Non-MAGI Children CE WA 675

 

The Centers for Medicare and Medicaid Services (CMS) implemented continuous eligibility for children who are receiving coverage for the non-MAGI programs who lose program eligibility prior to the end of a 12-month review period. This does not include Medical Spenddown (MSP), Tuberculosis (TB), Medically Needy (MDN), Qualified Working Disabled (QWD), Presumptive Eligibility (PE).

 

The following programs will have a work around until system updates can be made. Children moving from non-MAGI coverage to MAGI will continue to receive coverage on their existing program block. Do not move the child to the family medical program block.

 

When the work around is not needed: If the child has verified information already on file that would qualify them to meet the general requirements for a MAGI program as outlined in KFMAM 2222, this WA is not needed. It would be appropriate for the CE to be reset a new 12 months in this instance.

 

Examples of when this would occur are:

NOTE: This does not apply to a child who qualifies for CHIP. If the child qualifies for CHIP during a 12-month CE period for Medicaid, the WA would not apply.

 

SSI

  1. End-date Medical Condition to the last day of the month prior to the KEES current come-up month.

    1. Please follow the steps in the KEES User Manual: Medical Condition.

  2. End-date income for the child that has SSI to the last day of the month prior to the KEES current come-up month.

    1. Please follow the steps in the KEES User Manual: End Dating Existing Income.

  3. Run EDBC for KEES current come-up month.

    1. Please follow the steps in the KEES User Manual: Running EDBC.

  4. From the Medical EDBC Summary page, click the Override Program Configuration button.

  5. On the Program Configuration page, update the following fields:

    1. EDBC Override Reason: Administrative Decision.

    2. Program status: If the program block has a discontinued or denied status, please update this field to Active. Otherwise, leave blank.

    3. Update Reporting Type: Semi-Annual Reporting. This field is required.

  6. Click the Override button next to consumer who needs information updated.

  7. On the Program Configuration Override Detail page in the User Override section update the following fields:

    1. Role: MEM

    2. Status: Active

    3. QHP Screened: NO

    4. Claiming Code: Federal

    5. Status: leave blank

    6. Role Reason: leave blank

    7. Adult Child Code: leave blank

  8. Click Save and Return button.

  9. On the Program Configuration Override List page, click the Save and Return button.

  10. On the Medical EDBC Summary page, click the Override Medical Summary at the bottom of the page.

  11. The Medical EDBC Override List page displays. Select Override next to the failed SSI build for the beneficiary.

  12. Overriding a budget:

    1. Remove additional household members in the beneficiary’s IBU.

    2. From the Medicaid EDBC Override Detail page, in the User Override complete the following fields:

      1. Test: SSI Recipients.

      2. Test Result: Change to Pass.

      3. FPL%: leave as is.

      4. Premium: leave as is.

      5. Start date: First day of the month EDBC is being ran for.

      6. End Date: Last day of the month EDBC is being ran for.

    3. In the Individual Budget Unit (IBU) section complete the following fields:

      1. For the SSI beneficiary being overridden.

        1. Person: Name of individual

        2. Role: MEM

        3. Aid Code: Select the appropriate Aid Code:

          1. SSI Recipient – Disabled

    4. Click the Save and Return button to go back to the Medicaid EDBC Override List page.

  13. 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.

  14. The EDBC Medical Summary page now displays showing the newly created budget for our consumer. Click the Accept button.

  15. The EDBC List page displays. Click Save and Continue button.

  16. Once EDBC is saved and accepted, confirm that the CE Period displays on the Medical Person History page.

    1. If it doesn’t display correctly, create a KEES Help Desk ticket.

  17. Create a manual notice using the Standard Copy and paste spreadsheet as an overridden EDBC will never create a NOA.

  18. Create a Journal using the following approved Journal language:

    1. WA675 was used to continue coverage for <consumer name>.

 

300 (LTC, HCBS, PRTF, SI, SIA)

  1. End-date LTC Data Details on the last day of the month prior to changing coverage to MAGI.

    1. Please follow the steps in the KEES User Manual: LTC Data.

  2. Run EDBC for the month the LTC coverage ended. Use the Timely Notice Exception Reason of LTC Late Change.

  3. Review NOA.

  4. Change RMT to MAGI.

    1. Please follow the steps in the KEES User Manual: Add/Update Requested Medical Type - Medical.

      1. For step 6 in the user manual, please ensure the begin month is the current come-up month in KEES.

  5. End-date income for parents if any is reported to the last day of the month prior to changing coverage to MAGI.

    1. Please follow the steps in the KEES User Manual: End Dating Existing Income.

  6. Add Customer Options for CTM to ensure child does not receive CTM Coverage.

    1. Please follow the steps in the KEES User Manual: Caretaker Relative Denied CTM, Children need PLN - Customer Options.

  7. Run EDBC from the first month of PLN coverage through the KEES current come-up month.

    1. Please follow the steps in the KEES User Manual: Running EDBC.

  8. Override CE Period. Ensure that the CE End Month matches the original Review Month.

    1. Please follow the steps in the KEES User Manual: Override Continuous Eligibility.

  9. Review NOA.

  10. Once EDBC is saved and accepted, confirm that the CE Period displays on the Medical Person History page.

    1. If it doesn’t display correctly, create a KEES Help Desk ticket.

  11. Remove the end date that was added for parents’ income.

  12. Journal actions taken.

    1. WA675 was used to continue coverage for <consumer name>.

 

PMG

  1. End-date Medical Condition to the last day of the month prior to the KEES current come-up month.

    1. Please follow the steps in the KEES User Manual: Medical Condition.

  2. Run EDBC for KEES current come-up month.

    1. Please follow the steps in the KEES User Manual: Running EDBC.

  3. From the Medical EDBC Summary page, click the Override Program Configuration button.

  4. On the Program Configuration page, update the following fields:

    1. EDBC Override Reason: Administrative Decision.

    2. Program status: If the program block has a discontinued or denied status, please update this field to Active. Otherwise, leave blank.

