Revision 10-1; Effective January 1, 2010

 

 

C—610 General Information

Revision 02-3; Effective April 1, 2002

All Programs

This section contains Form H1000-A, Notice of Application, and Form H1000-B, Record of Case Action, entries for certifications, actions taken during certification periods, and denials. For transfer entries, refer to C-700, Transfer Guidelines.

 

C—620 Certification Entries

Revision 02-3; Effective April 1, 2002

 

 

C—621 Minimum Entries for Certification

Revision 02-3; Effective April 1, 2002

 

 

C—621.1 TANF Minimum Entries

Revision 02-3; Effective April 1, 2002

TANF

Section I
Item 02
Item 07
Item 08
Item 09
Item 13
Item 15
Item 16
Item 17
Item 25
Category
Mail Code
Date Filed
Case Name
Mailing Address
City
State
ZIP Code
County
Section II
Item 32
Item 33
Item 34
Item 35
Item 37
Item 38
Client Number
Client Name
Birth Date
Sex
Social Security Number (if known)
Social Security Claim Number (if enrolled in Medicare or receiving benefits)
Section III
Item 40
Item 41
Items 42-44
Item 46
Status in Group
ESP Code (unless Category 5)
Individual Income, if applicable
Medical Effective Date
Section IV
Item 55
Item 56
Item 58
Item 59
Total Railroad Retirement (if appropriate)
Total Other (Income) (if appropriate)
Dependent Care Deductions (if appropriate)
Adjusted Gross Income
Note: Total income minus deductions must equal adjusted gross income
Section V
Item 66 Total Needs
Section VIII
Item 127
Item 129
Item 132
Item 133

Item 134
Item 138
Items 149, 151, and 152
Type Program
Grant Effective Date
Action Code
Three Months Prior Indicator (only if eligible for three months prior medical assistance)
Three Months Prior Application Date (if entry made in Item 133)
Child Support Cooperation
For cases with earned income, enter dependent care and 90% earned income deduction information if these deductions are used in determining the adjusted gross
Section XIV
Item 188
Item 189
Item 190
Signature
Date Signed
Employee Number

 

C—621.2 SNAP Minimum Entries

Revision 02-3; Effective April 1, 2002

 

SNAP

Section I
Item 02
Item 04
Item 06
Item 07
Item 08
Item 09
Item 13
Item 15
Item 16
Item 17
Item 25
Category
Page number and the number of pages if there are more than 11 individuals
Budgeted Job Number
Mail Code
Date Filed
Case Name
Mailing Address – first line
City
State
ZIP Code
County
Section II
Item 32
Item 33
Item 34
Item 35
Item 36
Item 37
Item 38
Item 39
Client Number
Client Name
Birth Date
Sex (if known)
Race (if known)
Social Security Number
Social Security Claim Number (if visually verified)
Education Level (if Item 41 is 1, 2, 3, or 4)
Section III
Item 40
Item 41
Items 42-45
Item 48
Item 49
Status in Group
Work Registration
Individual Income, if applicable
Medical Cost of eligible members as appropriate
Disqualification Code and Date, if applicable
Section IV
Item 55
Item 56
Item 58
Item 59
Total Railroad Retirement (if appropriate)
Total Other (Income) (if appropriate)
Dependent Care Deduction (if any)
Adjusted Gross Income
Section V
Item 60
Item 63
Shelter
Net Income
Section VI
Item 78
Item 79
Item 80
Item 81
Item 82
Item 83
Item 84
Item 85
Item 89
Item 90
Item 91
Item 92
Item 96
Items 103 and 104
Type Review
Application Codes
Certification Date
Months Certified
Last Benefit Month
Household Number
Aid Type
Test (Gross/net income eligibility test identifier codes)
SSI Code (if applicable)
Utility Code
Action Code (if case is opened and closed on same document)
Action date (if entry made in Item 91)
Late Determination/Rescheduled Appointment Date, if applicable
(if appropriate)
Section VII
Items 112 and 113
Items 118-122
Associated TANF case numbers, if appropriate
(if appropriate)
Section VIII
Item 152 Child Support Disregard, if applicable
Section XI
Items 179-187 As appropriate to request or report benefits
Section XIV
Item 188
Item 189
Item 190
Signature
Date Signed
Employee Number

