Policy states that in order to qualify for Working Healthy-Medically Improved coverage, individuals must work at least 40 hours per month. KEES rules are incorrectly issuing Working Healthy-Medically Improved coverage only to individuals who work 40 hours per week instead of 40 hours per month. As a result, consumers who work at least 40 hours per month but less than 40 hours per week may be incorrectly denied for Working Healthy- Medically Improved coverage.
In this situation, workers are to use the override below:
NOTE: Step one assumes the user has entered all information necessary for EDBC to be run on the case.
From the Medical Condition List page: Do not end date the most recent Medical Condition record for the customer. Leave this high dated.
Add another Active Medical Condition Category record with appropriate Medical Condition Type of Medically Improved-Disabled or Medically Improved-Blind with current begin date. Leave this high-dated.
Run EDBC for the appropriate month. Working Healthy will pass showing WKH/RD/N/N.
From the Medical EDBC Summary page: Click Override Medical Summary.
On Medical EDBC Override List page: Click Override next to the working Healthy budget.
On Medical EDBC Override Detail page: Under Aid Code: Change the Working Healthy-Disabled/Blind Aid Code to the appropriate Working Healthy-Improved-Disabled or Working Healthy-Improved-Blind Aid Code.
Add benefit month Start Date and End Date. Click Save and Return.
On Medical EDBC Override List page: Click the box next to the correct overridden Working Healthy budget. Under EDBC Override Reason, select Administration Decision. Click Save and Return.
The Overridden aid code will display on Medicaid EDBC Summary page. Click Accept.
On EDBC List page: Click Save and Continue.
NOTE: If an individual has a Temporary Unemployment Plan (TUP) and qualifies for Medically Improved, follow Authorizing Benefits with a Temporary Unemployment Plan first. Once this is in place, follow the Working Healthy Medically Improved Override Process. This override process is needed when a TUP is used in conjunction with Medically Improved even if the individual works more than 40 hours a week.