trickle and Sprout for additional information.

 


Family Medical Project (F20) (Invalid 1/01/2002)

What was F20 medical?

 

·         The F20 (Family Medical Project) ended December 31, 2001. It may still appear on the Client Participation History CHIS screen of clients who received coverage under this program.

 

·         F20 was a medical program for individuals terminated from TANF cash assistance from 8-1-97 through 8-31-99 and who were not authorized medical benefits the month following termination.

 

·         Effective May 1, 2000, these clients were auto-opened on F20 for medical assistance only.

 

·         F20 cases were opened for three consecutive months regardless of the assistance unit's income or resources.

 

·         Only Centralized Medical Unit (CMU) at CSO 55 had the ability to open or close F20 medical cases. F20 cases could not be transferred to another CSO.

 

·         Most F20 cases were certified 05/00 – 07/00. However, if an F20 AU was closed before 07/31/00, the AU could be reinstated at the client’s request to provide the three months of F20 medical coverage with certification periods ending as late as 12/31/00.

 

·         At the end of the three month certification period, households that returned an eligibility review were evaluated for continuing eligibility and authorized continuing benefits if eligible through a medical extension or other family medical program. F20 was not continued.

 

·         At the end of the three month certification period, ACES automatically closed assistance units that did not return the eligibility review with Reason Code 273 - Family Medical Project Expired.

 

 

Modification Date: June 20, 2014