Workarounds related to this page:
WA221 - PMD Tier 1 with Income Under the SSI Limit Receive a Medically Needy Aid Code
NOTE: When an adult household member is receiving Caretaker Medical (CTM) and the only child leaves the home, CE is holding CTM for the adult. Workers needs to run EDBC with the CE Reset run reason giving timely notice. This process assumes that the child(ren) have already been coded ‘Permanently Out of the Home’ on the Household Status Detail page.
Access the case through Person Search or enter the Case Number in Task Navigation and click Go. The Case Summary page displays.
Click Eligibility from Global Navigation.
Click Customer Information from Local Navigation.
Click EDBC Results from Task Navigation. The EDBC List page displays.
Viewing Historical Records:
While on the EDBC List page, click the View button. An EDBC record with no end month represents the benefit that is issued each month until EDBC is run again, a review is due or a mass update indicates a change. Click the Medical hyperlink from a specific date to display the Medical EDBC Summary page with specific case details for that specific EDBC. To see a specific date range of history, follow the steps below.
While on the EDBC List page, enter the First Day KEES should return information for in the From field.
In the To field, enter the Last Day KEES should return information.
Click the View button. KEES will display all information that matches the search parameters entered.
NOTE: Individual Medical Person History can be viewed via the Case Summary page by clicking the Consumer’s Name hyperlink inside the Medical program block.
Click the Medical hyperlink under the Program column to view the Medical EDBC Summary page for the selected EDBC result.
The Medical EDBC Summary page can be viewed during the eligibility process prior to accepting EDBC or accessed from the EDBC List page when viewing prior Medical eligibility history.
Begin Month and End Month show the dates of the EDBC record.
NOTE: If there is no End Month – this means the EDBC is high-dated and has not ended. Since the EDBC is high-dated this is the consumer’s current eligibility. Prior Medical months are never high-dated.
Run Date shows the day EDBC was run.
Run Status show the Run Status values:
Not Accepted
Accepted Not Saved
Accepted Saved
Accepted By shows who accepted the EDBC result:
Worker’s Name
Manual EDBC
Batch Process
The EDBC Information block shows the type of EDBC:
Regular
Read Only – No Benefits Issued to MMIS as previous EDBC was run and accepted
EDBC Source values include:
Online EDBC Rules –Eligibility was determined by rules
Batch –The process of automatically running EDBC for cases that meet predetermined criteria
Manual – Eligibility was determined off system and the outcome was recorded in KEES
Program Status values include:
Active
Denied
Discontinued
Review Due
Displays the date the Review is due in <MM/DD/YYYY> format
Consumer Name Hyperlink
When clicking the name hyperlink, the Individual Eligibility Criteria page is displayed. This page shows potential eligibility for medical programs. It also shows financial and non-financial criteria used in making the determination.
Role values include:
MEM (Member)
FRI (Financial Responsible Included)
UP (Unaided Person): displays on converted programs.
Role Reasons pertain to individual eligibility and display if the consumer is FRI. They explain why the individual is considered in the program configuration or budgeting unit.
Status is whether the consumer is:
Active-At least one eligible program person
Denied - At initial application and all program persons are deemed ineligible
Discontinued - After program is ‘Active’ and EDBC is recalculated determining all program persons no longer eligible due to changes in the program
Status Reason displays if the consumer has been Denied or Discontinued and the ineligibility reason.
This block is used to determine if the program is eligible to receive assistance under the Elderly and Disabled program eligibility criteria. Fields include:
Name
Adult/Child
Aged 65 or Older
Receives Medicare
Declared Disability
Active Disability
This block shows the Medical program resource limit based on the program and the total amount of resource entered by the user.
Resource Total is a hyperlink to the Property Detail page. The Property Detail page shows a list of resources and the countable amount used in the determination.
This block only displays when a there is a Requested Medical Type of Resource Assessment Only or when a processing LTC eligibility after a resource assessment has been completed. The CSRA Determination block shows the Community Spouse Resource Allowance amount for LTC programs.
