WIC Eligibility Road to Success - events.mphi.org · WIC Eligibility ‐Road to Success 2 Policies...

WIC Eligibility ‐ Road to Success

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WIC Income Eligibility

2017/2018Presenter: Heather Kahn, MS, RD

PurposeThe purpose of this training is to review USDA WIC policies and procedures determining WIC eligibility for income, residency & identity.A Medicaid review will be presented, as well.

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Agenda

1. Policies to be updated2. Medicaid Review3. How do we Determine

WIC Eligibility?4. Examples5. Questions

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Policies soon to be updatedonce approved by USDA

1. Policy 2.02 Residency & 2.03 IdentityUpdated references: Policy 3.04 Transfers

2. Policy 2.04 Income EligibilitySimplified content & LanguageOrganized & grouped related informationUpdated references & websites

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POLICY UPDATE cont…

3. Policy 2.06: Adjunct Income Eligibility

Content Change: Incorporated MICHILD under the list of Adjunctive eligibility since now it is under the umbrella of Medicaid in Michigan.

Simplified content & Language

Organized & grouped related information

Updated references & websites

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POLICY UPDATE cont…

4. Policy 2.12: MigrantAdded the definition of a Migrant Farm Worker at the beginning of policy

DEFINITION: Migrant farmworker - An individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes, for the purposes of such employment, a temporary abode.

Edited Language

Updated References

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Medicaid ReviewHow do

Medicaid Programs Differ from Each Other?

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MEDICAID: MA

100% FPL or Federal Poverty Level BENEFIT PLAN ID: MA PLAN NAME:

“Full Fee-For-Service Medicaid”

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MEDICAID Plan DescriptionMembers are generally assigned to thisbenefit plan upon approval of theireligibility information & remain activeeven if eventually assigned to Medicaid Managed Care [MA-MC].

Once assigned to a Managed Care Organization, the health plan is the primary payer.

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APS: Ambulatory Prenatal ServicesThis program provides presumptiveeligibility for pregnant women limited toambulatory prenatal care services only.Covered services include physician visits forprenatal care, prescription drugs related topregnancy, and prenatal laboratory tests.

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HMP: Healthy Michigan Plan

133% FPL Benefit Plan ID: MA-HMP Adults: 19-64 years

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HMP DescriptionThis plan provides health care benefits toadults 19 through 64 years of age, notcovered by or eligible for Medicaid, withfamily incomes at or below 133% of thefederal poverty level (FPL) & who are noteligible for or enrolled in Medicare.Eligibility is determined through theModified Adjusted Gross Income (MAGI)methodology.

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Modified Adjusted Gross IncomeGenerally, your Modified Adjusted Gross Income (MAGI) is the total of your household's Adjusted Gross Income plus any tax-exempt interest income you may have.

It does not include assets.

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CHIP: Children’s Health Insurance Program

Provides health coverage to eligible children, through both Medicaid & separate CHIP programs.

Administered by states, according to federal requirements.

Funded jointly by states and the federal government.

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HK-EXP: Healthy Kids Expansion

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Full Fee-for-Service Healthy Kids Expansion 160% FPL Children under age 19 Funded by Children’s Health Insurance

Program (CHIP) Revised 7/1/2016


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MOMS: Maternity Outpatient Medical Services

195% FPL Immediate health care For PG Provides immediate health coverage for the

unborn child of an undocumented pregnant woman

Can be used during a Medicaid pending application

Must use Medicaid once it becomes available Also for non-citizens Can cover Entire Pregnancy & 2 Calendar Months

after pregnancy ends.

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MA-MICHILD (CHIP) CHILDREN UNDER AGE 19 212 % MAGI $10 monthly premium fee Non-emergency Transportation (NEMT) Under Medicaid Umbrella:

makes clients adjunctively eligible for WIC

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ESO: Emergency Services OnlyClients who do not meet citizenship requirements, but may be eligible for Emergency Services Only (ESO).