 

C—621.3 Minimum Entries for Medical Programs

Revision 02-3; Effective April 1, 2002

 

Medical Programs except TP 45

NOA Entries
Section I
Item 01
Item 02
Item 03
Item 06
Item 07
Item 09
Item 12
Item 13
Item 15
Item 16
Item 17
Item 25
Item 31
Case Number
Category
Prior Recipient
Budgeted Job Number
Mail Code
Case Name
Employee Number
Mailing Address
City
State
ZIP Code
County
Medical Programs Application Number
Section II
Items 33-38 Client Names and Biographical Data
Certification Entries
Section I
Item 02
Item 07
Item 08
Item 09
Item 13
Item 15
Item 16
Item 17
Item 25
Item 29
Item 30
Category
Mail Code
Date Filed
Case Name
Mailing Address
City
State
ZIP Code
County
Notice Date
Medical Delay (if appropriate)
Section II
Item 32
Item 33
Item 34
Item 35
Item 37
Item 38
Client Number
Client Name
Birth Date
Sex
Social Security Account Number (if known)
Social Security Claim Number (if enrolled in Medicare or receiving benefits)
Section III
Item 40
Items 42-44
Item 46
Status in Group
Individual Income, if applicable
Medical Effective Date
Section IV
Items 55, 56, and 58
Item 59
Case Income, if applicable

Adjusted Gross Income
Note: Total income minus deductions must equal adjusted gross income.
Section V
Item 66 Total Needs
Section VII
Item 125
Item 126
Number of Adults
Number of Children
Section VIII
Item 127
Item 132
Item 133

Item 134
Item 136
Type Program
Action Code
Three Months Prior Indicator only if eligible for three months prior medical assistance
Three Months Prior Application Date (if entry is made in Item 133)
Medicaid Termination Date
Section XIV
Item 188
Item 189
Item 190
Signature
Date Signed
Employee Number

 

C—621.3.1 TP 45 Minimum Entries

Revision 02-3; Effective April 1, 2002

 

TP 45

Section I
Item 02
Item 07
Item 08
Item 09
Item 13
Item 15
Item 16
Item 17
Item 25
Item 29
Category
Mail Code
Date Filed
Case Name
Mailing Address
City
State
ZIP Code
County
Notice Date
Section II
Item 32
Item 33
Item 34
Item 35
Item 37
Client Number
Client Name
Birth Date
Sex
Social Security Account Number (if known)
Section III
Item 40
Item 46
Status in Group
Medical Effective Date
Section VIII
Item 127
Item 132
Type Program
Action Code
Section XIV
Item 188
Item 189
Item 190
Signature
Date Signed
Employee Number

 

C—622 Entries for Three Months Prior

Revision 02-3; Effective April 1, 2002

 

 

C—622.1 Three Months Prior Medicaid – Currently Eligible – No Gap in Coverage

Revision 02-3; Effective April 1, 2002

 

TANF

Complete Form H1000-A, Notice of Application, using TANF entry requirements.

Item 46 – Enter prior medical effective dates for applicants eligible for three months prior medical coverage.

Item 133 – Enter the number of months of prior eligibility.

Item 134 – Enter three months of prior application date.

Note: For three months prior with a gap in coverage, see C-623.2.

 

C—622.2 Three Months Prior Entries for a Medically Needy Case

Revision 02-3; Effective April 1, 2002

 

TP 55 and 30

Make minimum certification entries for a case with or without spend down. For a TP 30 case, do not make entries in Items 179-187 if Item 137 has an entry of 40, 43, 44, or 48. Refer to Form H1000-A and Form H1000-B instructions for Items 133 and 137.

Make the following entries in Section XI when there is no gap in eligibility during the prior period:

Item 179 – Enter N if the prior month has spend down or E if the prior month does not have spend down. This code corresponds with the month entered in Item 183.

Item 183 – Enter the month to correspond with the code in Item 179.

Item 184 – Enter the net income to correspond with the month in Item 183. Round down to the whole dollar amount.

Item 185 – Enter the spend down amount to correspond with the month entered in Item 183. Enter 0 if there is no spend down.

