Within the context of a case, select Eligibility from global navigation.
Select Customer Information from local navigation.
Select Run EDBC from task navigation.
The Run EDBC page displays.
For initial determinations, the Benefit Month defaults to the first month of determining eligibility, 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 Benefit Month 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.
If the user is running EDBC for one of the following reasons, select a Run Reason from the drop-down menu:
NOTE: It is not necessary to select a Run Reason from the drop-down menu at initial application.
CE Reset: Used for Continuous Eligibility. CE Reset will break the existing/current CE if used; therefore, should only be utilized if indicated in business processes and/or at the discretion of KEES Helpdesk.
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: Run Without Review is only available to be selected when a program person is in their Reconsideration Period and the program has been rescinded using Rescind Without Review. Used when a review is due but has not been received or signed and EDBC needs to be run to determine eligibility for part of the household. Those who still require a review will be closed for their previous reason or made an active FRI when EDBC is run.
WKH Desk Review: Used to process Working Healthy 6 Month Desk Reviews. It should never be used for other Medical programs.
RE: Used when processing a review and should be used the first EDBC run month through come-up month.
Click the Run EDBC button on the right side of the page.
From the EDBC List page, click the Medical hyperlink under Program for the month being determined. The Medical EDBC Summary page appears.
Check to see why the Auth Amount column shows either Details or Failed. Details means 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 on the Medical EDBC Summary page:
Click the Consumer Name hyperlink 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.
If the results are correct, click the Accept button.
If the results are not what the user expected, click the Cancel button.
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 to go to the Distributed Document Search page.
Click the NOA (Notice of Action) hyperlink 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 actions. 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 timely notice, and the eligibility determination change is negative, KEES will create a Read-Only EDBC record.
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.
|
Timely Notice Exception Reason |
When to USE |
|
Best Plan-Pass |
Help Desk Only
|
|
LTC Late Change |
All LTC living arrangement changes, including:
|
|
Stop Aid Paid Pending |
Not used by Medical.
|
|
Waiver on File |
Adding Medically Needy to an MSP Only Program Troubleshooting Multi-Month EDBC for Family Med and E&D/LTC
|
If the Medical change is positive, KEES creates a regular EDBC record.