Results of Trickle, Sprout, and Spawn Charts

Created on: 
Aug 11 2016

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Aged/Blind/Disabled LTC Track

Note: Some Long Term Care (LTC) Assistance Units (AU) can trickle to numerous programs depending on their group status. The below chart is just an example.

Original Medical Coverage Group

Condition

Trickles, Sprouts,  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 Community First Choice

Ineligible for SSI

Trickles to L52

L52:  SSI Related Community First Choice

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

L99: LTC MN or Hospice W/Spenddown

N/A

None

 

Aged/Blind/Disabled 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

 

Foster Care – D-Track

Original Medical Coverage Group

Condition

Trickles, Sprouts, 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 changese to:

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

 

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

 

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

 

 

ADATSA Track (Invalid 12/31/13)

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 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

 

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

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.