Item 187 – Enter the household size to correspond with the month entered in Item 183. Enter the number of adults in the budget group in the first digit and the number of children in the budget group in the second digit.

If there is a gap in eligibility during the three-month prior period, process a separate Form H1000-A for the eligible months.

 

C—623 Entries for Open and Close Certifications

Revision 02-3; Effective April 1, 2002

 

 

C—623.1 TP 04, Medical Assistance Only – Deceased

Revision 02-3; Effective April 1, 2002

 

TANF

Make TANF minimum entries except for Items 41 and 129

Item 40 – Enter X with status in group code for deceased individual.

Item 46 – Enter the medical effective date for each eligible person.

tem 47 – Enter the appropriate dates.

Item 132 – Enter action code 090.

Item 133 – Enter three months prior indicator, if eligible.

 

C—623.2 TP 11, Three Months Prior Medical Assistance – Not Currently Eligible; Gap in Coverage; or Reopened Applications

Revision 02-3; Effective April 1, 2002

 

TANF

Make all TANF minimum entries except Items 41 and 129.

For reopened applications,

Item 08 – Enter the date the applicant requests the application be reopened.

Item 134 – Enter the month and year the original application was filed.

Item 140 – Enter M with primary Codes 5, 6, 7, or 8 for applicants eligible for retroactive coverage. Enter N with primary Codes 5, 7, or 8 for applicants who are not eligible for retroactive coverage but are included to show need.

Item 47 – Enter last day of medical coverage for all applicants with Code M in Item 40.

Item 132 – Enter Code 090.

Notes:

  • Enter MX with primary codes for an applicant who dies during the three month prior period or if the person died before the application was made on his behalf.
  • For Three Months Prior Currently Active – In addition to the above entries, enter the existing case number in Item 01 and the existing client number in Item 32.

 

C—623.3 Simultaneous Open and Close for TANF

Revision 02-3; Effective April 1, 2002

 

TANF

Use this procedure to process applications for

  • denied households eligible for restored benefits (See B-800, Restored Benefits),
  • applicants eligible for TANF for the current month but ineligible for future months,
  • applicants eligible for OTTANF, or
  • applicants eligible for TANF Medicaid for the application month but ineligible for the months following the application month.Note: Form H1000-A, Notice of Application, can be processed only if the month after the application month is entered in Item 129.

Make all minimum entries for the appropriate type program.

Note: Do not reassign an old case number.

Item 40 – Enter secondary status in group Code N for OTTANF applicants.

Item 47 – Enter last month of eligibility for each certified person. If an applicant is deceased, enter date of death.

Item 127 – enter Type Program 71 or 72 for OTTANF cases.

Item 132 – Enter Code 090.

Items 179, 180, 183, 184, 185 and 187 (Section XI) – Enter information to authorize benefits for Type Program 01 and 61 certifications. Exceptions: Do not make entries in Section XI for OTTANF cases. When the form processes, benefits are automatically issued.

 

C—623.4 Simultaneous Open and Close for Medical Programs

Revision 02-3; Effective April 1, 2002

 

Medical Programs

Use this procedure to process applications for

  • TP 55 and 30 with spend down in the application month;
  • TP 30 when the applicant is a caretaker or a second parent with an emergency condition; or
  • three months prior only including
    • TPs 30 and 55 with or without spend down, and
    • applications for TPs 30, 40, 43, 47, 48, and 55 reopened within two years after the original application was filed.

Make minimum certification entries for a case (with or without spend down) including the file date of the application. Note: Do not reassign an old case number.

Item 40 – Enter the appropriate SIG codes. For three months prior, only include in the certified group members who have Title XIX-reimbursable bills for the prior period. For TP 30, include only one member in the certified group.

Item 46 – Enter the Medical Effective Date (MED) or earliest possible MED. For TP 30 cases, enter the start date of the emergency condition taken from Form H3038, Emergency Medical Services Certification.

Item 47 – Enter the last day of medical coverage. For TP 30 cases enter the earliest of either

  • the end date of the emergency condition, or
  • the last day of the application month.

    Note: For TP 55 cases with spend down, computer edits will not allow a date later than the last day of the application month.

Item 66 – Enter the correct needs allowance for the month(s) entered in Items 46 and 47.

Item 127 – Enter the correct type program (30, 40, 43, 44, 47, 48, or 55).

