See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
Children under the age of 19 may be eligible for N13 or N33 medical when they meet the requirements described in Apple Health eligibility manual – WAC 182-505-0210 Washington apple health - Eligibility for children.
For income standards, see Apple Health eligibility manual - WAC 182-505-0100 Washington apple health - Monthly income standards based on the federal poverty level (FPL).
When a client is active or approved under some medical coverage groups while incarcerated, they can still be eligible to receive medical assistance in a suspended status. For more information, see Suspended Medical – State Bill (SB 6430).
The certification period for N13/N33 medical is 12 months. When the child turns 19, the certification period ends even if the 12 month period is not over.
The certification may extend beyond the end of the month of the child’s 19th birthday when certain conditions exist. For more information, see Apple Health eligibility manual - WAC 182-504-0015 Washington apple health - Certification periods for categorically needy programs.
Children receiving N13 or N33 medical are required to pay premiums and enroll in managed care. For more information, see Apple Health eligibility manual - WAC 182-505-0225 Premium requirements for premium-based health care coverage under programs included in apple health for kids.
For more information on whether all N13/N33 recipients pay a monthly premium, see Apple Health eligibility manual - WAC 182-505-0225 - Premium requirements for premium-based health care coverage under programs included in apple health for kids.
Premium amounts are based on the household’s net countable income.
Premium amounts for non-citizen children who are not lawfully present qualified or nonqualified (NQ) alien children in households with income above the 200% FPL have a higher premium amount which is no greater than the average of the state-share of the per capita cost for state-funded children's health coverage.
The orders in which premiums are determined are as follows:
For more information, see Apple Health eligibility manual - WAC 182-505-0225 - Premium requirements for premium-based health care coverage under programs included in apple health for kids.
For more information on how clients pay their premiums, see Apple Health eligibility manual - WAC 182-505-0225 - Premium requirements for premium-based health care coverage under programs included in apple health for kids.
A "Locked-In" premium tier is the lowest tier level that a child active on N13 (MAGI - CHIP Federal) or N33 (MAGI - CHIP State) is eligible for during the child’s Continuous Eligibility tracking period.
Premium tier information displays in ACES.online on the Premium Payment Status and Premium Amount - Children's Medical pages.
To remove a "locked-in" premium tier, enter Reason Code 536 - Fail with no Tier Tracking in the Reasons field on the Assistance Unit Details page of the ongoing month to reset the "locked-in" tier level from 1 to 2.
The Premium Payment Status and Premium Amount - Children's Medical page is AUTO updated when an optional child, not exempt from premiums, is found eligible for N13 (MAGI - CHIP Federal) or N33 (MAGI - CHIP Premium) medical prior to ACES deadline.
Two days after ACES deadline, during the monthly issuance run, ACES sends an interface to Financial Services Administration (FSA) who begins billing for medical coverage received the following month. The Premium Payment Status and Premium Amount - Children's Medical page displays the household’s premium amount after FSA has successfully interface with ACES.
The amount of the premium is determined by the amount of income in the Net Income field in the Net Income section on the Eligibility Details page.
A household’s premium amount and any delinquent payment information can be viewed on the Premium Payment Status and Premium Amount - Children's Medical page.
The Premium Payment Status and Premium Amount - Children's Medical page is not benefit-month driven. The page displays the latest premium that the Head of Household must pay per month.
If the N13 (MAGI - CHIP Federal) or N33 (MAGI - CHIP State) premiums are not paid for three consecutive months, the child is disenrolled from the program. The family must then pay all past-due premiums before the child can be re-enrolled.
When notification is received from Financial Services Administration (FSA) that a household has delinquent premiums, the following actions take place:
When notification is received from the Financial Services Administration (FSA) interface that a delinquent premium amount has been paid in full, the following automated process occurs for all N13 (MAGI - CHIP Federal) and N33 (MAGI - CHIP State) Assistance Units (AUs):
Premium tier information displays in the OP field on the STAT and ELIG screens, and on the CTCN screen in the Prem Tier Level field.
The PREM screen is AUTO updated when an optional child, not exempt from premiums, is found eligible for N13 (MAGI - CHIP Federal) or N33 (MAGI - CHIP Premium) medical prior to ACES deadline.
Two days after ACES deadline, during the monthly issuance run, ACES sends an interface to Financial Services Administration (FSA) who begins billing for medical coverage received the following month. After FSA has successfully interfaced with ACES, the PREM screen displays the household’s premium amount.
The amount of the premium is determined by the amount of income in the Net Income field on the MAFI screen.
A household’s premium amount and any delinquent payment information can be viewed on the PREM screen. You can also find the PREM information by selecting <F20> from the MAFI screen.
The PREM screen is not benefit-month driven. The PREM screen displays the latest premium that the Head of Household must pay per month. Historical data can be viewed by using the As Of Date field on the AMEN screen, Option B - AU/Client Inquiry.
If the N13 (MAGI - CHIP Federal) or N33 (MAGI - CHIP State) premiums are not paid for three consecutive months, the child is disenrolled from the program. The family must then pay all past due premiums before the child can be re-enrolled.
When notification is received from Financial Services Administration (FSA) that a household has delinquent premiums, the following actions take place:
When notification is received from the Financial Services Administration (FSA) interface that a delinquent premium amount has been paid in full, the following automated process occurs for all N13 (MAGI - CHIP Federal) and N33 (MAGI - CHIP State) Assistance Units (AUs):
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.