    3. Update Reporting Type: Semi-Annual Reporting. This field is required.

  5. Click the Override button next to consumer who needs information updated.

  6. On the Program Configuration Override Detail page in the User Override section update the following fields:

    1. Role: MEM

    2. Status: Active

    3. QHP Screened: NO

    4. Claiming Code: Federal

    5. Status: leave blank

    6. Role Reason: leave blank

    7. Adult Child Code: leave blank

  7. Click Save and Return button.

  8. On the Program Configuration Override List page, click the Save and Return button.

  9. On the Medical EDBC Summary page, click the Override Medical Summary at the bottom of the page.

  10. The Medical EDBC Override List page displays. Select Override next to the failed PMG build for the beneficiary.

  11. Overriding a budget:

    1. Remove additional household members in the beneficiary’s IBU.

    2. From the Medicaid EDBC Override Detail page, in the User Override complete the following fields:

      1. Test: Protected Medical Groups.

      2. Test Result: Change to Pass.

      3. FPL%: leave as is.

      4. Premium: leave as is.

      5. Start date: First day of the month EDBC is being ran for.

      6. End Date: Last day of the month EDBC is being ran for.

    3. In the Individual Budget Unit (IBU) section complete the following fields:

      1. For the PMG beneficiary being overridden.

        1. Person: Name of individual

        2. Role: MEM

        3. Aid Code: Select the appropriate Aid Code:

          1. PMG – Pickle Amendment Disabled.

    4. Click the Save and Return button to go back to the Medicaid EDBC Override List page.

  12. 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.

  13. The EDBC Medical Summary page now displays showing the newly created budget for our consumer. Click the Accept button.

  14. The EDBC List page displays. Click Save and Continue button.

  15. Once EDBC is saved and accepted, confirm that the CE Period displays on the Medical Person History page.

    1. If it doesn’t display correctly, create a KEES Help Desk ticket.

  16. Create a manual notice using the Standard Copy and paste spreadsheet as an overridden EDBC will never create a NOA.

  17. Create a Journal using the following approved Journal language:

    1. WA675 was used to continue coverage for <consumer name>.

 

Working Healthy

  1. From the Medical EDBC Summary page, click the Override Program Configuration button.

  2. On the Program Configuration page, update the following fields:

    1. EDBC Override Reason: Administrative Decision.

    2. Program status: If the program block has a discontinued or denied status, please update this field to Active. Otherwise, leave blank.

    3. Update Reporting Type: Semi-Annual Reporting. This field is required.

  3. Click the Override button next to consumer who needs information updated.

  4. On the Program Configuration Override Detail page in the User Override section update the following fields:

    1. Role: MEM

    2. Status: Active

    3. QHP Screened: NO

    4. Claiming Code: Federal

    5. Status: leave blank

    6. Role Reason: leave blank

    7. Adult Child Code: leave blank

  5. Click Save and Return button.

  6. On the Program Configuration Override List page, click the Save and Return button.

  7. On the Medical EDBC Summary page, click the Override Medical Summary at the bottom of the page.

  8. The Medical EDBC Override List page displays. Select Override next to the failed Working Healthy build for the beneficiary.

  9. Add a budget:

    1. From the Medicaid EDBC Override Detail page, in the User Override complete the following fields:

      1. Test: Working Healthy.

      2. Test Result: Change to Pass.

      3. FPL%: leave as is.

      4. Premium: leave as is.

      5. Start date: First day of the month EDBC is being ran for.

      6. End Date: Last day of the month EDBC is being ran for.

    2. In the Individual Budget Unit (IBU) section complete the following fields:

      1. For the Working Healthy beneficiary being overridden.

        1. Person: Name of individual

        2. Role: MEM

        3. Aid Code: Select the appropriate Aid Code:

          1. Working Healthy - Disabled

    3. Click the Save and Return button to go back to the Medicaid EDBC Override List page.

  10. 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.

  11. The EDBC Medical Summary page now displays showing the newly created budget for our consumer. Click the Accept button.

  12. The EDBC List page displays. Click Save and Continue button.

  13. Once EDBC is saved and accepted, confirm that the CE Period displays on the Medical Person History page.

    1. If it doesn’t display correctly, create a KEES Help Desk ticket.

  14. Create a manual notice using the Standard Copy and paste spreadsheet as an overridden EDBC will never create a NOA.

  15. Create a Journal using the following approved Journal language:

    1. WA675 was used to continue Working Healthy coverage for <consumer names>.