Item 132 – Enter code 090.

Item 133 – For three months prior only, enter the total number of unduplicated calendar months of three months prior.

Item 137 – For TP 30 cases, enter the appropriate TP. Refer to Form H1000-A and Form H1000-B instructions for this entry.

Section XI – For three months prior only, make appropriate entries for each of the prior months. For TP 30 cases, do not make these entries if Item 137 has an entry of 40, 43, 44, or 48.

For reopened three months prior applications,

Item 08 – Enter the date the applicant requests the application be reopened.

Item 134 – Enter the month and year the original application was filed.

 

C—624 Entries for Reinstatements

Revision 02-6; Effective July 1, 2002

 

 

C—624.1 TANF

Revision 10-1; Effective January 1, 2010

 

Make all Form H1000-A minimum entries.

Item 01 – Enter the previous case number.

Item 08 – Enter first day of the month of reinstatement.

Item 46 – Enter each individual's medical effective date.

Item 131 – Enter type review Code C.

Item 132 – Enter Code 054 or 055.

Item 164 – Enter the three-digit code for the individual's county of residence. See C-350.

Note: SAVERR edits prevent household additions when Code 054 is used in Item 132. Use Form H1000-B turnaround to make this change.

 

C—624.2 SNAP

Revision 10-1; Effective January 1, 2010

 

SNAP

Item 08 – Enter the original file date.

Item 79 – Enter 3X0.

Item 80-82 – Reenter the information from the certification period when the case was denied.

Section XI – Make entries as appropriate to order benefits.

 

C—624.3 TP 07/20 (Four, 12, or 18 Months Medicaid) for a Case Previously Denied in Error

Revision 10-1; Effective January 1, 2010

 

TANF

Make all TANF minimum entries except Items 41 and 129.

Item 01 – Enter case number of the case denied in error.

Item 32 – Enter each individual's previous client number.

Item 46 – Enter each individual's medical effective date as the day after the date the erroneous denial became effective.

Item 132 – Enter

  • Code 090 if the Medicaid end date is before the current process month, or
  • Code 055 if the Medicaid end date is during or after the current process month.

Item 136 – Enter the Medicaid end date.

Item 138 – Enter the reason for transfer to TP 07 or TP 20.

Item 164 – Enter the three-digit code for the individual's county of residence. See C-350.

 

C—624.4 TP 37 (12 or 18 Months Medicaid) for a Case Previously Denied in Error

Revision 10-1; Effective January 1, 2010

 

TANF

Make all TANF minimum entries except Items 41 and 129.

Item 01 – Enter case number of the case denied in error.

Item 32 – Enter each individual's previous client number.

Item 46 – Enter each individual's medical effective date as the day after the date the erroneous denial became effective.

Item 132 – Enter

  • Code 090 if the Medicaid end date is before the current process month, or
  • Code 050 if the Medicaid end date is during or after the current process month, or
  • Code 054 to reinstate a denied household that meets the requirements in A-800.

Item 149 – Enter Code 9 for the 90% Earned Income Deduction (EID).

Item 151 – Enter the original date of the 90% EID. Do not enter a dollar amount in Item 152.

Item 164 – Enter the three-digit code for the individual's county of residence. See C-350.

 

C—624.5 Reinstatement for Post Medicaid (TP 20), Transitional Medicaid (TP 07 or 37), or TP 29

Revision 10-1; Effective January 1, 2010

 

TANF

Make all TANF minimum entries.

Item 01 – Enter the previous case number.

Item 08 – Enter the first day of the month of reinstatement.

Item 46 – Enter each individual's medical effective date.

Item 131 – Enter Type Review Code C.

Item 132 – Enter Code 054 or Code 090.

Item 136 – TP 07, TP 20, or TP 29: Enter

  • the original end date as shown on SAVERR, or
  • an earlier end date, when applicable, when using Code 090.

Item 138 – Enter

  • S for TP 20, or
  • E or B for TP 07.

Item 151 – Enter the original date of the 90% EID. Do not enter a dollar amount in Item 152.

Item 164 – Enter the three-digit code for the individual's county of residence. See C-350.