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ESO: Emergency Services OnlyHMP-ESO: HEALTHY MI PLAN-ESOHK-EXP-ESO: HEALTHY KIDS-ESOMA-ESO: MEDICAID-ESOMICHILD-ESO: MICHILD-ESO

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SSI: Supplemental Security Income

Cash benefit to low income adults who are Aged, Disabled or Blind

Automatically eligible for Medicaid Contact Social Security Administration

(SSA) for Application. https://www.ssa.gov/onlineservices/

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Other Assistance Programs:SNAP (Food Stamps) & FIP/ Cash Assistance

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SNAP: Supplemental Nutrition Assistance Program

Free nutrition education & physical activity promotion program

Funding: USDA & FNS Who: children, youth, and adults

In Michigan, SNAP is also referred to as the Food Assistance Program (FAP).

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SNAP: Where Education is provided: child care

sites, pre-schools, schools, summer meal sites, worksites, faith faith-based organizations, senior centers, farmer's markets, retail food stores, and emergency food distribution sites.

MDHHS partners with:Michigan Fitness Foundation (MFF) Michigan State University Extension (MSUE).

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SNAP: Most FAP interviews are held by telephone. However, you may request an in-person

interview. If you are also re-applying for cash assistance,

you may be scheduled for an in-person interview.

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FIP: FAMILY INDEPENDENCE PROGRAM

o Provides FINANCIAL ASSISTANCE to families with children (Cash Assistance).

o Helps maintain and strengthen family life for children and the parent(s) or other caretaker(s) with whom they are living, and to help the family attain or retain capability for maximum self support & personal independence

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Cash Assistance: Who Qualifies Children must be a part of your family and meet age

requirements: under 18 or 18 years old & attending high school

The family or legal guardians of that child are also evaluated as part of the eligibility process.

Pregnant women

Parents of a child in foster care who is expected to return home within one year

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Tools to Verify Adjunctive Eligibility

1. CHAMPS: Medicaid - MILogin2. BRIDGES: Medicaid, FAP, FIP

https://www.mibridges.michigan.gov3. Healthcare4mi.gov: Medicaid4. Mihealth:

https://healthplanbenefits.mihealth.org

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USING CHAMPSCommunity Health Automated

Medicaid Processing System

Is Medicaid Current?

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CHAMPS Search Methods Member ID/CIN (client Identification #)/

RID (Pending Eligibility Recipient ID)If only 8 #s, Add 2 ZEROES before Medicaid # (00-MA ID)

Last name, first name, DOB Last name, first name, SSN

(Social Security #) SSN & DOB

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CHAMPS: Client SEARCH

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Member ID & First Name(Name change: client married/divorced)

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MA-MC: MEDICAID MANAGED CARE

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Medicaid EXPIRES: 12/31/299935

For more client info:SELECT “SHOW”

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SELECT“MEMBER DISPLAY BASE”

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Provides updated address for client

Upon Medicaid Approval, CHAMPS provides a “mihealth card”

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The mihealth card("myhealth") isa permanent plastic health ID card.

Beneficiaries with Michigan Medicaidincluding Emergency Medicaid), CSHCS, MIChild& Healthy Michigan Plan (HMP) coverage will get a mihealth card.

Benefits Approved The mihealth card is mailed to new

beneficiaries when benefits are approved.

Upon Medicaid renewal, beneficiaries that already have a card will not receive a new card.

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Upon Medicaid approval, a health plan is chosen & will vary by county

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Health Plan Guidelines Enrollment period usually covers

12 consecutive months. Health plans can be changed within 90 days after

joining or during open enrollment in May of each year, unless you live in a "rural exception county."

Call Michigan ENROLLS at 1-888-367-6557to make changes.

If you voluntarily join a health plan you can change plans or dis-enroll at anytime.

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Health Plan ID Card Will also be mailed Name of health plan Primary Care Provider (PCP) PCP's phone #

AND:

Member handbook Questions about Medicaid health plans, call

Michigan ENROLLS at 1-888-367-6557or 800-975-7630.

