Select Eligibility from Global Navigation. Select Customer Information from Local Navigation. Select Run EDBC from Task Navigation.
The Run EDBC page displays.
The Benefit Month defaults to the first month of determining eligibility for initial determinations, including prior medical months. The Benefit Month defaults to the come up month for ongoing eligibility.
If running EDBC for a month other than the defaulted month, select the needed month from the drop-down menu and click the Select button.
Select or de-select the appropriate Program check box(es).
If applicable, select the appropriate answer for Timely Notice Exception.
NOTE: Timely Notice Exception will most often occur when the user needs to re-run EDBC for a paid month where Long Term Care either starts or stops.
Select a Run Reason from the drop-down menu if the user is running EDBC for one of the following reasons:
NOTE: It is not necessary to select a Run Reason from the drop-down menu at initial application.
CE Reset: Used for continuous eligibility.
CSRA Reassessment: Used to re-determine the Community Spouse Resource Allowance (CSRA) calculation. If the user wants a new assessment and recalculation, change the Requested Medical Type to Assessment Only and run with CSRA Reassessment run reason. See Add/Update Requested Medical Type and Division of Resources/CSRA for more information.
Passive Response: Used when a Passive Review has been received.
Run Without Review: Used when there is a Pending request for coverage and a review is due but has not been received and/or signed.
WKH Desk Review: Used to process Working Healthy 6 Month Desk Reviews. It should never be used for other Medical programs.
RE: Used to run EDBC for the review month. The RE run reason sets new review dates after EDBC is calculated.
Click the Run EDBC button on the right side of the page.
From the EDBC List page, click the Medical hyperlink for the month being determined under Program to navigate to the Medical EDBC Summary page to see why the Auth Amount column shows Details or Failed. Details mean the medical criteria passed. Failed means the medical criteria did not pass. See Reading the Medical EDBC Summary Page for the budget details.
Review the EDBC results the Medical EDBC Summary page:
Click the Consumer Name hyperlink to under Program Configuration to view the Individual Eligibility Criteria page. This page shows if the consumer meets non-financial eligibility criteria. Click Close to navigate back to the Medical EDBC Summary page.
Click on any available Hyperlinks listed under the various blocks on the Medical EDBC Summary page to view specifics about budgets that failed or passed.
For CE Eligible Aid Codes, review the Continuous Eligibility section. If updates to the CE End Month are needed, click the Override CE Period button. See Override Continuous Eligibility for more information.
NOTE: When EDBC is overridden to adjust a CE End Date the programs Review Date will recalculate and be set to align with the earliest program person’s review due date. Workers will need to verify Review Due date is correct.
Click the Accept button if the results are correct. Click the Cancel button if the results are not what the user expected.
NOTE: If the results are not expected, refer to the Ineligibility Status Reason Table for more information. Do not accept or save EDBC results that may be wrong.
Review the EDBC Results from the EDBC List page. Click the Save and Continue button which takes the user to the Distributed Document Search page.
Click on the hyperlink of the NOA (Notice of Action) to review for accuracy. See NOAs (Notices of Action) for more information.
Select Journal from Utility Navigation. Add a journal entry to document all program action. See Journal for more information about journaling functionality.
Follow STEP 1 - STEP 8 for each month of eligibility up to the current system month.
NOTE: If the user attempts to run/re-run EDBC after 10-day notice, KEES will create a Read-Only EDBC record if the eligibility determination change is negative. If Medical assistance is needed, follow these steps:
Re-run EDBC
Select Yes from the Timely Notice Exception drop-down menu.
Select the applicable Reason from the Reason drop-down menu.
If the medical change is positive, KEES creates a regular EDBC record.