Note: SAVERR edits prevent the actions listed below when Code 054 is used in Item 132. Therefore, use Form H1000-B turnaround to

  • add a person.
  • correct the end date of the original TP 07, TP 29, or TP 37 period. Change the end date only if it was incorrect when the case originally transferred to transitional Medicaid.

 

C—625 Miscellaneous Certification Entries

Revision 02-3; Effective April 1, 2002

 

 

C—625.1 Certifying Benefits for the Month After Certification

Revision 02-3; Effective April 1, 2002

 

TANF

Make all minimum TANF entries.

Item 46 – Enter first calendar day of the month after the application month.

Item 129 – Enter first calendar day of the month after the application month.

Note: Do not make future grant or medical effective dates for TANF more than one month past the future cutoff month.

 

C—625.2 Certifying a TP 29 Case

Revision 02-3; Effective April 1, 2002

 

TANF

Certify only one individual on each TP 29 case.

Item 40

  • For the individual being certified on TP 29 enter
    • SIG 8G if the individual was SIG 8 on the TANF case, or
    • SIG 7G if the individual was SIG 7 on the TANF case.
  • For other household members listed on the case enter
    • SIG 0 or 2Y for an adult, or
    • SIG 2, 2I, 2IT, 2IU, 2W, or 3 for a child.

Note: The case must be include a SIG 2, 2W, or 3 for the caretaker or second parent to be certified.

Item 127 – Enter Type Program 29.

Item 132 – Enter opening Code 057 on Form H1000-A, Notice of Application, or code 121 on Form H1000-B, Record of Case Action.

Item 136 – Enter the Medicaid end date.

 

C—625.3 Independent Child as the Case Name When a Representative from a Child Care Facility Applies for the Child

Revision 02-3; Effective April 1, 2002

 

Medical Programs

Make all minimum entries for the appropriate type program.

Item 13 – Enter the child's residence or, upon request, the address of the child care facility located near the child.

Item 25 – Enter the BJN's county code.

Item 26 – Enter the name of the child care representative as representative payee.

Item 271 – Enter Code R.

Item 40 – Enter SIG Code 8 to designate the child as case name.

Item 164 – Enter the child's residence county code.

 

C—630 Entries for Actions Taken During the Certification Period

Revision 02-3; Effective April 1, 2002
 

 

C—631 Entries for Case Name Changes

Revision 02-3; Effective April 1, 2002

 

 

C—631.1 Case Name Changes with Same Household Members

Revision 02-3; Effective April 1, 2002

 

SNAP

Item 10 – Enter new case name.

Item 40 – Enter # to remove former head of household status.

Item 40 – Enter A for new head of household.

Item 78 – Enter type review.

 

C—631.2 Case Name Changes When Head of Household Leaves

Revision 02-3; Effective April 1, 2002

 

SNAP

Item 10 – Enter new case name.

Item 33 – Enter # to remove former head of household.

Item 40 – Enter A for new head of household.

Item 78 – Enter type review.

Item 83 – Enter new household number, if applicable.

 

C—632 Entries for Households Becoming Eligible for SSI

Revision 02-3; Effective April 1, 2002

 

 

C—632.1 TANF Caretaker Becomes Eligible for SSI

Revision 08-4; Effective October 1, 2008

 

TANF

Item 40 – Enter Code 9.

Item 41 – Enter Code V.

Item 66 – Enter new needs amount.

Item 131 – Enter type review code.

Item 132 – Enter Code 105.

Remove any income entries for the caretaker.

 

C—632.2 TANF Child Becomes Eligible for SSI

Revision 02-3; Effective April 1, 2002

 

TANF

Item 40 – Enter Code 3.

Item 41 – Enter Code J.

Item 66 – Enter updated budget entries.

Item 131 – Enter type review.

Item 132 – Enter action code.

Note: SAVERR will not allow a SIG 5 child on the same case a SIG 3 child.

 

C—633 Entries for Adjusting Certification Periods

Revision 02-3; Effective April 1, 2002

 

 

C—633.1 Extending the Certification Period of an Active SNAP Case

Revision 02-3; Effective April 1, 2002

 

SNAP

Item 78 – Enter Code I.

Item 81 – Enter the new number of months certified.

Item 82 – Enter the new last benefit month.