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RESOURCE INFORMATION

1. Current beneficiaries can find out which health plan they are enrolled in by calling the BeneficiairyHelp Line at 800-642-3195 (TTY 866-501-5656).

2. OR, Log into their myHealth Portal account online at www.michigan.gov/myhealthportal.

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Lost Card Call the Beneficiary Help Line at 1-800-642-3195

to request a card replacement

Or request a replacement card using the myHealthButton (app for cell phones) ormyHealthPortalwww.michigan.gov/myHealthPortal

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Health Care Phone # Resources

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HOW TO APPLY for Assistance programs:https://www.mibridges.michigan.gov/access/

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MIBridges includes Applications for: Health Care Coverage Food Assistance Cash Assistance Child Care Emergency Services

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Paper Application

DCH-1426Application for Health Coverage & Help Paying Costs, is the paper application

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Healthcare4mi.com

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FAP & FIP: Call for Eligibility(Benefits are on same EBT card)

Dial 888-678-8914

WITH PROMPTS:

1. Select #1 for English

2. Select #1 for Food or Cash assistance(#2 for WIC)

-enter 16 digit account Number:

(5077-1100-####-####)

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FAP & FIP: Call for Eligibility cont…(Benefits are on same EBT card)

3. System provides food stamp cash amount &Cash assistance amount available on card.

4. Select choice #5: provides last 10 transactions:

-Provides purchase information in the cash amount

-Provides “Load” amount in cash value on a specific date

(must be within the past 30 days).

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FYI: FAP and FIPEBT Food Benefit Issue schedule:

http://www.michigan.gov/documents/dhs/Benefit_Issuance_Dates_January_through_November_2011_and_Ongoing_Final_343053_7.pdf

CASH Assistance Payment Schedule:

http://www.michigan.gov/documents/dhs/DHS-1111_262016_7_382139_7.pdf

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MI-WIC Policy 2.0 Eligibility/Certification

Eligibility determination consists of… Income eligibility and verification –

Policy 2.01, 2.04, 2.05, 2.06, 2.08 Adjunct program reporting- Policy 2.06 Identify verification- Policy 2.03

Authorized Person Client

Residency verification- Policy 2.02

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2.0 Eligibility/Certification Policies

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2.0 Eligibility/Certification Policies

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2.01 Eligibility/Certification of Clients

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Clients must be PG, BF, NPP, C1-C4 or Infant

Must meet residency, income and identity requirements

2.02 Residency

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Proof of residency required at: Enrollment Each certification Transfer

Short certification if client did not bring proof: 60 days


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2.02 Residency

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Proof Allowed: Michigan ID/Driver’s license Voter registration Utility or rent/mortgage

receipt Passport/Visa Homeless shelter address Mihealth card Other records that the WIC

State Agency considers adequate to establish residency

This may include, but is not limited to:

Victim of theft, loss or disaster Homeless individual Migrant Person (transferring to Michigan) holding a

VOC card. Person who has recently moved into the

service area.

2.02 Applicants with NO PROOF of residency shall be fully certified with the completion of an Attestation Form.

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2.02 ResidencyApplicants who are unable to provide proof of residency during the initial enrollment onto the WIC program shall be required to provide proof at the next certification.

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How To Locate Attestation Form:

CLINIC MODULE:

Miscellaneous =>

Signature New

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2.03 Identity

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Proof required:

For NEW clients & Authorized Personsat initial enrollment

For transfers from Out of State & Overseas Visual personal recognition by WIC staff at

issuance of benefits or subsequent certifications is allowed once initial proof of identity has been established.

Identity Proof66

Hospital Record/Crib Card Health Insurance Identification Social Security Card Photo Identification Driver’s License Student Identification Card State Identification Card Work Identification Card Pay Stubs Voter Registration Card Mihealth card Michigan WIC Bridge Card WIC/WIC Overseas records

from other states/jurisdictions

Left Proof at Home… Short cert 60 days to bring in

proof Schedule next visit

within 60 days Immunization Record Birth Certificate


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2.03 Applicants with NO PROOF of identity shall be fully certified with the completion of an Attestation Form.

