Approving LTC Coverage in the Same Month Penalty Ends

 

If approving a case for LTC coverage in the same month the Transfer of Property penalty has ended, the user needs to override EDBC to adjust the LTC payment start date. If the user does not adjust the LTC payment start date, the consumer receives LTC coverage for the entire month.

NOTE: The user needs to end date the Non-Compliance penalty record to the last day of the month prior to the month requiring Medicaid approval. Once the case has been approved, the user should re-enter the correct end date of the Non-Compliance record.

Complete the following:

  1. Complete Non-Financial Data Collection and Financial Data Collection pages.

  2. Run EDBC. See Running EDBC for detailed steps.

  3. Click the Medical hyperlink from the EDBC List page. The Medical EDBC Summary page displays.

  4. Click the Override Medical Summary button. The Medical EDBC Override List page displays.

  5. Click the Override button for the Medically Needy Test Budget. The Medical EDBC Override Detail page displays.

  6. On the Medical EDBC Override Detail page:

    1. In the LTC Details section select the box next to the name of the consumer and select the Edit button.

    2. Enter the day after the penalty ends in the Living Arrangement/Level of Care Start Date field using the <mm/dd/yyyy> format or the calendar icon.

    3. Enter the last day of the Start Date month in the Living Arrangement/Level of Care End Date field using the <mm/dd/yyyy> format or the calendar icon.

    4. Select Save and Return.

  7. On the Medical EDBC Override Detail page:

    1. In the User Override section Select Pass from the Test Results drop-down menu.

    2. Enter the day after the penalty ends in the Start Date field using <mm/dd/yyyy> format or the calender icon.

    3. Enter the last day of the Start Date month in the End Date field using <mm/dd/yyyy> format or the calender icon.

    4. Select the value from the Aid Code drop-down menu if a value is not already listed.

  8. Select Administrative Decision from the EDBC Override Reason drop-down menu.

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

  10. Click the Accept button. The EDBC List page displays.

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

NOTE: See Manual NOA Generation for detailed steps on sending a notice.