 

C—633.2 Shortening the Certification Period of an Active SNAP Case

Revision 02-3; Effective April 1, 2002

 

SNAP

Item 78 – Enter type review Code I.

Item 81 – Enter the new number corresponding to the original certification date in Item 80 and the new last benefit month in Item 82. Example: If the certification date was 06/01/01, and the new last benefit month is 9/01, enter 04 in this item.

Item 82 – Enter the new last benefit month.

 

C—634 Miscellaneous Action Entries

Revision 02-3; Effective April 1, 2002

 

 

C—634.1 Death of an Active Client

Revision 02-3; Effective April 1, 2002

 

TANF

Item 40 – Reenter the original status in group codes for the deceased individual plus code X.

Item 47 – Enter the individual's date of death.

Item 131 – Enter the type review code.

Item 132 – If the case is also being denied because of death, enter Code 058 or 059.

 

C—634.2 Canceling a Previous SNAP Issuance

Revision 02-3; Effective April 1, 2002

 

SNAP

Item 179 – Enter Code N.

Item 180 – Enter cancellation Code G.

Item 181 – Enter number of the issuance being cancelled.

Item 182 – Enter the issuance date of the benefit being cancelled.

Item 183 – Enter the benefit month of the issuance being cancelled.

Item 185 – Enter the benefit value of the issuance being cancelled.

Item 186 – Enter the recoupment amount (if appropriate).

 

C—634.3 Households with Disqualified Members

Revision 02-3; Effective April 1, 2002

 

 

C—634.3.1 Households with Members Disqualified for Citizenship, or 18-50 Work Requirement, or Noncompliance with SSN Requirements

Revision 02-3; Effective April 1, 2002

 

SNAP

Make the following entries for the disqualified person:

Item 40 – Enter status in group Code K.

Item 41 – Enter Code T.

Items 42B-45 – Enter prorated income of disqualified person.

Item 60 – Enter appropriate shelter expenses.

Item 83 – Enter number of household members not disqualified.

Item 87 – Enter Code C if household has member disqualified as ineligible alien.

Item 88 – Enter number of household members disqualified as ineligible aliens.

Item 90 – Enter code for prorated shelter expense, if applicable.

Also make corresponding entries onForm H1000-C, Secondary Client Input, in Item 216 to identify the reason for disqualification.

 

C—634.3.2 Households with Members Disqualified for SNAP Employment Services Noncompliances, Felony Drug Convictions, Refusing to Cooperate with the Quality Control Process, or Being a Fugitive

Revision 08-3; Effective July 1, 2008

 

SNAP

Make the following entries for the disqualified person:

Item 40 – Enter status in group Code K.

Item 41 – Enter Code T.

Items 42B-45 – Enter total income of disqualified person.

Item 60 – Enter total shelter expenses.

Item 83 – Enter number of household members not disqualified.

Item 90 – Enter appropriate code for shelter expense.

Also make corresponding entries onForm H1000-C, Secondary Client Input, in Item 216 to identify the reason for disqualification.

 

C—634.4 Reinstating a Person Disqualified for Intentional Program Violation When the Disqualification Expires

Revision 02-3; Effective April 1, 2002

 

SNAP

Make minimum entries for certification or changes.

Item 40 – Enter the appropriate code.

Item 41 – Enter the appropriate code.

Item 49 – Make no entry.

Item 83 – Enter number of eligible household members including the person who is no longer disqualified.

 

C—634.5 Reporting Increases in Household Composition with More than 11 Persons

Revision 02-3; Effective April 1, 2002

 

All Programs

Use more than one set of forms. In addition to the standard entries on the first Input document, complete Item 04, page 1.

Use a Form H1000-A, Notice of Application, packet. Separate the NOA and the Case Index Card from the packet and destroy, leaving the H1000-A Input and case record copy intact. White out the preprinted application number, enter the case number in Item 01, and make the following entries:

Item 03 – Sequence Number

Item 04 – Page

Item 06 – Budgeted Job Number

Item 07 – Mail Code

Item 09 – Case Name

Items 32-50 – Begin with line "b"

Staple the Input document together and batch as one.

 

C—634.6 Change of Payee or Caretaker

Revision 02-3; Effective April 1, 2002

 

TANF

Item 10 – Enter new case name.