This may include, but is not limited to:

Victim of theft, loss or disaster Homeless individual Migrant

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2.03 Identity

Applicants who are unable to provide proof of identity during the initial enrollment onto the WIC program shall be required to provide proof at the next certification.

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2.04 Income DeterminationMaximum allowable is 185% of poverty unless…

Adjunctively eligible

Migrant, homeless or works for cash(Does not have verification/Proof) (No Proof of Income Attestation form)(ie. Has income, but cannot prove)

NO income (Client Agreement)-Policy 2.07(Has absolutely NO INCOME)

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2.04 Income Rules If client HAS proof of income, but did not bring it

to cert/recert appointment • SHORT CERT: 30 days of benefits

Migrant families have income determined every 12 months

IEVAL/CEVAL DO NOT evaluate income, Unless other family member is certified

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Definition of Income

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Income means gross cash income before deductions for income tax, social security, insurance premiums, etc.

Includes OVERTIME PAY If self-employed or farm

income, net income is used for eligibility determination: 1040

Policy 2.04 Income Determination

Ways to Calculate Income…

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Current: The family’s current (past 30 days) rate of income

30 days worth of pay stubs: weekly, bi-weekly, semi-monthly, or monthly


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Annual: Families who qualify for this category include but are not limited to

Construction workers Farmers Seasonal agricultural farmworkers Self-employed persons Persons on extended leave

due to illness or childbirth. Income over the past twelve months (can use

“year to date income” annualized) Income as stated on the most current IRS 1040

tax form filed

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Temporary Low Income: Income for the NEXT 30 DAYS Income that is below a family’s normal level due

to infrequency or irregularity of employment (income available to the family in the NEXT 30 days), ie. Laid off

Families who qualify for this category include but are not limited to

Workers on strike Temporary or seasonal workers Unemployed workers

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Year to Date Income (YTD) Check stub has Year to date information MI-WIC feature calculates YTD based on

date of check stub and total amount YTD Will provide an annual income to be

entered into system.

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2.04 Income Sources Wages (including overtime), salary,

commissions, tribal “per capita” payments, can be electronic pay stub

Military Pay (see 2.04A) Net income from Farm or Self

Employment (IRS 1040 schedule F, C) Social Security benefits (SSI) Dividends, interest on savings or bonds,

income from trusts or real estate

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2.04 Income Sources cont… Public Assistance

DO NOT INCLUDE Food Stamp/SNAP benefits Government civilian or military retirement,

pensions or veterans’ payments Pensions or annuities Alimony or child support payments Regular contributions from persons not living in the

household Net royalties Other CASH income-can be on a regular basis

(baby sitting) or one-time (lottery winnings)

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2.04A Military Pay What DOES count:

Base pay Basic Allowance for Subsistence (BAS) Foreign Language Pay (FLPP) Family Separation Allowance (FSA) Jump Pay, Dive Pay, Sea Pay, Flight Pay Continental United States Cost of Living Allowance

(CONUS COLA) Allowed to Income Average over the year:

Clothing Maintenance Allowance (CMA) Bonus Pay (Bonus) Special Pay

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Military Pay: What DOES NOT count: Basic Allowance for Housing

(BAH or BAQ) Family Separation Housing (FSH) Family Subsistence Supplemental Allowance (FSSA) Overseas Housing Allowance (OHA) Overseas Continental United States Cost of Living

Allowance (OCONUS COLA or COLA) Combat Duty or Combat Zone Pay

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2.04 Income Exclusions The value of in-kind housing and other in-kind

benefits. Loans Payments or benefits from

Federal Programs or Acts:- See list 14e i-xxxv (page 4-7)- ie. VISTA, Foster grandparents payments,

Payments through Job training Partnership Act.

