Medical Condition - Family Medical

Workarounds related to this page:

• WA221 - PMD Tier 1 with Income Under the SSI Limit Receive a Medically Needy Aid Code

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 from 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. Using a Presumptive Medical Condition results in a Medicaid benefit at EDBC. Do NOT use a Presumptive PMDD Tier 2 Medical Condition for MediKan.

   • Presumptive - for Tier 1 Medicaid only: Verify a PMDT determination has not already been completed for MediKan.

   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 Add the new Active Medical Condition type.

3. Click the Add button to navigate to the Medical Condition Detail page.

4. Select the consumer from the Name drop-down menu.

5. Review the Medical Condition Category for accuracy.

6. Select a Verified Status from the drop-down menu.

7. Select a Medical Condition Type from the drop-down menu.

   NOTE: Use SSA Disabled for LTC children Medical Condition Type.

8. Enter the Begin Date, using the <mm/dd/yyyy> format or the calendar icon.  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 it 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 necessary, 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.

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