KEES has four different types of Medical Program Blocks: Medical, Presumptive Eligibility, ADAP, and SSPP. When determining if an existing Program Block can be used, it is important to know which recipients can share a Medical Program Block (ex: MSP, MDN, SSI). There are also recipients that require using a separate Medical Program Block (ex: LTC or Working Healthy). See Add New Program for more information. Staff should always look at using or re-purposing an existing Program if possible BEFORE creating a new one.
Adding a new Program Block on a case should only be done when there is not another Program that can be used based on the flow. The considerations (below) should be used in conjunction with the chart.
Staff will need to use logic and prudent person when determining when to use an existing Program vs adding a new Program to the case. Things to keep in mind are:
Is there currently a KEES Help Desk ticket on the case preventing an existing Program Block from being used, or coverage authorized?
If so, a new Program Block should not be added unless otherwise directed by the KEES Help Desk.
Is the Program closed, and still in a Reconsideration period?
If so, should Rescind be used?
If not, using the Chart for recipients, could the person(s) be added to this Program?
Is the Program closed and all persons permanently out of the home?
If so, this Program may be used/re-purposed.
Is there only one applicant that needs to be determined for multiple types of coverage i.e. MAGI and Elderly and Disabled?
If so, the Program Block and RMT can be updated for each unique request. A new Program is not needed for each determination.
A MAGI Program Block had Mom and son on it. Son moves out of home, and now PA is requesting LTC. The previous MAGI Block could be re-purposed, and no new Program Block would need to be created.
An LTC Program Block member passes away. A new request for MAGI coverage for the same HH is received 5 months later. The existing LTC Program Block can be repurposed for the MAGI request, and no new Program Block would need to be created.
An LTC Program Block member fails to return their review timely and has been closed. A new request for MAGI coverage is received for the same HH within the Review Reconsideration Period. The existing LTC Program Block should not be repurposed for the MAGI request since it is likely the LTC review could be returned. A new Program Block would need to be created.
An adult caretaker is requesting coverage for themselves only, and reports having a disability. The caretaker is determined not to be eligible for MAGI coverage. The E&D determination is now needed. Using the same Program Block, the casebank and RMT is updated and E&D coverage is determined. A new Program Block would not need to be created.
*Use the chart below when determining if a Recipient can share on a Program Block.
**This chart is not intended to determine if a Program Block is Useable. This Chart is only to determine which recipients can share a Program Block.
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RMT |
Which Active Recipient(s) Can Share a Program Block |
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ADAP |
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Each ADAP recipient should be on their own Program Block. Only 1 ADAP program block is allowed on a case. |
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Medical |
Inmate |
Each Inmate recipient should be on their own Program Block. |
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LTC |
Each LTC recipient should be on their own Program Block. |
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MAGI |
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Medical |
Medical, MAGI, MSP, PPS, and Qualified Disabled Working Individual recipients can share a Program Block. |
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MSP |
MSP, MAGI, Medical, PPS, and Qualified Disabled Working Individual recipients can share a Program Block. |
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PPS |
PPS, MAGI, Medical, MSP, and Qualified Disabled Working Individual recipients can share a Program Block. PPS RMTs listed in this chart do not include the ASM and FCM Programs. These are processed by DCF and do not go on a Medical Program Block. |
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Qualified Disabled Working Individual |
Qualified Disabled Working Individual, MAGI, Medical, MSP, and PPS recipients can share a Program Block. |
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Resource Assessment Only |
Each Resource Assessment Only recipient should be on their own Program Block. |
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Working Healthy |
If there are two Working Healthy recipients, and the recipients have separate Working Healthy Premiums, these recipients cannot share a case. This causes Premium Billing system issues. Each recipient will have to have their own case. |
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Presumptive Eligibility |
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PE recipients must always receive their PE benefits on a PE Program Block. However, all PE recipients can be on the same PE Program Block regardless of whether it is PE Child, PE PW, or PE Adult. |
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SSPP |
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Each SSPP recipient should be on their own Program Block. Only 1 SSPP program block is allowed on a case. |
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Unshared Spenddown |
All |
Unshared Spenddowns need to be on separate cases regardless of RMT. |