Procedures for Administering the Direct Certification Medicaid Reduced Determination
Certain students may be predetermined as having reduced price eligibility due to the Direct Certification CE Matches routine which is accomplished through the POS system each month.
A reduced price status indicated by this process may be due to Medicaid and or Chip participation.
Students with such a reduced status via the Direct Certification process may also be a member of a household designated as having a free status due to income as indicated on a free and reduced application.
The Texas Department of Agriculture has initiated a new rule pertaining to households that fall into this situation in that they must submit proof of income to the various Contracting Entities so as to verify the free meal status.
To support this ruling, Systems Design has created a new letter titled “Letter to Household, Predetermined Reduced-Price Eligibility for Household and Household Application Reported Income”. This letter is available to be printed just as the other Notice of Benefit letters when the program detects that a student is designated as reduced through the DC process and there is a family application in the system with an income based free status. This new letter will be produced in English and Spanish.
Each time a Direct Certification Process is completed, the resulting Excel spreadsheet must be visually scanned to see if there are any Categorically Eligible Medicaid or CHIP Reduced students. Unlike other Directly Certified students, these students will not be changed to reduced immediately but will remain free until the income determination is made.
After the identification process of the subject students is completed , the administrator then proceeds to the application program LA 01 and searches for the application on which any Medicaid or Chip qualified student may be listed. Click here for an example of how to find the student on an application. Once an application is discovered to have a Medicaid Reduced student listed and that application indicates a free status based on income and household contact information is noted, a letter should be printed by going to LA 02 Letter of Approval of Benefits. Click here for instructions on printing the benefit letters. It is suggested to use option 3 in LA 02, print a letter to an individual household. Click here for an example of this letter.
The administrator then should then go to SM 08 01 12 to set up a user code 44 for students who may be in this category.
TDA suggests that a phone call be made to the household providing an opportunity to verify income prior to sending the letter produced. Click here for an example of how to set up a user code.
Note that individual school district’s child nutrition departments have discretion in the management of this process.
Summary of Suggested actions to be taken.
A reduced price status indicated by this process may be due to Medicaid and or Chip participation.
Students with such a reduced status via the Direct Certification process may also be a member of a household designated as having a free status due to income as indicated on a free and reduced application.
The Texas Department of Agriculture has initiated a new rule pertaining to households that fall into this situation in that they must submit proof of income to the various Contracting Entities so as to verify the free meal status.
To support this ruling, Systems Design has created a new letter titled “Letter to Household, Predetermined Reduced-Price Eligibility for Household and Household Application Reported Income”. This letter is available to be printed just as the other Notice of Benefit letters when the program detects that a student is designated as reduced through the DC process and there is a family application in the system with an income based free status. This new letter will be produced in English and Spanish.
Each time a Direct Certification Process is completed, the resulting Excel spreadsheet must be visually scanned to see if there are any Categorically Eligible Medicaid or CHIP Reduced students. Unlike other Directly Certified students, these students will not be changed to reduced immediately but will remain free until the income determination is made.
After the identification process of the subject students is completed , the administrator then proceeds to the application program LA 01 and searches for the application on which any Medicaid or Chip qualified student may be listed. Click here for an example of how to find the student on an application. Once an application is discovered to have a Medicaid Reduced student listed and that application indicates a free status based on income and household contact information is noted, a letter should be printed by going to LA 02 Letter of Approval of Benefits. Click here for instructions on printing the benefit letters. It is suggested to use option 3 in LA 02, print a letter to an individual household. Click here for an example of this letter.
The administrator then should then go to SM 08 01 12 to set up a user code 44 for students who may be in this category.
TDA suggests that a phone call be made to the household providing an opportunity to verify income prior to sending the letter produced. Click here for an example of how to set up a user code.
Note that individual school district’s child nutrition departments have discretion in the management of this process.
Summary of Suggested actions to be taken.
- Complete the DC process
- Scan visually the resulting CE Matching Excel spreadsheet for Medicaid or Chip Reduced Students
- Locate those identified students and their application numbers
- Determine if the subject application indicates a free status based on income
- Produce the benefit letters
- Set up the user code 44 in the student’s Masterfile
- Call the subject household(s)
- Determine action to be taken
- If there is no response after the designated response period it becomes verification for cause
- Send the letter produced in LA 02
- Allow the designated time for a response
- Record the results in LA 01 on the subject family’s application
- If the household does not qualify for free meals due to the reported income, all the students in
- the household will become a reduced status. The status of the students on the application will
- then be changed to reduced in their individual master files. If, however, the income as verified
- qualifies the household for a free status then all students including the student designated as
- Medicaid Reduced retain the free status.