Trickle and Sprout
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Trickle and Sprout


Revised November 4, 2013



NOTE:

As a result of implementation of the Affordable Care Act (ACA), Family, Children, Refugee and Pregnancy Medical coverage groups will no longer trickle or sprout effective with benefits month 10/13. For further information, see EAZ Manual – Affordable Care Act (ACA) Transition plan.


What is priority coverage?

 

What are tracks?

 

What happens when an AU Trickles and Sprouts?

 

What happens when an AU Spawns?

 

When will an AU Trickle, Sprout, or Spawn?

 

What if an AU is not eligible for a specific medical coverage group?

 

When does an AU closed during Adverse Action sprout a medical extension AU?

 

When will an AU Trickle/Sprout outside its original track?

 

What causes an AU to stay active for one child, but sprout a new AU for another child?

 

Results of Trickle, Sprout, and Spawn Charts

 

ABD LTC Track

 

ABD SSI Related Track

 

ADATSA Track

 

Family LTC Track

 

Family Track (Invalid 10/01/13)

 

Disability Lifeline Track

 

Pregnancy Track (Invalid 10/01/13)

 

Refugee Track (Invalid 10/01/13)


What is priority coverage?

 

·         Priority coverage is the medical program that provides applicants/recipients with the best scope of care options.

 

·         Trickle and Sprout is part of the automated eligibility determination that ACES performs when considering a client’s eligibility for the highest priority medical coverage groups.


EXAMPLE

Categorically Needy (CN) medical provides the broadest scope of medical coverage. Examples of CN medical programs: F04 (Categorically Needy), F06 (Categorically Needy (CN) for Children) and F07 (Children's Health Insurance Program (CHIP).

 

Medically Needy (MN) medical provides slightly less medical coverage than CN medical.  Example of MN medical: F99 (MN Children W/Spenddown).

 

A client applies for F04 medical for herself and child.  The system looks at the client’s income and resources to determine eligibility for F04 medical first. If eligible, the system approves the household for F04 medical. If not, then system reviews medical eligibility for the following programs in this order:

 

F06;

F07 (with premium) and lastly;

F99 (MN Children with Spenddown).


What are tracks?

 

·         Tracks are the different types of medical coverage groups, such as:

 

o    F = Family Related, includes Children's Medical

 

o    S = SSI recipient or Categorically Related to SSI

 

o    P = Pregnancy

 

o    L = LTC SSI Related

 

·         The program code, type, and medical coverage group chart has the groups separated by category of assistance.  See Program Codes.

 

·         Each category of assistance is its own separate track.

 

·         In most situations, an AU will only sprout or trickle within the same track.

 

What happens when an AU Trickles and Sprouts?

 

·         When an AU trickles it stays in the same track and keeps the same AUID.

 

·         When an AU sprouts, it also stays in the same track, but ACES assigns it a new AUID.


EXAMPLE

Trickle:

 

When an S02 medical AU is denied or closed due to excess earned income. ACES will trickle the medical coverage to S99 using the same AUID.

 

Sprout:

 

When a TANF/F01 cash AU is terminated for excess earned income, ACES closes the TANF AU and sprouts a new F02 medical extension AUID.


What happens when an AU Spawns?

 

·         Spawning is when a client active on a lower priority medical coverage group AU becomes eligible for a higher priority AU.

 

·          Spawned AUs stay in the same track and keeps the same AUID.


EXAMPLE

Mom is receiving F07 medical for her 2 children and paying a monthly premium. During her eligibility review she reports that her income has decreased.  When the worker updates her case and recalculates eligibility, the F07 AU with monthly premiums spawns back to an F06 AU with no monthly premium using the same AUID.


When will an AU Trickle, Sprout, or Spawn?

 

·         Trickles, sprouts, and spawns occur when ACES starts with one program and/or medical coverage group, then after eligibility runs, determines the AU is eligible for a different assistance type.

 

·         Trickling and sprouting only happens when an AU is closed or denied.

 

·         When a pending TANF is denied, a pending medical AU will sprout.


EXAMPLE

An application for TANF benefits is submitted on 5/7. During the interview on 5/12, the client withdraws their request for benefits.  When the pending TANF AU is denied with Reason Code 550 - Voluntary Withdrawal, ACES sprouts a pending F04 medical AU.


What if an AU is not eligible for a specific medical coverage group?

·         If an AU is not eligible for a specific medical coverage group ACES will trickle through the entire track looking for a program for which the AU is eligible. If it finds one, the AU is approved; if not, the AU is denied or closed.