Resource Total is a hyperlink to the Property Detail page. The Property Detail page shows a list of resources and the countable amount used in the determination.
The Medical Summary block shows the EDBC rules result for an Eligible Budget, Potential Eligibility, and Failed and Overridden Budgets.
Eligible Budgets-shows the program eligibility was determined for based on medical hierarchy.
Potential Eligibility-shows other ‘possible’ medical program eligibility.
Failed and Overridden Budgets-shows any budgets that failed EDBC rules or were overridden. If failed budgets are overridden through the Override Medical Summary budget, they will also be listed here in bold.
Select the Program Hyperlink under the Test column to access the Program Specific EDBC page. This page shows how much income was counted for that program. If there is more than one person on the program block, each budget is represented by an individual hyperlink. The Program Specific EDBC page shows:
Income Used
Deductions Allowed
Income Allocations
Protected Income Limit
Select the Income Determination Hyperlink(s) from the Program Specific EDBC page to see the Person Line Item Detail page. The Person Line Item Detail page shows the user how much income was counted for each consumer. Select Close to return to the Medical EDBC Summary page.
The Result column under the Eligible Budgets block shows pass.
The FPL% shows the percentage of income related to the federal poverty level.
FYI - (27806) The FPL % that displays is inaccurate. However, the calculation for coverage is correct and can be accepted.
The Premium/LTC Liability/Spenddown shows the specific amount budgeted per program.
Aid Code is the state assigned classification determined by the program applied for and on the consumer’s eligibility determination. See Medical Aid Codes for more information. For example:
When the MDN/XX aid code is generated for a Long Term Care case this needs to be changed to a 300/XX aid code. (SSI and PMG aid codes do not need any adjustments since these are already Title 19 aid codes.)
300/OA/N/N which translates to 300% of SSI Standard – Aged/Not Sobra/Not Inmate
Title 19 aid codes are required for LTC. See Medical Aid Codes for more information.
Must have a Title 19 aid code for MMIS. When the user processes a case for Long Term Care the aid code is 300/XX if the consumer is under the 300% of the SSI limit on income. For 2015, this is $2199.00 in monthly income. If the Consumer's income is in excess of $2199.00 per month the consumer receives an MDN/XX aid code on the EDBC Summary. This aid code MUST be changed to the 300/XX aid code using the Medical Summary Override in order for benefits to be sent to the MMIS. Select the appropriate Medically Needy - below SSI Standard or Medically Needy - below SSI Standard Cost Share depending on the consumer's population (Aged, Blind, Child, or Disabled) and liability determination. Coding changes must take place in the MMIS for it to be able to accept the MDN/XX aid code AND the LTC eligibility together.
Select the Override Medical Summary button. The Override List page displays.
Select the Override button for the Medically Needy budget. The Override Detail page displays.
Select the correct Medically Needy – XXXX below SSI Standard Cost Share (most of the time this is the “Aged” category, but could be “Disabled”).
Remove the comma from the Patient Liability amount (if necessary).
Set a Start Date of the first day of the EDBC month.
Set an End Date the last day of the EDBC month (essentially a one month base).
Click the Save and Continue button. The Override List page displays.
Select an Override Reason of Administrative Decision.
Click the Save and Return button. The Medical EDBC Summary page displays.
If the Medical EDBC Summary looks correct (has 300 aid code, correct patient liability, and LTC details) click the Accept and Save button.
LTC Details show the LTC specific criteria. For example:
IC/NF/SN which translates to Institutional Care/Nursing Facility/Skilled Nursing
Member Tested shows consumers tested and passed.
Role values include:
MEM (Member)
FRI (Financial Responsible Included)
UP (Unaided Person): displays on converted programs.
Role Reasons pertain to individual eligibility and display if the consumer is not a MEM. They explain why the individual is not considered in the budgeting unit.