1230.045.00  REDETERMINATIONS

CD13-67; OEC13-10 July 19, 2013; IM-#104 August 21, 2002, CD09-06; OEC09-02 January 14, 2009

FAMIS generates recertification forms to families forty-five (45) days prior to their eligibility end date.  Upon receipt of the form, repeat the procedures used for initial eligibility determination.  A personal visit with the family is not required.  Allow at least ten (10) calendar days for the return of the form.  Redetermine eligibility prior to the last day of the current eligibility period and authorize the children with future authorization begin dates.

When redeterminations and child authorizations are not entered prior to the end of the current certification period, the child authorizations close overnight on the last day of the eligibility period.

FAMIS limits the application date on the REQUEST (FM0G) screen to 30 days prior to the current date.  In rare instances, there is a need to explore eligibility more than 30 days prior to the current date (ie, hearing reversals).

Example: Jane Doe has an active Child Care (CC) case through 08/31/13. Jane reapplies for September, 2013 benefits on 08/16/13 and is rejected on 08/26/13. Jane requests a hearing on 10/17/13, which is held on 10/28/13. The hearing is held open through 11/05/13 to allow time for Jane to submit additional information. The agency's action to reject the reapplication is reversed. The County Office is notified of this on 11/11/13 and instructed to restore benefits to Jane back to the application date. The Eligibility Specialist enters an application in FAMIS using an application date of 11/01/13 as FAMIS will not allow entry of the true original application date of 08/18/08 as it is more than 30 days in the past.

Jane's EU consists of herself and her two children, John & Jessica. Jane's adjusted gross income is $2,100.00 per month (between 124% and 150% of poverty). Jane qualifies for Transitional Child Care (TCC) benefits from 09/01/13 through 08/30/14 based on the hearing decision reversing the 08/26/13 rejection action.

In the example above, FAMIS will recommend a REJC (rejection) action, reason MAX (income exceeds maximum) for this EU as the EU was not active on the application date entered on the REQUEST (FM0G) screen (11/01/13). Because FAMIS does not recognize that the EU was active on the original application date (08/16/13), FAMIS will determine eligibility based on the 123% federal poverty level only and will not explore TCC eligibility. In order for FAMIS to explore TCC eligibility, the system must be able to recognize the EU's active status on the original application date (08/16/13). The SELWIBCA (FMXH) screen must be used  to accomplish this function.

Worker Initiated Budget Calculation Area (WIBCA) Process

The purpose of the WIBCA is to establish continuous eligibility and allow the system to recognize when an EU should be evaluated for TCC eligibility. For WIBCA instructions, please see the FAMIS User Guide: WIBCA Child Care. FAMIS User Guides Interim Change Section.

The WIBCA can be authorized prior to the application entry on the REQUEST (FM0G) screen, during the application controlled flow, or after the application is taken out of the flow. If the application has already been taken out of the flow and processed when the WIBCA is authorized, reset the Eligibility Determination on the same day.

When the application is processed, the system will display the first month of the certification period as the month of the application date entered on the REQUEST (FM0G) screen. In the above example, this date is 11/2013. The recertification date will be set to 12 months from the previous recertification date. In the above example, the previous recertification date was 08/2013 and the new recertification date is 08/2013. The above EU will display eligibility in the system from 11/2013 – 08/2014. Although the above EU is eligible for benefits from 09/01/2013 – 10/31/2013 due to the hearing reversal, this eligibility period can not be displayed in FAMIS. The child's authorization to the provider can be entered back to the application date on FM0G, which is 11/01/13 in the above example. Corrective payments should be issued from the first invoice generated to the provider for any time period that can not be authorized on the CCAUTH (FM3O) screen. In the example above, a corrective payment should be made for services rendered from 09/01/13 through 10/31/13 using the invoice that is generated for 11/2013 services. If the parent utilized a provider other than the current provider during that time period, authorize the child to the previous provider for one day in order to generate an invoice. A corrective payment should be issued based on the invoice that is produced from this authorization.

1230.045.05  PRIORITY REVIEWS

CD12-12, OEC12-01 January 30, 2012

Set priorities to review factors, such as satisfactory progress for educational or training programs, by using the FAMIS reminder process or by length of individual authorizations.