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2.04 Income Exclusions cont… School lunch benefits/child care feeding

programs Payments from Low Income Home Energy

Assistance Act Student financial assistance funded by Title IV,

including Pell grants… Value of child care payments under the Child

Care and Development Block Grant National Flood Insurance payments

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2.05 Income Guidelines

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MI-WIC POP UP

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2.06 Adjunct Income EligibilityMedicaid:

Healthy Kid’s Program Healthy Michigan Plan (HMP)MICHILD

MOMS/Presumptive Eligibility FIP (Cash Assistance)

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2.06 Member of a family that: Receives SNAP (Food Stamps) Receives FIP (Family Independence Program) Includes a Pregnant Woman

or Infant receiving Medicaid:

Will Make ENTIRE FAMILY Adjunctively Eligible.

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Upon approval of adjunct income eligibility,

applicants can verbally declare

their income.

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When do I verify Income?Income Determination Certification Recertification

No Income Determination Infant Evaluation Child Evaluation Transfer with current VOC

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No Proof of Income…

No proof brought to certification, but available

Short cert Document “no proof of income” on the

income verification screen 30 day certification, bring proof at next visit

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HAS INCOME, but NO PROOF

Works for CASH Attestation form required unless

adjunctively eligible Full certification period Migrant, Works for cash, Homeless

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cAshAttestation Form

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Attestation Form: No proof of income (paid in cash)

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NO INCOME whatsoever

Declaration of No Income Client Agreement Staff must ask client questions from

“no income pop-up screen” To determine if member of another

household Make needed referrals Homeless

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NO INCOME: Client Agreement

By signing this form I also understand and agree:

The information I have given to the WIC Program is TRUE. WIC staff may check any of this information.

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2.07 Declaration of NO INCOME

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Client states they have NO INCOME

Source = no income FURTHER screening Describe how they are

supported with food, shelter, medical care…

Proofs -How Do I Know What I Need to Do?

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2.08 Family Size

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Special Considerations Resident of Institution or

group home Family living in homeless

shelter, group residence Foster child: Family of one

Income eligibility based on Total Family Size

Include: Unborn child(ren) Adopted child(ren) Deployed Husband


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Pregnant woman & Expected # infants

Pregnant woman

Family size counts EXPECTED # of INFANTS

Woman pregnant with twins…

Pregnant woman 1Twins 2Family size 3

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Policy 2.08 Definition of Family…“A group of related or nonrelated individuals who are living together as ONE ECONOMIC UNIT (except that residents of a homeless facility or an institution are not considered as members of a single family).”

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Family or Household SizeWIC Policy 2.08

Family members share income, goods & services

More than one family can live in a house=> Shares apartment with sister, pays rent,

has own income Must have its own source of income

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2.11 Foster Child Eligibility

ONE PERSON FAMILY where DHHS is legally responsible for child

Payments made by DHHS or from any other source for the care of the foster childshall be considered the income for the child.

If adopted, the child becomes & is counted as a member of the family and WIC eligibility shall be based on the income of the adoptive family.

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2.11 Foster Child Eligibility

If custody changes, VOID Foster child’s benefits

Do Not Terminate Foster Child

Child will still be able to transfer to another family & receive benefits without having to

be recertified

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Foster child income processP-Cert Screen: Check Foster

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Income Tab: Select Foster Child & hit GO

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Enter rest of income data105


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Client Info Screen:106

2.12 Migrant FarmworkerAn individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes, for the purposes of such employment, a temporary abode.

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2.12 Migrant Family Eligibility

Designate as migrant upon enrollment, verify migrant status at each certification

Give Priority appointments (within 10 days)

Do not need proof of ID or residency –Sign no proof of ID or Residency Attestation Form

Income completed every 12 months

Self-declaration allowed-No Proof of Income Attestation form

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2.12 Migrant Family Eligibility

VOC/Verification of Certification

Accept VOC for migrant family

Income eligible if verified in last 12 months

Provide VOC to migrant families so they have proof of WIC enrollment

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2.17 Certification Periods PG: Estimated date of delivery + 42 days

BF: one year past delivery date

NPP: 6 months past delivery or pregnancy end date

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2.17 Certification Periods Infants under 6 months of age:

one year past birth date

Infants 6 months of age & over shall be certified at the time of entrance into the Program for six (6) months.

