medical extensions
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medical extensions


Revised June 23, 2014



Categorically Needy 4-month Extension (F03)

 

Categorically Needy Family Medical Extension (F10)

 

Categorically Needy 12-Month Extension (F02)

 

Refugee Medical Extension (R02)

 


Categorically Needy 4-month Extension (F03)

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of the Affordable Care Act (ACA), effective with applications received on or after 10/01/2013 this medical program is no longer valid.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 F03 medical?

 

How is an F03 AU opened?

 

How long is the F03 Certification period?

 

What happens at the end of the F03 certification period?

 

Will F03 open automatically for Assistance Units that are consolidated or contain optional members?
 


 

Who is eligible to receive F03 medical?

 

·            Active recipients on an F01 (TANF/SFA Categorically Needy) or an F04 (TANF-related Categorically Needy) AU that closes because the household now receives child or spousal support in excess of the payment standard. See WAC 182-523-0100 Washington Apple Health - Health care extensions.

 

How is an F03 AU opened?

 

·            An F03 AU automatically sprouts when an AF/ F01 AU or F04 AU is closed for Reason Code 324 - Child Support More Than Grant or Reason Code 507 - Change in Child Support Payments.

 

·            An AF/F01 or F04 AU is closed for Reason Code 324 when ACES receives an interface from the Division of Child Support reporting a household has received child support in excess of the TANF payment standard for 2 months in a row.

 

·            An AF/F01 or F04 AU can be manually closed by entering Reason Code 507 on the (STAT) screen if you learn that a client is receiving on-going child support or spousal support payments greater than the TANF payment standard for the AU.

 

·            Alert 416 – AU CLOSED BY BATCH – REDETERMINE MEDICAL ELIGIBILITY and Alert 231 – IV-D COLLECTION EXCEEDS GRANT, AMT = $  generates for these cases.

 

How long is the F03 Certification period?

 

·            The certification period for F03 is four months.

 

·            Although ACES automatically opens the F03 AU, you must still review the case to determine the family’s eligibility for a medical program with a longer certification period. See EAZ Manual, ASSISTANCE UNITS – Medical Assistance Units for the financial responsibility rules to apply when making this determination.

 

What happens at the end of the F03 certification period?

 

·          Six weeks prior to the medical extension certification period ending, a client is sent an eligibility review form.  In order to process the review correctly, screen in and process an F04 AU.  See How do I screen an F04 AU? and How do I process a pending F04 AU?


NOTE:

ACES allows a review to be initiated on an F03 AU.  DO NOT initiate and complete a review on an F03 AU as this will result in another F03 four month extension.


Will F03 open automatically for Assistance Units that are consolidated or contain optional members?

 

·            No, a consolidated AU or an AU with an optional member is not automatically closed in this situation, and does not sprout an F03 AU. For additional information on consolidated AUs, see EAZ Manual WAC 388-408-0030 What children must be in the same TANF or SFA assistance unit?  For additional information on optional AU members, see  EAZ Manual WAC 388-408-0025 When can I choose who is in my TANF or SFA assistance unit?

 

·            Alert 231 – IV-D COLLECTION EXCEEDS GRANT, AMT = $   generates when a child in a consolidated AU or an AU with optional members receives child support in excess of the grant amount for 2 months in a row.

 

·            To process Alert 231  received for a consolidated AU or an AU with optional members, you must redetermine financial and medical eligibility for all household members. Apply cash assistance unit rules (EAZ Manual, ASSISTANCE UNITS, Cash Assistance Programs ) and medical program assistance unit rules (EAZ Manual, ASSISTANCE UNITS – Medical Assistance Units ) when making these determinations

 


Categorically Needy Family Medical Extension (F10)

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 F10 medical?

 

How is an F10 AU opened?

 

How long is the F10 certification period?

 

What happens at the end of the F10 certification period?  

 



Who is eligible to receive F10 medical?

 

·            An applicant or recipient who meets all of the following conditions is eligible to receive Categorically Needy Family Medical Extension (F10) medical coverage:

 

o        Has received at least one month of F01 (TANF Categorically Needy) or F04 (TANF-Related Categorically Needy) medical.

 

o        Is ineligible for continued F01 or F04 coverage due to excess earned income (closed or denied for Reason Code 334 - Exceeds Earned Income Limit.)

 

o        Does not meet the 3-of-6 month requirement for F02 (Categorically Needy 12-month Extension) medical coverage. See Medical, Categorically Needy 12-month Extension (F02).

 

How is an F10 AU opened?

 

·            When an F01 or F04 AU is closed or denied and the AU meets the requirements above, the AU trickles to F10. See Medical, Trickle and Sprout.

 

·            Letter 025-04 (Approval for Medical Extension Benefits from Medical Termination) generates when an F10 AU is opened.

 

·            You cannot screen an F10 AU as it must generate from an F01 or F04 closure/denial.

 

·            You can reinstate an F10 AU for any month in the certification period if the AU is closed in error. See Reinstatement.

 

How long is the F10 certification period?

 

·            The certification period for F10 is either one month or two months – depending on which is necessary for the client to meet the 3-of-6 month requirement for F02.

 

What happens at the end of the F10 certification period?

 

·            ACES includes F10 AUs when determining if a client meets the 3-of-6 month requirement for F02 eligibility. See EAZ Manual, MEDICAL ASSISTANCE PROGRAMS, Medical Extensions.

