Revised 6-1-08
1. When medical benefits are not continued at the Temporary Assistance for Needy Families (TANF) closure and should have been, the worker is responsible for updating the Family Assistance/Client Services (FACS) system to reflect the information listed in (1) - (3) of this Instruction.
(1) In the Interview notebook in the Financial Assistance tab enter Type Action Taken = C, Reason = correct reason code, and Effective Date = same effective date.
(2) In the Eligibility notebook in the Medical General tab enter Type Action Taken = R, Reason = 18A, and Effective Date = correct date. In the Financial Assistance tab enter Continued Medical Begin Date = correct date or repeat entry.
(3) For each person included for continued medical benefits (CMB), in the Interview notebook under the Household tab enter Benefit Type = C, Status = E, Date = closure date, Benefit Type = M, Status = A, and Date = most recent certification date.
2. Information regarding the private medical insurance must be kept current in the case record and the computer system.
3. This requirement is met by providing the person with an application. The case record must be documented to show this requirement has been met.
4. For example, if a TANF benefit was to be closed effective 05-01-00 but failed to get closed until 08-01-00, the effective date of CMB would be 05-01-00. Notice #1 would have normally been issued in July. Since the benefit was not closed timely, the assistance unit will not receive notice #1.
5. When a notice or report form is not issued to the assistance unit, the worker is responsible for working with the assistance unit to obtain the information necessary to establish their continued medical eligibility. The case record must contain documentation as to how continued medical eligibility was established.
6. (a) The Form 08TA018E, Continued Medical Benefit Reply Form, is computer generated on the 25th of each month and is shown on the notice list and the computer screens CM5A or CM5O for each human services center (HSC). The CM5A screen lists the most recent 08TA018E reports issued for a HSC while the CM5O screen shows only those 08TA018E reports issued after the first three months of CMB and information has not been received and updated by the HSC in the fourth or fifth months of the initial six months of eligibility. To access these screens enter CM5A or CM5O space HSC number. When the assistance unit responds to Form 08TA018E, it is the responsibility of the worker to update the CM5A or CM5O screen. If the information provided indicates continued eligibility, an "X" is entered in the indicator field and the date the form was returned or information received is entered in the date returned field.
(b) CMB benefits are suspended if the CM5A or CM5O screen has not been updated. A notice of suspension is computer generated to the assistance unit. If it is determine that the assistance unit continues eligible for CMB benefits after the suspension action has taken place, the worker must reinstate the benefits effective the same effective date as the suspension. If a determination is made that the assistance unit will be ineligible at the beginning of the seventh month, the appropriate action is taken on the FACS system on the Medical General tab.
7. Gross earned income must be verified and documented.
8. When the assistance unit returns the Form 08MA007E, Recertification of Eligibility for SoonerCare Health Benefits, and continued medical benefits are appropriate, the worker must update the Certification Period in the Medical General tab of FACS. The FACS system updates the entries for the Continued Medical Begin Date, Continued Medical Expiration Date, and shows the TANF benefits removed.