Adding Medically Needy to an MSP Only Program

MSP consumer requested Medically Needy (w/ 3 months prior option)

If the consumer has made a new request and would like prior medical coverage we would not add these as Retro Months. The section for Retro Months is only for the 3 months prior to the initial application month.  Retro Months are only added for initial application and would not be added for individuals with existing coverage that is changing.

These steps should produce correct EDBC results. If you do not get correct results, do not accept the EDBC and contact the help desk.

First—make sure all consumer records are correct/current for the income & resources.

1. Add an RMT of Medical effective the first month the consumer needs the spenddown

   • If processing Prior Medical this is 3 months prior to the request being made.

   • If no Prior Medical is requested this is the month the request for Medically Needy spenddown is made.

   • The RMT of MSP automatically end dates the month prior to the Medical start month.

2. The 6 month base period from the month of request MUST be set first for the Prior Medical base to calculate correctly.  Run EDBC for the month of request with a Timely Notice Exception of Waiver on File.

   • This sets the 6 month spenddown base period beginning the month the request for spenddown was made.

   • This must be done first before doing a prior base period.

   • Run EDBC for each month in order through the come-up month using a Timely Notice Exception of Waiver on File.

   • Check the base period for each month you run EDBC to make sure the base period is calculated with the correct dates. You can view the base period by selecting the Medically Needy hyperlink on the Medical EDBC Summary page (This is done to make sure the base holds for each month and that the EDBC months are run in order).

3. Once the current base period is set, if Prior Medical is needed THEN

   • Run EDBC for the first Prior Medical Month with a Timely Notice Exception Reason of Waiver on File. (the rules stop the base when the new current spenddown base period starts—this creates a three month base period).

   • Run EDBC for the second Prior Medical Month with a Timely Notice Exception Reason of Waiver on File.

   • Run EDBC for the third Prior Medical Month with a Timely Notice Exception Reason of Waiver on File.