SOBRA has never been a CE Program, however, KEES currently sets a CE Period for it in error. With the May 2022 Release, this has been corrected and staff will no longer be able to extend the CE Period to protect the SOBRA coverage during the PHE. For all SOBRA programs (excluding SOBRA PW) please use the following workaround instructions during PHE.
Note: The below steps assume that the EDBC has been run and an individual(s) will be discontinued.
In the Other Program Assistance Detail page, in the End Date of Treatment field, update this date to the last day of the come up month. Click the Save and Return button.
Run EDBC for the come up month. Review the EDBC Medical Summary page to ensure the member remains active on SOBRA coverage in the Eligible Budgets, in the Medical Summary section.
NOTE: There will not be a CE period for this member in the Continuous Eligibility, in the Medical Summary section.
Click the Accept button if the results are correct. Click the Cancel button if the results are not what the user expected.
Click the Save and Continue button.
Create a Journal using the following approved Journal language: In accordance with its Disaster Relief SPA and 1135 waiver, coverage will be temporarily extended for current recipients as indicated in Policy Directive 2020- 03-01.
Create a manual Form if needed, using the Standard Copy and Paste spreadsheet as an overridden EDBC will never create a NOA.
With the May 2022 Release, CE will no longer protect a consumer who has failed non-financial categorical eligibility. Staff will no longer be able to extend the CE Period to protect the coverage during the PHE for the following consumers:
Pregnant Women who are no longer pregnant, and are outside of their post-partum period.
Children who have turned 19 and are not a caretaker.
Adults who no longer have a child under the age of 19 in the home.
The following process is to be used when overriding EDBC to ensure that individuals normally discontinued remain eligible for continued coverage. Due to the CMS mandate, coverage should continue during the emergency COVID-19 crisis (PHE).
Note: The below steps assume that the EDBC has been run and an individual(s) will be discontinued.
From the Medical EDBC Summary page, click the Override Program Configuration button.
On the Program Configuration page, update the following fields:
EDBC Override Reason: Administrative Decision.
Program status: If the program block has a discontinued or denied status, please update this field to Active. Otherwise, leave blank.
Update Reporting Type: Semi-Annual Reporting. This field is required.
Click the Override button next to consumer who needs information updated.
On the Program Configuration Override Detail page in the User Override section update the following fields:
Role: MEM
Status: Active
QHP Screened: NO
Claiming Code: Federal
Status: leave blank
Role Reason: leave blank
Adult Child Code: leave blank
Click Save and Return button.
On the Program Configuration Override List page, click the Save and Return button.
On the Medical EDBC Summary page, click the Override Medical Summary at the bottom of the page.
The Medical EDBC Override List page displays. Next build a new budget.
Building a budget:
From the Medicaid EDBC Override List page click the Add button.
From the Medicaid EDBC Override Detail page, in the User Override complete the following fields:
Test: Select the appropriate Test Category:
CTM: Caretaker Medical
PW or PLN: MAGI Title 19 (this would also be used for SOBRA PW)
PLT/CHIP: MAGI CHIP
Test Result: Pass
Premium: if applicable
Start date: First day of the month EDBC is being ran for (spenddowns - use first day of the month of the beginning of the base period)
End Date: Last day of the month EDBC is being ran for (spenddowns - use last day of the month of the end of the base period)
CHIP Start Date: if applicable
Premium start date: if applicable
In the Individual Budget Unit (IBU) section complete the following fields:
For the individual
Person: Name of individual
Role: Mem
Aid Code: Select the appropriate Aid Code:
CTM/CH: Caretaker Medical – Children
CTM/PA: Caretaker Medical – Parent or Caretaker
PLN/PW: Poverty Level Programs – Pregnancy Woman
PLN/PW SOBRA: Poverty Level Programs – Pregnancy Woman SOBRA
PLN for children ages 1-5: Poverty Level Programs – 1-5 Year Olds
PLN for children ages 6-19: PLP – Age 6-18 FPL less than 113
PLT/CHIP: For 19 year olds:
Title XXI – Age 6-18 (for $0 premium)
Title XXI – Age 6-18 Cost Share (for a $20 or $30 premium)
For PW PLT/CHIP:
Title XXI – Pregnant Woman (for $0 premium)
Title XXI – Pregnant Woman Cost Share (for a $20 or $30 premium)
Click the Add button
Note: Be sure to include all people that will be part of the individual’s IBU:
Person: Name of individual
Role: FRI
Role Reason: Tax Dependent (for all other children that should be considered in the IBU), Primary Tax Payer (PA), or Spouse (SP)
Aid Code: Leave Blank
Click the Add button
Click the Save and Return button to go back to the Medicaid EDBC Override List page. Continue to step 10.
If overriding a CE Eligible Aid Code, the Continuous Eligibility Override Detail page displays. If overriding for a non-CE eligible aid code, skip to step 11.
Enter the CE End Month using the <MM/YYYY> format or the calendar icon. The CE End Month should create a 4-month CE Period. Example: Come up month is 6/22, CE End Month is 10/22.
Select the Adjustment Reason: Disaster
Repeat step 10 for all applicants requiring a CE End Month adjustment.
The Medical EDBC Override List page displays again. Now the budget has been created. Check the box next to the budget and click Save and Return.
The EDBC Medical Summary page now displays showing the newly created budget for our consumer. Click the Accept button.
The EDBC List page displays. Click Save and Continue button.
Create a Journal using the following approved Journal language:
In accordance with its Disaster Relief SPA and 1135 waiver, coverage will be temporarily extended for current recipients as indicated in Policy Directive 2020-03-01.
Create a manual Form if needed, using the Standard Copy and paste spreadsheet as an overridden EDBC will never create a NOA.
If an Add A Person request is received, the above override instructions will need to be followed to continue any consumer that meets the below criteria. This would apply to each month EDBC is ran for the person being added.
Pregnant Women who are no longer pregnant, and are outside of their post-partum period.
Children who have turned 19 and are not a caretaker.
Adults who no longer have a child under the age of 19 in the home.