Trickle and Spawn

Created on: 
Jan 10 2018

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

What is priority coverage?

Priority coverage is the type of medical program that provides applicants/recipients with the best scope of care options. Trickle and Spawn are part of the automated eligibility determination process that ACES performs when considering a client’s eligibility for the highest priority medical coverage groups.

Categorically Needy (CN) medical provides the broadest scope of medical coverage.  Examples of CN medical programs:

  • L01 - Long Term Care (LTC) in a Medical Facility SSI Recipient
  • L02 - Long Term Care (LTC) in a Medical Facility SSI Related
  • S01 - SSI Recipient
  • S02 - SSI Related Medical
  • N11 - Modified Adjusted Gross Income (MAGI) - Children's Medical - Federal
  • N13 - Modified Adjusted Gross Income (MAGI) - Children's Health Insurance Program (CHIP)

Medically Needy (MN) medical provides slightly less medical coverage than CN medical.  Examples of MN medical programs:

  • F99 - Children's MN Program with Spenddown
  • L95 - MN LTC or Hospice with no Spenddown
  • L99 - MN LTC in a Medical Facility with Spenddown
  • S95 - MN SSI Related Medical with no Spenddown
  • S99 - MN SSI Related Medical with Spenddown
EXAMPLE: A client applies for medical for their child. The system looks at the client’s income to determine eligibility for N11 medical first. If eligible, the system approves the household for N11 medical. If not, then system reviews medical eligibility for N13 medical and then MN medical.

What are tracks?

Tracks are the different types of medical coverage groups, such as:

  • S - SSI recipient or Categorically Related to SSI
  • P - Pregnancy
  • L - Long Term Care (LTC) SSI Related
  • N - Modified Adjusted Gross Income (MAGI)

Each category of assistance has a separate track. In most situations, an Assistance Unit (AU) only trickles within the same track. For a list of program codes and types, see ACES Manual - Program Codes chapter.

What happens when an Assistance Unit (AU) trickles?

When an AU trickles, it stays in the same track and retain the same AU number.

EXAMPLE: When a Categorically Needy (CN) SSI Related Medical (S02) AU is denied or closed due to excess income, ACES trickles the medical coverage to Medically Needy (MN) SSI Related Medical with Spenddown (S99) using the same AU number.

What happens when an Assistance Unit (AU) spawns?

Spawning is when a client active on a lower priority medical coverage becomes eligible for a higher priority coverage. Spawned AUs stay in the same track and retain the same AU number.

EXAMPLE: Mom is receiving N13 - Modified Adjusted Gross Income (MAGI) - Children's Health Insurance Program (CHIP) medical for her two children and is paying a monthly premium. During her review, she reports that her income has decreased. When eligibility is recalculated, the N13 AU with a monthly premium spawns to a N11 - MAGI - Children's Medical - Federal AU with no monthly premium using the same AU number.

When does an Assistance Unit (AU) trickle or spawn?

Trickles and spawns occur when ACES starts with one program and/or medical coverage group, then after eligibility runs, determines the AU is eligible for a different assistance type.

Can clients trickle between Long-Term Care (LTC) coverage groups?

Clients can trickle among all the L-Track medical coverage groups when any or all of the following changes occur: 

  • Client gains or loses Supplemental Security Income (SSI).
  • Client switches between Home, Alternate Living Facility (ALF) or Medical Facility Settings.
  • Client is approved for and/or discharged from one or more Home and Community Based Services or Waiver Services.
  • Client's countable income increases or decreases.
  • Client's resources change.

What if an Assistance Unit (AU) is not eligible for a specific medical coverage group?

If an AU is not eligible for a specific medical coverage group, ACES trickles through the entire track looking for a program for which it is eligible. If ACES finds one, the AU is approved; if not, the AU is denied or closed. For a list of programs that trickle or spawn see ACES Manual - Results of Trickle and Spawn Charts chapter.

When does an Assistance Unit (AU) trickle outside its original track?

When the client is eligible for continued medical in a different coverage track, the AU trickles outside its original track, this process is called jumping tracks.

 

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

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