Child Care Subsidy: Copay; To Exempt, or not to Exempt

The family share copayment is assigned to one provider per case. When more than one provider is used by the family, the worker determines which provider gives the most costly care to the family. The worker uses the current Appendix C-4-B, Child Care Provider Rate Schedule, to determine the daily rate for each child based on the child’s service plan. The worker adds the monthly cost of care per child and then per provider. The worker assigns the family share copayment to the provider giving the care that result in highest total cost.

  • The worker chooses N for non-exempt in the “copay exempt” field K78 of the Auth. Daycare tab for each authorization approved for the provider giving the most costly care to the family.
  • For all other providers, the worker chooses S for second provider in field K78 “co-pay exempt.”
  • The system maps the entire family share copayment to each child’s authorization where the “copay exempt” field is marked N and maps a zero copayment to each authorization marked S in the “copay exempt.”
  • The authorization(s) for the non-exempt provider must be open on the system without edits before the worker enters the authorization(s) for the provider exempted from copay. When the worker tries to enter both authorizations at the same time, the authorization coded S in K78 edits as it cannot find the open authorization for another provider.

Example:

Thelma requests child care for her 7 year old son Barney and her 3 year old son Andy. She works Monday through Friday 8:00 am to 5:00 pm, and she does not have off on school holidays. Thelma has provided all verification and she will qualify for the Blended 23 rate for Barney and Weekly 5 for Andy. Thelma tells the worker that she wants her children to go to different providers as there are not openings for both children at the same center. Thelma is requesting that Barney attend Mayberry West Kids Care and that Andy go to Mayberry North Kids Care. Thelma will let worker know if she moves either of her children to another provider.

As the children are attending different centers, one of the facilities will be copay exempt. To determine which facility will be exempt, the worker will need to consult appendix C-4-B to determine this, and then assign the copay to the provider that is providing the most costly care. In this situation, the care would be assigned to Mayberry North Kids Care as it is more costly to provide care for Andy at a rate of Weekly 5. The line for Barney at Mayberry West Kids Care will need to be coded as a second provider (S) in the K78 field.

Coding the Case with a 2nd Provider as Co-pay Exempt

Open the “Child Care” Tab (Eligibility Notebook)

  • Action Type: OPEN
  • Reason – Leave Blank
  • Request Date – DATE SERVICES REQUESTED
  • Certification Date – DATE ALL REQUIRED VERIFICATION RECEIVED
  • Effective Date – Skip this field on an ‘Open Action’
  • Date of Last Review – DATE ALL REQUIRED VERIFICATION RECEIVED
  • Effective Months – 99 (Re-send if completed)
  • Number of Children Receiving Child Care – 02 (Re-send if completed)
  • Diverted Income – Leave Blank
  • Court Ordered Child Care – Leave Blank
  • Family Co-Pay – Computer Entered
  • Child Support – Leave Blank (unless household has child support expense)
  • TCC End Date – Leave Blank

Code the first authorization as “N-not co-pay exempt”.

This is the authorization of the child care facility that requires the most cost. In this example, it is more costly to provide child care for Barney receiving Weekly 5 units of Child Care at Mayberry West Kids Care.

Open the “Auth Day Care Tab” (Eligibility Notebook).

  • Person Name: Select Child (In this example, Barney is selected)
  • Contract Number – In this example, 28736
  • Type of Care – Computer Entered
  • Action Taken – OPEN
  • Reason – In this example, FOR CARETAKER TO RETAIN EMPLOYMENT
  • Child Care Request Date – DATE SERVICES WERE REQUESTED
  • Begin/Change Date – DATE ALL REQUIRED VERIFICATION RECEIVED OR DATE CHILD CARE SERVICES WILL BEGIN
  • Co-Payment and Co-Payment Eff. Date – Computer Entered
  • Review Date – Computer Entered
  • End Date – Leave Blank
  • Unit Type – In this example, Weekly
  • Number of Units – In this example, 5 DAYS PER WEEK
  • Notice Indicator – Application Approval

SAVE THE CASE and SEND CASE TO SUPERVISOR. Check to make sure the child care has been certified and the first authorization has cleared without any edits.

Refresh the case before entering any information.

Open the “Child Care” tab (Eligibility Notebook)

Make a change for the next effective month.

  • Action Type  – CHANGE OF INFORMATION ONLY
  • Effective Date – Enter the next effective date.

Code the next authorization with “S-second provider for this case, co-pay exempt”.

SAVE THE CASE and SEND CASE TO SUPERVISOR. Check the EKL screen to see if both authorizations have cleared without any edits.

A month later, Thelma reports that there was an opening at Barney’s child care center and that she wants to transfer Andy  to Mayberry West Kids Care the following Monday.

  • The worker will need to make a child care change for the requested date. This time, the worker will code N in K78.  

In this case you would do a provider change, closing the authorization for Andy at Mayberry North Kids Care, and opening an authorization for Andy at Mayberry West Kids Care.

Refer to article: Child Care Subsidy: Provider Change

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