At this time, there is no system functionality to support a Medically Needy Spenddown for pregnant women or children. If a worker determines that a spenddown is appropriate, these steps will need to be followed.
NOTE: Step 1 assumes the following has already happened:
The worker has calculated the spenddown amount, using the Spenddown Worksheet (off-system calculation). Any appropriate medical expenses should be used to determine the final spenddown amount before the spenddown is set up in KEES.
For prior medical (3 month) spenddowns: The worker has already entered the prior medical months on the Medical Person Detail page. The worker has ran EDBC in each of the prior medical months to determine that the applicant is over income – but has NOT Accepted/Saved the EDBC Results; the Cancel button should be clicked instead.
Navigate to KEES. Run EDBC in the first month of the new spenddown base period. (This should be the month after the previous base period ended.) EDBC will Fail for Over Income.
On the Medical EDBC Summary page, select the Override Program Configuration button.
On the Program Configuration Override List page, select an EDBC Override Reason of Administrative Decision.
Select a Program Status of Active and set the Reporting Type to Semi-Annual Reporting.
Click the Override button for the consumer needing a MEM Role.
On the Program Configuration Override Detail page:
Select a Role of MEM.
Select a Status of Active.
For QHP Screened select No.
Under Role Reason select the blank value (all the way at the top of the drop-down list)
Under Status Reason, select the blank value (at the top of the drop-down list)
Select the Save and Return button.
On the Program Configuration Override List page, click the Save and Return button.
On the Medical EDBC Summary page select the Override Medical Summary button.
Click the Add button on the Medical EDBC Override List page.
Complete the following:
Set the Test category to Medically Needy.
Set the Test Result to Pass.
Enter the off-system calculated spenddown amount in the Premium/LTC Liability/Spenddown field.
Enter the first day of the first month of the spenddown base period in the Start Date field.
Enter the last day of the last month of the spenddown base period in the End Date field.
NOTE: For current spenddowns, the base period should be for a six-month period. For prior medical spenddowns, the base period should be three months.
Select the individual’s name from the Person drop-down.
Set their Role to MEM.
Select the appropriate Aid Code
Medically Needy – Pregnant Women Cost Share (MDN/PW/N/N)
Medically Needy – Child Cost Share (MDN/CH/N/N)
Click the Save and Return button.
On the Medical EDBC Override List page, click the Save and Return button.
On the Medical EDBC Summary page, confirm the individual’s aid code and spenddown base period is correct, then click the Accept button.
On the EDBC List page, click the Save and Continue button.
Continue running EDBC using the same process for the following month through the come-up month.
NOTE: Make sure to enter the same base period start and end dates and amounts for each month EDBC is ran.
Journal your actions and send the appropriate NOAs.