Working Healthy Premiums

 

Steps to Override the Working Healthy Premium to $0

 

NOTE: Working Healthy premiums can only be increased at the:  

 

Prior Medical Request- Working Healthy Premium Increases

For Working Healthy, to allow for an increase in premium amounts between each Prior Medical month, or between the last Prior Medical month and the month of application the WKH Desk Review Run Reason should be used.

Example:

Working Healthy Application received 10/01/2019 with a Prior Medical assistance request. Consumer reports they need Prior Medical assistance for 08/2019 and 09/2019.

The amount of actual income earned in 08/2019 would give them a premium of $50, 09/2019 would give them a premium of $55, and the current month of application (10/2019) the premium would increase to $69.

EDBCs should be run in order, processing the PM month of 08/2019 first.  When EDBCs are ran for 09/2019 and 10/2019, the WKH Desk Review Run Reason should be used. This would allow for the premium to change and increase from $50, to $55, then to $69.

 

Steps to Override the Working Healthy Premium to $0

  1. Select Run EDBC from Task Navigation. The Run EDBC page displays.

  2. Choose the Month you are processing from the drop-down menu and click the Select button.

  3. Click the check box for the Medical Program you are running EDBC and click the Run EDBC button. The EDBC List page displays.

  4. Click the hyperlink for the Medical Program. The Medical EDBC Summary page displays.

  5. If the coverage looks correct, click the Override Medical Summary button on the bottom of the page. The Medical EDBC Override List page displays.

  6. Click the Override button for the Working Healthy “Pass” budget you wish to override. The Medical EDBC Override Detail page displays.

  7. Enter $0.00 in the Premium/LTC Liability/Spenddown field.

  8. Enter a Start Date using the <mm/dd/yyyy> format or click the calendar icon.

NOTE: Use the first day of the EDBC month.

  1. Enter an End Date using the <mm/dd/yyyy> format or click the calendar icon.

NOTE: Use the last day of the EDBC month.

  1. Click the Save and Return button. The Medicaid EDBC Override List page displays showing the new overridden budget at the bottom of the Medical Summary block.

  2. Select Administrative Decision from the EDBC Override Reason drop-down menu at the top of the page.

  3. Click the Save and Return button. The Medical EDBC Summary page displays.

  4. If the Medical EDBC Summary is correct, click the Accept button. The EDBC List page displays.

  5. Click the Save and Continue button. The Case Summary page displays.

  6. Send a Manual NOA since the premium amount on the EDBC was overridden.