 

·         The trickled or sprouted assistance unit is usually a medical AU and is generally a lower priority program than what the original AU was.

 

·         See Results of Trickle, Sprout, and Spawn Charts for a list of programs that trickle, sprout, or spawn.

 

When does an AU closed during Adverse Action sprout a medical extension AU?

 

·         If the TANF or F04 medical AU that is closed doesn’t automatically sprout a medical extension AU, check to see if the AU was closed during the adverse action period. If it was, the TANF or F04 AU will have a paid through date of the end of the following month unless the user waives adverse action.

 

·         If the AU is closed during the adverse action period, but before monthly issuance, the third month (first month of the medical extension) is not in the system yet, so the medical extension AU is not created online at the time the action is taken.

 

·         The medical extension AU is created by the system when the Month Begin job runs for the month following the month the action is taken to close the AU.

 

·         Do not attempt to open another medical AU until after Month Begin has run. See ACES Production Calendar for Month Begin dates.


EXAMPLE

Today is 9/23. You close a TANF AU and do not waive adverse action. The paid through date in ACES is 10/31. Currently, only benefit months September and October are in the system so the medical extension AU is not created. When monthly issuance runs on 9/25 benefit month November displays in the system. When Month Begin occurs on 10/4, ACES automatically creates the MA extension AU which displays in ACES on 10/5.


When will an AU Trickle/Sprout outside its original track?

 

·         This process is called jumping tracks and occurs when the client is eligible for continued medical in a different medical coverage track.


EXAMPLE

Client active on Pregnancy TANF starts receiving unemployment benefits of $400 a month. When the updates are completed and eligibility recalculated, ACES closes the TANF AU with reason code 331 - Excess Net Income and sprouts an active P02 medical AU.  In this example the system jumped from the Family (F) - track to the Pregnancy (P) - track.

 

When a client active on G02 fails to complete an eligibility review and is closed with reason code 525 - No Eligibility Review Form, ACES sprouts an active S02 medical AU.  In this example the system jumped from the Disability Lifeline (G) - track to the SSI Related (S) - track.  


What causes an AU to stay active for one child, but sprout a new AU for another child?

 

·         This situation occurs when there are multiple children on an F06 or F07 AU that have different continuous eligibility tracking ranges (CTCN) and the system determines that the children are eligible for different medical programs.

 

·         See Continuous Eligibility for Categorically Needy Children’s Medical


EXAMPLE

Mom receives F06 medical for one child with a certification period of 5/09 – 4/10. On 9/15/09, a second child is added to the AU. The 1st child has a CTCN of 5/09 – 4/10 and the 2nd child’s CTCN is 9/09 – 8/10.

 

During her eligibility review on 4/10/10, the client reported that her income had increased.  When the worker completed the review, the F06 AU stayed active for the 2nd child with a certification period extended out to 8/10, and an F07 AU sprouted for the 1st child with a new CTCN range and 12 month certification.


Results of Trickle, Sprout, and Spawn Charts

ABD LTC Track

ABD SSI Related Track

ADATSA Track

Family LTC Track

Family Track

Disability Lifeline Track

Pregnancy Track

Refugee Track


ABD LTC Track

Original Medical Coverage Group

Condition

Trickles, Sprouts,  Spawns to:

L01: SSI LTC

Ineligible for SSI

None

L02: ABD LTC CN

Closed / denied excess resources

L99

Closed / denied excess income

L95

Closed / denied fails citizenship

L04

L04: ABD LTC Undocumented Alien

Closed / denied excess resources

L99

Closed / denied excess income

L95

L95: ABD LTC MN - No Spenddown

Closed / denied excess resources

L99

Closed / denied excess income

L99

L99: ABD LTC MN - with Spenddown

N/A

None


ABD SSI Related Track

Original Medical Coverage Group

Condition

Trickles, Sprouts, Spawns to:

S01: SSI Recipients

Ineligible for SSI

None

S02: CN Medical

Closed / denied excess income

S95 or S99

Failed citizenship

S07

S03: QMB

Income over 100% of FPL

S05

Denied 'QMB Start Date' and income over 100% FPL

None

S04: QDWI

 

Under age 65

S03

S05: SLMB

 

Income over 120% FPL

S06

S06: QI-1

 

N/A

None

S07: Undocumented Alien

 

Closed / denied excess income

S95 or S99

S08: HWD

 

N/A

None

S30: Breast/Cervical Cancer Treatment

 

N/A

None

S95: ABD MN - No Spenddown

Closed / denied excess income

S99

S99: ABD MN - with Spenddown

N/A

None


ADATSA Track

Original Medical Coverage Group

Condition

Trickles, Sprouts, Spawns to:

W01: ADATSA

If disability type W and approval code AW - denied closed reason code 239

W02


Family LTC Track

Original Medical Coverage Group

Condition

Trickles, Sprouts, Spawns to:

K01: Family LTC CN Medical

Closed / denied excess income

K95 or K99

Closed / denied fails citizenship

K03 or K95

K03: Family LTC Undocumented Alien

Closed / denied excess income

K95 or K99

K95: Family LTC MN - No Spenddown

Closed / denied excess income

K99

K99: Family LTC MN - with Spenddown

N/A

None


Family Track (Invalid 10/01/13) 

 

Original Medical Coverage Group

Condition

Trickles, Sprouts, Spawns to:

F01: AF / TANF

Closed due to excess income and qualifies for 12 month transitional medical

F02

Closed due to receipt of excess child or spousal support and qualifies for transitional medical

F03

Closed / denied due to excess gross or net income

F04

Closed / denied due to no eligible dependent child(ren)

F06 for child(ren)

Closed / denied due to excess earned income (reason code 334) and has rec’d at least one month F01 and does not meet 3-of-6 months criteria for F02

F10

F01: AF/P Pregnancy

 

P02

F02: Transitional Medical

N/A

None

F03: Categorically Needy

4-month

N/A

None

F04: AF / TANF CN Medical

Closed / denied due to excess earned income (reason code 334) and has rec’d at least one month F01 and does not meet 3-of-6 months criteria for F02

F10

Closed / denied excess income

F06, F07, or F99 for eligible child(ren)

Closed / denied excess resources

F06 for eligible child(ren)

Closed / denied no eligible dependent child(ren)

F06 for eligible child(ren)

Closed due to excess income and qualifies for 12 month transitional medical

F02

Closed for no MCR (reason code 141 or 142)

F06 for eligible child(ren)

F05: Newborn Medical

PN / RE client not receiving medical when baby born

F06 for newborn

PN / RE child is greater than 12 months old

F06 for child

F06: Children's Medical

Closed due to excess income

F07 or F99

F07: State Children’s Health Insurance Program

Closed due to excess income

F99

F08: Undocumented Alien Medical – Children

Closed due to excess income

F99

F09: Undocumented Alien Medical

Closed due to excess income

F99

F10: Categorically Needy Family Medical Extension

Meets 3-of-6 month requirement

F02

F99: MN - With Spenddown

N/A

None

 


Disability Lifeline Track

Original Medical Coverage Group

Condition

Trickles, Sprouts, Spawns to:

G01: GA-U/Disability Lifeline Unemployable

Closed / denied excess resources

None

Closed / denied excess income

None

G02: GA with CN ABD Medical

Closed / denied excess resources and HOH living arrangement = ALF

G03 (Invalid after 11/11/13)

Closed / denied excess net income and HOH living arrangement = ALF

G03 (Invalid after 11/11/13)

Closed due to excess gross or net income, excess resources, incomplete ER,  whereabouts unknown

S02

G03: GA ALF CN Medical

Closed / denied excess resources

G95 or G99

Closed / denied excess net income

G95 or G99

G95: GA ALF MN - No Spenddown

Closed / denied excess resources

G99

Closed / denied excess gross or net income

G99

G99: GA ALF MN - Spenddown

N/A

None


Pregnancy Track (Invalid 10/01/13)

Original Medical Coverage Group

Condition

Trickles, Sprouts, Spawns to:

P02: MA-P Pregnancy Medical

Closed / denied excess income

P99

Closed / denied fails citizenship

P04

Closed pregnancy extension expires

P05

P04: MA-P Undocumented Alien Pregnancy Medical

Closed / denied excess resources

P99

Closed / denied excess gross or excess net income

P99

Closed pregnancy extension expires

P05

P05: MA-P Family Planning Extension Medical

N/A

None

P99: MN with Spenddown

N/A

None


Refugee Track (Invalid 10/01/13)

Original Medical Coverage Group

Condition

Trickles, Sprouts, Spawns to:

R01: Refugee

Closed excess income or resources, and meets criteria to qualify for transitional medical

R02

Denied with reason: 230, 289, 550, 552, 566

Pending R03

Closed with reason: 204,230,235,245,301,

330,331,401,525,528,

551,557,599

R03 through the end of the 8 month cert or for 1 month cert if 8 months of eligibility has ended.

R02: Transitional Medical

N/A

None

R03: CN Medical Only

N/A

None

Modification Date: November 4, 2013