See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
Original Medical Coverage Group |
Condition |
Trickles or Spawns to: |
---|---|---|
L01: SSI Long Term Care |
Ineligible for SSI |
None |
L02: CN SSI Related Long Term Care |
Closed / denied excess resources |
L99 |
Closed / denied excess income |
L95/L99 |
|
Closed / denied fails citizenship |
L04 |
|
L04: Non Citizen CN SSI Related LTC or Hospice |
Closed / denied excess resources |
L99 |
Closed / denied excess income |
L95/L99 |
|
L21 - CN SSI HCB Waiver |
Ineligible for SSI |
None |
L22: CN SSI Related HCB Waiver |
Closed/denied excess resources/income |
None |
L24: State Funded LTC |
Closed/denied excess resources/income |
None |
L31: SSI PACE or Institutional Hospice |
Ineligible for SSI |
Trickles to L32 |
L32: SSI Related PACE or Hospice |
Closed/denied excess resources Closed/denied excess income |
L99 L95/L99 |
L41: SSI Roads to Community Living |
Ineligible for SSI |
Trickles to L42 |
L42: SSI Related Roads to Community Living |
SSI begins |
Trickles to L41 |
L51: SSI Non-Institutional CN CFC or MPC |
Ineligible for SSI |
Trickles to L52 |
L52: SSI-Related Non-Institutional CN CFC or MPC |
Closed/denied excess resources Closed/denied excess income |
None |
L95: LTC MN or Hospice No Spenddown |
Closed / denied excess resources |
L99 |
Closed / denied excess income |
L99 |
|
L95: LTC MN or Hospice No Spenddown |
Change results in CN Eligibility |
L02/L04/L32/L42/L52 |
L99: LTC MN or Hospice W/Spenddown |
N/A |
None |
L99: LTC MN or Hospice W/Spenddown |
Change results in CN or MN No Spenddown Eligibility |
Worker gets message: Client appears eligible for CN or MN No Spenddown. Screen new AU. |
Original Medical Coverage Group |
Condition |
Trickles or 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 |
S95: ABD MN - No Spenddown | Change results in CN Eligibility | S01/S02/S07 |
S99: ABD MN - with Spenddown |
N/A |
None |
S99: ABD MN Spenddown not met | Change results in MN/CN Eligibility |
Worker gets message: Client appears eligible for CN or MN No Spenddown. Screen new AU. |
S99: ABD MN Spenddown met | Change results in MN/CN Eligibility |
S01/S02/S07/S95 |
Original Medical Coverage Group |
Condition |
Trickles or Spawns to: |
---|---|---|
D02: FC/AS/JR Medical |
SSI approved |
D01 |
Child turns 18 |
D26 |
|
Placement code changed to: E – Foster Care Expansion F – Foster Care Placement R – Relative Placement T – Tribal Foster Care Placement P – Interstate Compact on Placement of Children (ICPC) |
D26 |
|
D26: Washington Apple Health Post-Foster Care Coverage |
Client turns age 21 and Placement code E- Foster Care Expansion changes A – Adoption Support Client in Relative Placement D – DD Client in Relative Placement H – Foster Care Higher Education J – Juvenile Rehabilitation Placement M – Interstate Compact on Placement of Adoption & Medical Assistance (ICAMA) S – Special Immigration Juvenile Status in Foster Care U – Unaccompanied Minor Program V – Voluntary Placement Program |
D02 |
Original Medical Coverage Group |
Condition |
Trickles or 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 |
Original Medical Coverage Group |
Condition |
Trickles or 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 |
Original Medical Coverage Group |
Condition |
Trickles or Spawns to: |
---|---|---|
W01: ADATSA |
If disability type W and approval code AW - denied closed reason code 239 |
W02 |
Original Medical Coverage Group |
Condition |
Trickles or 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 |
Original Medical Coverage Group |
Condition |
Trickles or 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 |
Original Medical Coverage Group |
Condition |
Trickles or Spawns to: |
---|---|---|
R01: Refugee |
Closed excess income or resources, and meets criteria to qualify for transitional medical |
R02 |
Pending R03 |
||
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 |
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.