C1-C4: 12 months past certification date

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2.17 Certification PeriodsTime Variations for Recertification

of Infants and Children:

In cases where there is difficulty in appointment scheduling due to illness or to synchronize

appointments with other family members, a time variation of +/- 30 days from the certification due

date is permissible.

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2.18 Notification of Client Rights and Responsibilities The Michigan WIC Client Agreement

shall be used to inform clients/authorized persons of their WIC Program rights and responsibilities.

Read by or read to the client/authorized person at each cert/recert in an appropriate language

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2.18 Notification of Client Rights and Responsibilities Sign & date the Client Agreement At each cert/recert When Authorized person changes When client transfers into Michigan

Copy of Client Agreement• At initial certification• Upon request at other certification/recerts

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2.19 Verification of Certification (VOC)

The local agency shall issue a VOC to each client participating in the WIC Program.

The VOC shall be issued to the authorized person at the time of each certification.

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2.19 Verification of Certification (VOC)

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Must have Signature & printed name of Local Agency Official

2.20 Ineligibility Notices Written notice is required when client is:

Ineligible at certification

Terminated at mid-cert for income ineligibility

Sanctioned, suspended or disqualified

BF woman who discontinues breastfeeding after 6 months

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2.20 Ineligibility Notices Written notification of ineligibility shall contain the following: Date of notice Client’s name Reason for ineligibility Client’s right to a fair hearing

Note: Automatically prints when Ineligibility Notice is printed

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2.20 NE: Nutrition Education Plan

Issuance of the NE Plan provides notification of the end of certification for each client/parent/caretaker.

Notification of Right to Fair Hearing IS NOT REQUIRED.

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2.21 Mid-Cert Income Determination Mid-certification income reassessment must be

done when a local agency receivesinformation that a client’s income or family size has changed.

If less than 90 days are left within the existing certification period, no redetermination of income eligibility is needed.

If more than 90 days are left in the existing certification period, determine current income based on the income documentation provided

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2.21: Mid-Cert Income Determination If the client’s income is determined to be over

income and the client/family does not have adjunct eligibility, the client/family shall be terminated with 15 days notice and benefits shall be issued during that period.

If client is no longer eligible, use the term reason of No Longer Eligible to end the certification period in MI-WIC.

Remember to give the client a notice of ineligibility.

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Special Cases Is a Deployed Husband counted in family size?

Yes

Parent is paying child support and is applying for WIC. Are they allowed to exclude their child support payments from their Gross Income?

No

Mom receives child support. Must mom count child support in her income?

Yes

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FAQ:Are they allowed to use “NO INCOME” AGAINif they had stated NO INCOME for their last certification period?

Currently, there is no Federal Guidance for this situation

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Answer:Questions to Assess current income status:

o How have they been able to support themselves & their family over the past year?

o If they are not on Medicaid, why or why not?

o Are they participating in any other MDHHS programs?

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Guidance Technically they could declare

NO INCOME again.

Be sure they understand the Client Agreement & consequences of fraud.

MI-WIC Policy 2.07 Declaration of No Income

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WIC Policy Manual

Michigan.gov/WIC• WIC Providers• Michigan MI-WIC Policy Manual

WIC DuJour 1-800-WIC-1636 then…• Press 1 and 1 (MI-WIC)• Press 1 and 2 (Policy)

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MEDICAID

MEDICAID PROVIDER MANUAL

http://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidProviderManual.pdf

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Thank you!

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Heather Kahn, MS, RDEligibility Program Area Lead

(517) 335-9694

Local Agency Questions…

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WIC Eligibility Road to Success - events.mphi.org · WIC Eligibility ‐Road to Success 2 Policies...

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