Due to a rules upgrade done on MAGI and Medical RMTs, RMT’s which have not been upgraded (PPS, LTC, Working Healthy) will produce a Read Only EDBC when on the same program block as an upgraded RMT. When Aged-Out Foster Care Medical (AGO) is being determined and is on a program with combined RMTs as described above i.e. MAGI and PPS (for AGO), the following workaround should be used until the PPS RMT rules can be upgraded.
Note: The “PPS” RMT will need to be changed to “Medical” for anyone receiving or eligible for AGO prior to running EDBC.
The below steps assume that EDBC has been run and an individual(s) will be discontinued or denied. If the AGO consumer passes for another program skip to step 7.
From the Medical EDBC Summary page, click the Override Program Configuration button.
On the Program Configuration page, update the following fields:
EDBC Override Reason: Administrative Decision.
Program status: Active
Update Reporting Type (Only required when overriding a Full Closure/ Discontinuance, simply overriding 1 person, does not require this): Semi-Annual Reporting
Click the Override button next to consumer who needs information updated.
On the Program Configuration Override Detail page in the User Override section update the following fields:
Role: MEM
Status: Active
QHP Screened: NO
Claiming Code: Federal
Status: leave blank
Role Reason: leave blank
Adult Child Code: leave blank
Click Save and Return button.
On the Program Configuration Override List page, click the Save and Return button.
If there is passing budget for a program other than AGO, click the Override Medical Summary button at the bottom of the Medicaid EDBC Summary page. The Medicaid EDBC Override List page displays.
Click the Override button for the passing budget with the sub-program other than AGO. The Medical EDBC Override Detail page displays.
Change the Status from Pass to Fail.
Click the Save and Return button. The Medicaid EDBC Override List page displays.
NOTE: The BOLD record is the OLD record. The new record displays the budget as a failed budget.
Click the Add button. The Medicaid EDBC Override Detail page displays.
On the Medicaid EDBC Override Detail page complete the fields as follows:
Test = Foster Care Extended Medical
Test Result = Pass
FPL = 0
Start Date = First day of the benefit month for which EDBC was run
End Date = Last day of the benefit month for which EDBC was run
Person = Select the person eligible for the Aged-Out Foster Care Medical (AGO)
Role = MEM
Aid Code = Foster Care Medical – Aged Out
Click the Save and Return button. A passing budget displays an AGO aid code.
The Continuous Eligibility Override Detail page displays.
If continuing AGO coverage for PHE, enter the CE End Month using the <MM/YYYY> format or the calendar icon. The CE End Month should be set for a 4-month CE Period.
Example: Come up month is 6/22, CE End Month is 10/22.
Select the Adjustment Reason: Disaster
Repeat step 10 for all applicants requiring a CE End Month adjustment.
If approving new AGO coverage, enter the CE End Month using the <MM/YYYY> format or the calendar icon. The CE End month should be set for a 12-month CE Period.
Example: Application month 05/2022, CE End Month is 04/2023.
Select the Adjustment Reason: Erroneous Calculation
Repeat step 10 for all applicants requiring a new CE Period.
The Medical EDBC Override List page displays again. Now the budget has been created. Check the box next to the budget and click Save and Return.
The EDBC Medical Summary page now displays showing the newly created budget for our consumer. Click the Accept button.
The EDBC List page displays. Click Save and Continue button.
Create a Journal.
Create a manual Form if needed, using the Standard Copy and paste spreadsheet as an overridden EDBC will never create an NOA.