Eligibility Review

Created on: 
Nov 15 2019

Online Processing

Mainframe Processing

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

What is the eligibility review/recertification process?

The eligibility review/recertification process determines if a client is still eligible to receive continued assistance. It is the procedure by which a user:

  • Initiates an eligibility review;
  • Enters any changes with required verification based on the household's current circumstances; and
  • Extends the certification period.

For more information, see the following EA-Z Manual Chapter:

How are eligibility reviews scheduled?

Eligibility reviews are AUTO scheduled by ACES or manually scheduled by a user. For more information, see Scheduling.

How often is an eligibility review required?

For cash and medical programs, see EA-Z Manual - WAC 388-434-0005 How often does the department review my eligibility for benefits?

For Basic Food, see EA-Z Manual - WAC 388-416-0005 How long can I get Basic Food?

When are eligibility review appointment letters generated?

Eligibility review appointment letters are normally generated during nightly batch on the 11th of each month.  For more information, see:  ACES Production Calendar.

Based on workers' appointments listed on the SCHD screen in ACES Mainframe, the client is sent either:

  • Letter 013-01 (Office Appointment for ER)
  • Letter 013-02 (Phone Appointment for ER)
  • Letter 013-03 (Weekly Appointment for Eligibility Review)
  • Letter 022-01 (Mail-in ER for Cash/Food/Medical (Non-LTC)
NOTE:  For offices that select the Weekly Scheduling method, clients are sent Letter 013-03.  For more information see: Scheduling  chapter.

How are certification periods determined?

For more information on how certification periods are determined, see:

What happens if an eligibility review is not initiated?

For reviews scheduled for date/time specific review appointments:

Note: Letter 026-05 (Medical/LTC ER Termination) is generated for medical AUs.

For reviews scheduled using the weekly block of time method:

  • No Alerts generate.
  • If the review is not initiated by the last business day of the week it is scheduled, Letter 026-04 generates the last system calendar day of the week.
EXAMPLE: Eligibility Review is scheduled for the week of October 12, 2015 – October 16, 2015. The system is online Saturday October 17, 2015. If the review is not initiated by Saturday, Letter 026-04 is generated in batch the night of Saturday October 17, 2015. This gives the user one additional day to take action on the case before a letter is sent.

What happens if an eligibility review is initiated but not completed?

Basic Food and cash Assistance Units (AUs) close at the end of the certification period. Medical AUs do not close and  remain active until they are manually closed.

NOTE: If an eligibility review is initiated on medical AU and not completed, users need to set a tickler to manually close the AU if all needed verifications are not received.

Online Processing

How does ACES support the eligibility review process?

ACES supports the eligibility review process by:

  • Scheduling appointments. For more information, see Scheduling.
  • Updating the ER Received field on the Case Actions page for TANF/SFA, FS, G01, G02 and any Categorically Needy (CN) medical program when a review has been received.
  • Tracking the initiation and completion of eligibility reviews.
  • Allowing entry of eligibility review information.
  • Initiating required interfaces and referrals.
  • Identifying required verifications.
  • Sending alerts and letters.
  • Displaying the next review type on the AU Demographic page.

How is the eligibility review type determined?

For more information on how the eligibility review type is determined, see Mainframe Processing - How is the eligibility review type determined?

How does ACES indicate an eligibility review has been received?

ACES updates the ER Received field on the Case Actions page with a [Y] – Yes the day after one of the following documents are scanned in DMS (Document Management System):

  • Application for Benefits (14-001)
  • Eligibility Review (14-078)
  • Eligibility Review for Long Term Care Benefits (14-416)

How do I initiate an eligibility review?

ACES does not automatically initiate eligibility reviews or allow workers to initiate eligibility reviews on Basic Food AUs more than 45 days before the end of the certification period.

ACES allows workers to initiate an eligibility review on Transitional Food Assistance (TFA) and Washington State Combined Application Program (WASHCAP) AUs any time during the certification period.

Click Initiate Review on the Case Actions page to initiate an eligibility review.

Note: The review type cannot be changed when the system has tentatively scheduled a review appointment.
Note: When a review is initiated for a Cash or Basic Food AU, a review is also initiated for the following associated medical coverage groups: S02 (SSI Related Categorically Needy), S03 (QMB) and S05 (SLMB).

How do I complete an eligibility review?

To complete an eligibility review take the following steps:

  1. Go to the Case Actions page. For more information, see How do I access Case Actions page in ACES 3G?
  2. Click the Initiate Review link in the Eligibility Reviews section of the Case Actions page. Once the review has been initiated, the Date Initiated field populates today's date and the Process ER link becomes available.
  3. Click Process ER.
  4. Continue through the eligibility review process by using the Navigation tree. For more information on navigating, see How do I navigate in ACES 3G?
  5. On the Review page complete the following fields:
  • Eligibility Review Complete field - Click the Yes or No radio button.
  • Expedited Services - Click the appropriate Yes or No radio button. If Yes, a Discovery Date is required.
  1. Click Eligibility on the Navigation tree.
  2. Click Details to the right of any AUs that are currently active on the Eligibility page.
  3. On the Eligibility Details page click Confirm Benefits.
  4. Print IID – click Yes or No radio button.  If Yes, select print option for head-of-household.  For more information, see How do I print an Interactive Interview Declaration (IID)?    
  5. Click Commit Changes on the Eligibility page.

ACES generates the following letters based on the type of AU being recertified:

  • Letter 027-01 Cash/Medical/Food Recertification,
  • Letter 027-04 LTC Recertification, or
  • Letter 027-05 WASHCAP Post Review.

