101.05.03 ACCOUNT TRANSFERS (AT’S) RECEIVED FROM THE FFM

Individuals who apply for health coverage through the FFM are assessed for Medicaid and CHIP eligibility and health coverage through the FFM. If some or all household members appear to be Medicaid or CHIP eligible, the electronic accounts for those household members are transferred to DOM. If some or all household members are not eligible for Medicaid or CHIP but are eligible for health coverage through the FFM through a participating health insurer, those individuals are enrolled in a Qualified Health Plan (QHP) by the FFM. Individuals who are enrolled in a QHP with income between 100% - 400% of the FPL based on family size can qualify for premium credits to purchase insurance or for cost-sharing subsidies that reduce annual cost-sharing expenses of the insurance purchased through the FFM. Individuals referred for Medicaid or CHIP coverage are first evaluated by the system to determine the following: • If there is sufficient information on the AT file to identify household members and confirm that applying household members are not currently eligible in any active case, the case is auto registered in the system as a pending application. Sufficient information includes an SSN for all applying. • When an AT is received on a non-qualified non-citizen, determine if individual has received an emergency medical service in the application month or prior three months. The FFM assesses the individual for eligibility but not for an emergency service. • If a household member or entire case is closed in the system, the individual or case will have an application contact opened so that an application can be processed for the applying household members. • If an AT lacks sufficient identifying information to auto-register an application or redetermination contact, the AT defaults to a pdf document on Report RJ564. This report is used by the regional office to register the application in the system and is loaded into the electronic record in MEDS. The regional office assigned the AT will complete the application in the same manner as an application received by DOM.