Medical Condition

 

The Medical Condition Detail page is used for E&D medical program persons under age 65 and claiming to have a disability.  A Batch Interface could create or update an Active Medical Condition at the time of registration or if a consumer is declared disabled by SSA.

Complete the following steps:

  1. Select Eligibility from Global Navigation. Select Customer Information from Local Navigation. Select Medical Condition from Task Navigation. The Medical Condition List page displays.
  2. Select the appropriate status in the Medical Condition Category drop-down menu.

·    Active - A consumer has been determined disabled by SSA or DDS.

·         Declared – For Tier 2 MediKan (see note below). The consumer states he/she is disabled (12 months or result in death).

NOTE: The Medical Condition must remain Declared for MediKan recipients until the consumer is determined disabled by SSA. Using a Presumptive Medical Condition will result in a Medicaid benefit at EDBC. Do NOT use a Presumptive PMDT Tier 2 Medical Condition for MediKan.  

See Other Program Assistance section of the user manual for more information on MediKan data collection requirements.

·         Presumptive - For Tier 1 Medicaid only: Use only if the consumer has been verified Tier 1 eligible by PMDT.

NOTE: Fields display dynamically on the Medical Condition Detail page based on the Medical Condition Category selected in STEP 2.

NOTE: Medical Condition changes do not utilize effective dating:

·         If a Declared or Presumptive Medical Condition changes to Active, the original medical condition should be Edited to include an end date.

·         In addition to end dating the old condition type, the user would need to Add the new Active Medical Condition type.

  1. Click the Add button. The Medical Condition Detail page displays.
  2. Select the consumer from the Name drop-down menu.
  3. Review the Medical Condition Category for accuracy.
  4. Select a Verified Status from the drop-down menu.
  5. Select the appropriate Medical Condition Type from the drop-down menu.

NOTE: A Medical Condition is not needed for  individuals under 21 on the SED and TA Waivers. 

  1. Enter the Begin Date, using the <mm/dd/yyyy> format or the calendar icon, for the first day of the month eligibility is being determined. Records should remain high dated until a change has been completed.

·    For a Declared, Presumptive, or DDS Medical Condition, the user will enter a Begin Date as the first day of the month of application or the first day of Prior Medical if prior medical has been requested, when processing a new application.

·     For an Active Medical Condition, the user will enter the Begin Date as the actual day that SSA deemed the consumer disabled.  Refer to EATSS to confirm the actual Disability Begin Date/Disability Onset Date.

9.    When End Dating a Medical Condition, enter the End Date, using the <mm/dd/yyyy> format or the calendar icon, for the last day of the month before the new eligibility is being determined. 

NOTE: For an Active Medical Condition, only enter an end date if it has been verified the consumer has lost disability. Adding an end date to an Active Medical Condition when the consumer remains disabled can negatively impact Non-Medical disability benefits such as Food Assistance.

  1. Click the Save and Add Another button to add additional records. Otherwise, click the Save and Return button.