What is the LAM indicator?

The Living Above Means (LAM) field applies to Basic Food Assistance Units (AUs) only and must be updated on the Review page at application, re-open and eligibility review.

The following text displays to prompt the user to document the household circumstances If Household meets criteria for LAM; please click here to document how they are meeting their needs.

In the Living Above Means field, select Yes (Y) if you suspect the client(s) is living above their means.

For more information, see EA-Z Manual - Verification.

How do I access the Living Above Means (LAM) Template?

  1. From the Review page, for a household identified as Living Above Means (LAM), click the here to document link. The Living Above Means Template displays, select the appropriate responses from the list provided. 
  2. To save the response click Create Remarks. The Remarks template box displays, with the selected text auto generated. Add or modify the text if needed. 
  3. To save the Remarks, click Save. The Remarks post to the Assistance Unit Detail Remarks page.

How do I complete an eligibility review on a Basic Food AU up to 45 days before the end of the certification period?

If the AU is closed, reinstate both the ongoing and historical months, see Reinstatement. To ensure certification is set correctly, users should always process the oldest month first.

If the AU is active, take the following steps:

  1. Click Initiate Review click on the Case Actions page.
  2. Click Process ER on the Case Actions page.
  3. Update the case information as needed.
  4. Click the Yes radio button next to Eligibility Review Complete on the Review page. 
  5. On the Eligibility Details page, the Review Begin Date is the month following the current certification period and the Review End Date defaults based on program requirements.
  6. Confirm the benefits and commit changes.

Eligibility Reviews completed on Basic Food AUs up to 45 days prior to the end of the certification period and before monthly issuance in the month prior to the certification end date receive the following letters. These letters display the new certification period beginning the month following the current certification period:

  • Letter 027-01 Cash/Medical/Food Recertification,
  • Letter 027-04 LTC Recertification, or
  • Letter 027-05 WASHCAP Post Review

How do I complete an eligibility review after deadline but before the first of the following month?

Reinstate both the ongoing and historical months. For more information, see Reinstatement. To ensure certification is set correctly, users should always process the oldest month first.

Once the AU is active, take the following steps:

  1. Click Initiate Review click on the Case Actions page.
  2. Click Process ER on the Case Actions page.
  3. Update the case information as needed.
  4. Click the Yes radio button next to Eligibility Review Complete on the Review page. 
  5. On the Eligibility Details page, the Review Begin Date is the same as the ongoing month and the Review End Date defaults based on program requirements. 
  6. Confirm the benefits and commit changes.

How do I complete an eligibility review after the first day of the month following the month the review was due?

When the review is received after the first day of the month following the month the review was due re-open benefits effective the date you determine they were eligible. 

When the review is not received until after the month it is due, the review should be handled as a new application.

What happens when an eligibility review has been received in DMS for Categorically Needy Medical or Medicare Savings Program (MSP) Assistance Units (AUs)?

If an eligibility review has been received in DMS but has not been initiated or completed in ACES:

  • The Case Actions page displays a [Y] in the ER Received field.
  • At monthly issuance, the AU remains open until the review end date.  
  • Medical eligibility continues until the review is completed.

If an eligibility review has been received in DMS and the review was initiated, but has not been completed in ACES:

  • The Case Actions page displays a [Y] in the ER Received field.
  • At monthly issuance, the AU remains open until the review end date.
  • Medical eligibility continues until the review is completed.

The following medical programs are included in this functionality:

  • G03 K01 L02 L04 L22 L24 L32 L42 L52 T02
  • S02 S03 S04 S05 S06 S08

Can I initiate a review on a Spenddown Assistance Unit (AU)?

If the Spenddown AU for which the review is due is in Active (A) status, a review may be initiated on the following types of AUs:

  • F99 (MN Children W/Spenddown),
  • G99 (MN Alternate Living Facility W/Spenddown),
  • K99 (MN Family LTC W/Spenddown),
  • L99 (LTC MN W/Spenddown) or;
  • S99 (MN SSI Related W/Spenddown) the previous AU can be reopened.
NOTE: An eligibility review can be initiated in Spenddown (M) or Active (A) status after monthly issuance, when the ongoing month is the month after the current base period end month.
EXAMPLE: An eligibility review is received May 19, 2018 for an S99 AU with a base period end date of July 30, 2018. The review can be initiated after monthly issuance on June 23, 2018 when the ongoing month is August 2018. 

What happens to a Temporary Assistance for Needy Families (TANF) or State Funded Assistance (SFA) Assistance Unit (AU) when an eligibility review has been received in DMS but not initiated or completed?

For more information on what happens when to TANF or SFA AU hen the review form has been received but not completed or initiated, see Mainframe Processing - What happens to a Temporary Assistance for Needy Families (TANF) or State Funded Assistance (SFA) Assistance Unit (AU) when an eligibility review has been received in DMS but not initiated or completed?

Mainframe Processing

How is the eligibility review type determined?

For offices designated to use date/time specific eligibility review appointments, the eligibility review type is determined based on the valid value entered in the Next Review field on the MISC screen in ACES Mainframe. The Next Review field can be updated by accessing Option Y - Reschedule Appointments. The review types are:

  • M -Mail

  • O -Office

  • T -Telephone

  • X - Mail – Elderly/Disabled Waiver (system generated only) 

  • U - Unselected (Do not use)

  • Blank (system generated).

For offices designated to use the weekly eligibility review appointments:

  • Eligibility review types O - Office, T - Telephone, U - Unselected, and Blank may be entered and the system sends Letter 013-03 (Weekly Appointment for Eligibility Review).

 

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