medical extension report (mer)
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medical extension report (mer)


Revised August 26, 2013



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of the Affordable Care Act (ACA), effective with applications received on or after 10/01/2013 this medical program is no longer valid.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

·         On 8/26/13, the final quarterly reports are going to be sent.

·         On 9/18/13, the final warning letters for households that have not returned their quarterly report will be generated.

·         On 9/20/13 (monthly issuance), F02 AUs will terminate for delinquent quarterly reports.

·         On 9/21/13, all active F02 AUs will be recalculated and the fields related to the quarterly report process removed for the ongoing month November.

·         On 9/30/13, the final daily MA F02 interface file containing AUs that have paid in full will be received from OFR. The data will be processed and alerts will be generated as usual. Workers will still be allowed to reinstate MA/F02 AUs.


What is a Medical Extension Report?

When is a Medical Extension Report sent?

How do I process a Medical Extension Report?

What happens when a Medical Extension Report (MER) is received late?

What happens if an MER is not received?
 


What is a Medical Extension Report?

  • The Medical Extension Report (MER) is a form ACES sends to households receiving F02 (CN 12 Month Extension) for the family to complete and return.
  • The Medical Extension Report appears as Letter 022-10 in aces.online Letter History.
  • When the client returns the form to DSHS, the information is used to determine the client's eligibility for the second 6-months of the extension and the premium payment amount, if any.

When is a Medical Extension Report sent?

  • Letter 022-10 (Medical Extension Report) is sent to the client in the third and sixth month of the F02 certification period.
  • When the report has been sent, ACES displays an [S] in the Report Cmplt field on the MISC  screen.
  • The MER is due to be returned by the 10th of the following month. Clients use the form to report the income received during the first three months or the second three months of the F02 certification period.

How do I process a Medical Extension Report?

To process a Medical Extension Report, take the following steps:

  1. On the BPAM screen enter the household's combined gross income and work related childcare expenses. ACES then compares the net income amount to the 100% FPL. See EAZ Manual WAC 182-505-0100 Medical programs --Monthly income standards based on the federal poverty level (FPL).
  2. If the net income is under the 100% FPL, ACES will not compute a premium for the eligible adults. If the combined earned income minus the work related childcare expenses exceeds the 100% FPL, ACES computes a monthly premium amount per adult household members. See EAZ Manual WAC 182-523-0120 Medical extensions - Premium requirements.
  3. In Option R - Interim/Hist Change, go to the parent(s) EARN and DPEX screens and update as necessary for related Basic Food Assistance AU's.
  4. On the MISC screen for the F02 AU:
    • Enter the date you received the MER in the Date Report Recdfield.
    • Enter a code in the Report Cmplt field. See <F1>Help.
  5. Call DONE and confirm eligibility for the F02 AU. ACES generates letter 027-01 (Cash/Medical/Food Re-certification).

What happens when a Medical Extension Report (MER) is received late?

  • A MER is late when it is returned after the monthly issuance date of month five or month eight.
  • If the client has good cause for a late report, process the same as an MER that is returned before the issuance date, except ACES will not automatically send letter 033-02 (Receipt of Medical Extension Report). You must manually generate the letter to tell the client the total premium amount, if any, or the exemption from the premium obligation.
  • When the case has been closed for no MER, determine if the client had good cause before reinstating the F02 AU. See EAZ Manual WAC 182-523-0110 Medical extensions - Reporting requirements.
  • Make sure the BPAM screen has accurate income and childcare expense information to ensure the correct premium amount is billed. Manually generate letter 033-02 (Receipt of Medical Extension Report) to inform the client of the premium amount.

What happens if an MER is not received?

  • The F02 AU will close with Reason Code 235 - Review Not Complete at the end of the 7th month of the medical extension period.
     
Modification Date: August 26, 2013