SOBRA Spenddown

1. If the consumer is requesting a Prior Medical Spenddown, complete the below steps. If prior medical is not requested, skip to step 2:

   1. On the Case Summary page, select the Month of Application using the <mm/dd/yyyy> format or the calendar icon date for the Display field and click the View Button.  The Case Summary page redisplays.

   2. Click on the View Details button in the Medical Program Block.  The Medical Detail page displays.

   3. Click the Edit button. The Medical Detail page redisplays.  

   4. In the Program Persons section, click the Edit button by the SOBRA applicant.  The Medical Person Detail page displays.

   5. Enter the Prior Med month(s) in the Retro Months field.

   6. Choose MAGI from the Requested Medical Type drop-down menu.

   7. Click the Add button.  

   8. Click the Save and Return button.  The Medical Detail page redisplays.

   9. Repeat steps 4-6 for any other family members requesting Prior Medical coverage.  

   10. After Prior Medical has been added for all members requesting coverage, click the Save and Return button on the Medical Detail page. The Case Summary page displays.  

2. Enter the relevant Non-Financial Data.

NOTE: Applications for SOBRA PW Spenddowns must have a Medical pregnancy record entered on the Pregnancy Detail page.  

3. On the OPA page:

   1. Select the Name of the SOBRA applicant from the drop-down menu.

   2. Select the Type of Assistance from the drop-down menu.

      • SOBRA Emergency

      • SOBRA Labor and Delivery

   3. Select KS from the State drop-down menu.

   4. Select the County from the drop-down menu.

   5. Enter the Effective Date of Treatment.  

   6. Enter the End Date of Treatment.  

   7. Enter the 1st day of the month services were provided  for the Begin Date.

   8. Enter the last day of the month services were provided in the End Date.

   9. Select Verified from the Medical Verified drop-down menu.

   10. Click the Save and Return button. The Other Program Assistance List page displays with the newly entered information.  

4. Complete the remaining Non-Financial and Financial Data Collection pages.  

5. Run EDBC for the month services were provided.  The EDBC List page displays.

6. Click on the hyperlink in the Program column.  The Medicaid EDBC Summary page displays.

7. Review the EDBC results. EDBC should show a Status of Denied for those individuals in which a Spenddown is being determined.

8. Click the Override Program Configuration button located in the Name section of the page.   The Program Configuration Override List page displays.  

9. Select Administrative Decision from the EDBC Override Reason drop-down menu.

10. In the User Override section of the page, select a:

    1. Program Status of Active.

    2. Reporting Type of Semi-Annual Reporting.

11. In the Program Configuration section of the page, click the Override button for the SOBRA consumer.  The Program Configuration Override Detail page displays.

12.  In the User Override section of the page select the following values from the drop-down menus:

    1. Role of MEM.

    2. Status of Active.

    3. QHP Screened is No.

    4. Role Reason of Blank Value (scroll to the top of the drop-down menu to select).

    5. Claiming Code of Federal.

    6. Status Reason of Blank Value (scroll to the top of the drop-down menu to select).

    7. Adult Child Code of Blank Value (scroll to the top of the drop-down menu to select).

13. Click the Save and Return button.  The Program Configuration Override List page displays.

NOTE: Repeat steps 18—20 for any other family members in which a Spenddown is being determined.   

14. Once the SOBRA applicant’s role has been changed to MEM, click the Save and Return button on the Program Configuration Override List page.  The Medical EDBC Summary page redisplays.

15. Scroll to the bottom of the page and click on the Override Medical Summary button.  The Medicaid EDBC Override List page displays.  

16. Select Administrative Decision from the EDBC Override Reason drop-down menu.  

17. Scroll to the bottom of the page and click the Add button.  The Medicaid EDBC Override Detail page displays.

18. In the User Override section, select or enter the following values:

    1. Test of Medically Needy.

    2. Test Result of Pass.

    3. FPL %.

    4. Spenddown amount that was calculated off system.

    5. Start Date of the 1st day of the 1st month of the Spenddown base period.

    6. End Date of the last day of the last month of the Spenddown base period.

    7. Name of the SOBRA consumer in the Person drop-down menu.

    8. Role of MEM.

    9. Aid Code of Medically Needy – Pregnant Women SOBRA Cost Share.

    10. Click the Add button.

NOTE: Complete G – I for any other family members requesting Spenddown coverage.  

19. • SOBRA children use an Aid Code of Medically Needy – Child SOBRA Cost Share.  

    • A child that is a citizen or eligible non-citizen would have an Aid Code of Medically Needy – Child Cost Share.

20. Click the Save and Return button. The Medicaid Override EDBC List page displays showing the newly created budget.

21. Click on the box located on the left of the new budget.

22. Click the Save and Return button.  The Medical EDBC Summary page displays.  

23. In the Eligible Budgets section of the page, review the Medically Needy block as well as the Aid Codes.  If everything is correct, click the Accept button.  The EDBC List page displays.  

24. If the determination is correct, click the Save and Continue button.  

25. Run EDBC for the next chronological month (that follows the month of the medical emergency).  

26. Click on the hyperlink in the Program column.  The Medicaid EDBC Summary page displays.

27. Review the Medicaid EDBC Summary.  The SOBRA applicant should show a Discontinued Status. If everything is correct, click the Accept button.  The EDBC List page displays.  

28. If the determination is correct, click the Save and Continue button.  

NOTE: When determining a SOBRA Spenddown, EDBC should be overridden for the SOBRA applicants only for those month(s) in which the qualifying SOBRA Emergency occurred. For all other months, EDBC should be run and eligibility Discontinued for the SOBRA applicant. A SOBRA Spenddown applicant should not remain Active on a Spenddown.