 

·            F10 trickles to F02 at the end of its certification period as long as the household meets all TANF-related medical eligibility requirements, other than income and resources.

 

·            You cannot initiate a review on an F10 AU. If a review is attempted, Edit 2036 - REVIEW IS NOT PERMITTED FOR THIS AU TYPE is generated.

 

·            At the end of the F10 certification period, if the household becomes ineligible for F02, redetermine eligibility for other medical coverage.

 


CATEGORICALLY NEEDY 12- MONTH EXTENSION (F02)

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 F02 medical?

 

How do I open F02 medical?

 

How long is the F02 certification period?

 

What are the Reporting Requirements for F02 recipients?

 

How do I process a Medical Extension Report (MER)?

 

What happens if the Medical Extension Report (MER) is not received or received late?

 

What happens at the end of the F02 certification period?


 

Who is eligible to receive F02 medical?

 

·            Clients in assistance units that are no longer eligible to receive TANF / SFA cash assistance due to an increase in earnings, or

 

·            An assistance unit that contains a member who has received TANF, SFA cash, or related medical assistance (F04 or F10) in any three of the last six months.

 

·           See WAC 182-523-0100 – Washington Apple Health - Health care extension.

 

How do I open F02 medical?

 

·            An F02 AU automatically sprouts when a TANF AU AF/F01 or Categorically Needy Family Medical AU F04 is closed for Reason Code 301 – Exceeds Income Standard or Reason Code 334Exceeds Earned Income Limits.

 

·            An F02 AU will not sprout from an AF/F01 AU or F04 AU if the AU has been manually closed with a 500 level reason code.

 

·            In the following situation, the F02 AU will not sprout until the next month ACES Month Begin jobs run.  ACES Month Begin jobs typically run the first Saturday after deadline.  For an exact date each month, see ACES Production Schedule Calendar.

 

o        The AF/F01 AU is closed during the adverse action period, but before monthly issuance and adverse action requirements are not waived.

 

o        In these situations when the F02 AU does not sprout at F01 or F04 closure, do not manually open a new medical AU.  ACES will automatically generate an F02 AU for the ongoing month when the ACES Month Begin job runs.


EXAMPLE

Today is 10/23; the ongoing month in ACES is November.  You close aTANF case and do not waive adverse action.  The TANF paid through date in ACES is 11/30 – the AU is eligible for F02 beginning 12/01.  Because only benefit months October and November are currently in the system, the medical extension AU is not created.  When monthly issuance runs on 10/25, benefit month December will be in the system, and when the month begin jobs run on 11/1, ACES will automatically create the F02 AU.  You will be able to see the AU on-line on 11/2.


How long is the F02 certification period?

 

·            F02 is certified for up to twelve months, in two six-month segments.

o        The certification period begins the month following the closure of F04 or F01 medical.

 

o        Months one through six are the initial six-month extension period.

 

o        Months seven through twelve are the second six-month extension period.

 

What are the Reporting Requirements for F02 recipients?

 

·            Families receiving F02 are required to report income and employment-related child care costs they pay:

 

o        In the middle of the 3rd month ACES sends Letter 022-10 Medical Extension Report to the client and is due by the twenty-first day of the 4th month.  When returned, this report will include the client’s income and employment related child care for months one, two, and three.

 

o        In the middle of the 6th month ACES sends Letter 022-10 Medical Extension Report to the client and is due by the twenty-first day of the 7th month.  When returned, this report will include the client’s income and employment related child care for months four, five, and six.

 

How do I process a Medical Extension Report - (MER)?

 

·         See Medical Extension Report (MER).

 

·         See  EAZ Manual – Medical extensions.

 

What happens when a Medical Extension Report (MER) is not received or received late?

 

·         See Medical Extension Report (MER).

 

·         The children listed on the F02 AU that have Continuous Eligibility for Categorically Needy Children’s Medical will sprout in a new Categorically Needy Children’s medical (F06) AU for the remainder of the 12 month period.  See Continuous Eligibility for Categorically Needy Children’s Medical.

 

What happens at the end of the F02 certification period?

 

·            Six weeks prior to the medical extension certification period ending, a client is sent an eligibility review form.  ACES does not allow an Eligibility Review to be initiated on an F02 AU.  In order to process the review correctly, screen in an F04 AU.  See How do I screen an F04 AU?

 


Refugee Medical Extension (R02)

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 R02 medical?

 

How long is the R02 certification period?

 

How do I open R02 medical?

 


Who is eligible to receive R02 medical?

 

·         R02 medical assistance is authorized for recipients of Refugee Cash Assistance (RCA) or Refugee Medical Assistance (RMA) who become ineligible for RCA due to an increase in income.

 

·         See EAZ Manual – WAC 388-466-0140 Income and resources for refugee assistance eligibility.

 

How long is the R02 certification period?

 

·         A recipient remains eligible for R02 benefits until the end of the sixth or eighth month following entry into theUnited States.

 

·         See WAC 182-507-0130 Refugee medical assistance (RMA).

 

How do I open R02 medical?

 

·         R02 medical sprouts automatically when RCA or RMA closes due to increased income and the refugee has been in the United States for less than eight months.

Modification Date: June 23, 2014