Items 32-37 – Enter information about case name if the person was not previously included in the case.

Items 40-41 – Enter code for new case name.

Item 46 – Enter medical effective date for new case name if the person is certified as a caretaker and was not previously included in the case.

Item 33 – Enter # to remove previous individual if the individual is to be removed from the case.

Items 40-41 – Enter new codes if the previous case name is to remain in the case.

Item 131 – Enter type review code.

Item 132 – Enter Code 120.

Enter budget and Item 66 entries for situations with these changes.

 

C—634.7 Three Months Prior Medicaid – No Gap in Coverage on an Active Case

Revision 05-4; Effective August 1, 2005

 

TANF

Item 46 – Enter new medical effective date.

Item 131 – Enter the type review code.

Item 132 – Enter reinvestigation Code 107 if sustaining or other codes if raising or lowering.

Item 133 – Enter number of months of prior eligibility.

Item 134 – Enter three months prior application date.

To change a medical effective date for more than six months before the current process month, send a memo with supervisor'sapproval to State Office Data Integrity (SODI) Section, Systems Control Division, State Office, Y-922, explaining why the information needs to be processed.

 

C—634.8 Entering the 90% Earned Income Deduction and Child Care to Ensure Automatic Removal of the Deduction

Revision 05-4; Effective August 1, 2005

 

TANF

Item 42B – Enter gross earned income.

Item 58 – Enter standard work expense deduction. Do not enter childcare or 90% deduction.

To report child care deduction:

Item 149, line 1 – Enter C.

Item 152, line 1 – Enter total child care deduction.

To report the 90% earned income deduction:

Item 149, line 2 – Enter 9.

Item 151, line 2 – Enter the last month of the four month eligibility period.

Item 152, line 2 – Enter the total allowable 90% earned income deduction.

Item 59 – Enter the remainder of Item 57 minus Items 58 and 152.

SAVERR automatically removes the 90% deduction after cutoff in the month before the month entered in Item 151. If the case is denied, SAVERR transfers assistance to Type Program 37 and adds 12 or 18 months to the month in Item 151.

When processing the automatic removal of the 90% deduction, SAVERR notifies the individual and sends the advisor an updated H1000-Bsequence.

SAVERR will not automatically remove the 90% deduction or transfer the case to TP 37 when a case is on hold. If a Form H1000-B, Record of Case Action, is submitted to remove the hold, remove the 90% deduction by entering

  • 9 in Item 149, and
  • 0 in Item 152.

If denying the case, process a transfer to TP 37.

 

C—640 Denial Entries

Revision 02-3; Effective April 1, 2002

 

 

C—641 Denial of a TANF/Medical Programs Application

Revision 02-3; Effective April 1, 2002

 

TANF and Medical Programs

Item 29 – Action Notice

Item 127 – Type Program

Item 132 – Action Code

 

C—642 Denial of a SNAP Application

Revision 02-3; Effective April 1, 2002

SNAP

To deny an application of Form H1000-A, Notice of Application, make the following entries:

Item 29 – Enter date Form H1017, Notice of Benefit Denial or Reduction, is sent to applicant.

Item 79 – Enter application code.

Item 91 – Enter denial code.

Item 92 – Enter date of denial.

To deny an application on Form H1000-B, Record of Case Action, make these additional entries:

Item 08 – Enter date applied.

Item 78 – Enter C.

 

C—643 Hold Code 5 Actions Pending Automatic Grant Denial

Revision 02-3; Effective April 1, 2002

 

TANF

Item 131 – Enter the type review code.

Item 132 – Enter Code 107. Use Code 110 for Type Program 07 cases.

Item 142 – Enter hold Code 5.

Item 143 – Enter denial code.

Do not enter any budgetary changes

If the hold is not released in the hold effective month, an updated sequence Form H1000-B, Record of Case Action, is produced at cutoff of the hold effective month showing the grant denial.

 

C—644 Denial of an Active Case Because of Failure to Comply with Employment Services

Revision 02-3; Effective April 1, 2002

 

SNAP

Item 41 – Enter U for the primary wage earner who did not comply.

Item 78 – Enter type review.

Item 91 – Enter Code 610.

Item 92 – Enter last day of month the denial is effective.