|
NAME |
WA NUMBER |
PROGRAM |
BRIEF DESCRIPTION |
|
EDBC |
SOBRA has never been a CE Program, however, KEES currently sets a CE Period for it in error. With the May 2022 Release, this has been corrected and staff will no longer be able to extend the CE Period to protect the SOBRA coverage during the PHE. For all SOBRA programs (excluding SOBRA PW) please use the following workaround instructions during PHE. |
||
|
With the May 2022 Release, CE will no longer protect a consumer who has failed non-financial categorical eligibility. Staff will no longer be able to extend the CE Period to protect the coverage during the PHE for the following consumers:
|
|||
|
Grievance Task Is Not Closing When Contact Log Is Updated |
415 |
ALL |
RETIRED |
|
448 |
ALL |
This workaround includes the class of Admission (COA) codes that represent Cuban/Haitian entrants. They do not have to meet the 5-year bar. If an individual has any of the mentioned COA codes – AND – has a Country of Birth of Cuba or Haiti, they are treated as Refugees. This includes their spouse and children, if they are also Cuban/Haitian Nationals. NOTE: There is an exception. If an individual has a COA Code of CU7 this indicates they are NOT a Cuban National and are therefore ineligible. Currently KEES approves benefits for an individual with a COA Code of CU7. If this is the case please see Section B of this workaround. |
|
|
492 |
ALL |
There is a system issue that makes it appear as if the wrong person has been set as the Casehead after a new case number is created. |
|
|
RE Run Reason Validation without an Available RE Run Reason |
508 |
ALL |
RETIRED |
|
Interest/Dividends/Investments not counting correctly in EDBC |
589 |
ALL |
There is currently an issue with Interest/Dividends/Investments income being counted incorrectly when a consumer has multiple Interest/Dividends/Investment income records in KEES. Currently Interest/Dividends/Investments are not being counted when the individual income records are below $50. Per Policy if all the combined records equal more than $50 it is countable. |
|
593 |
ALL |
When workers encounter non-citizens with the following designation: · SQ4 Afghan Evacuees · SQ5 Afghan Evacuees · DT · U4U · UHP · C11 AND · The 5 Year Bar is not met
This Workaround shall be completed when EDBC shows a consumer with a status reason of Ineligible Non-Citizen is received. |
|
|
598 |
ALL
|
This WA is to be utilized when applying Pre-Tax deductions for a consumer that is currently active LTC/WH and MSP/LMB. If the consumer should be eligible for MSP/QMB coverage due to the newly entered Pre-Tax deduction staff should follow the following steps. |
|
|
Tier III TALX |
501 |
ALL MAGI-Budgeted Programs |
RETIRED |
|
675 |
ALL
|
The Centers for Medicare and Medicaid Services (CMS) implemented continuous eligibility for children who are receiving coverage for the non-MAGI programs who lose program eligibility prior to the end of a 12-month review period. This does not include Medical Spenddown (MSP), Tuberculosis (TB), Medically Needy (MDN), Qualified Working Disabled (QWD), Presumptive Eligibility (PE).
Children moving from non-MAGI coverage to MAGI will continue to receive coverage on their existing program block. Do not move the child to the family medical program block.
When the work around is not needed: If the child has verified information already on file that would qualify them to meet the general requirements for a MAGI program as outlined in KFMAM 2222, this WA is not needed. It would be appropriate for the CE to be reset a new 12 months in this instance. |
|
|
676 |
ALL |
Due to changes in federal legislation, children with SOBRA coverage are eligible for a continuous eligibility period. Essentially, since SOBRA is a limited coverage and only covers qualifying emergency services, what this means is that once a SOBRA child is initially approved on SOBRA coverage for an emergency medical service, they are automatically eligible to be reinstated on SOBRA coverage for a future date of service if they request SOBRA coverage again and have another qualifying emergency service within the next 12 months (even if they haven’t submitted an app). |
|
|
667 |
ALL |
KEES implemented 10 COA codes that were added from the Department of Homeland Security. CMS created policy surrounding 8 COA codes that must meet the five-year bar if the applicants entered the United Stated after September 30th, 2023. |
|
|
PMD Tier 1 With Income Under the SSI Limit Receive a Medically Needy Aid Code |
221 |
E&D |
RETIRED |
|
TB Failing for EDBC Non-Citizens |
404 |
E&D |
RETIRED |
|
537 |
E&D |
Currently some users are unable to create PMDT Contact and PMDT Return tasks using the Contact Log in KEES. Additionally, tasks are not updating existing tasks appropriately when the right conditions are met. Users should continue following the current processes to create a task or update a task. However, once it has been verified that a task cannot be created (including the contact log), a corresponding task must be created. If it isn’t possible to update a task, a corresponding task must be created. |
|
|
Verify SSN Through the Federal Hub when Citizenship and ID is Verified or Exempt |
561 |
E&D |
In situations where a consumer has an unverified SSN in SSN Provided status on the Individual Demographics page, but has Citizenship and ID in Verified or Exempt from Verification status on the Citizenship/Identity page, the following process will need to be used to verify the SSN through the Federal Hub. |
|
562 |
E&D |
Persons eligible for SI or Poverty Level programs do not receive any additional benefit from LMB and are, therefore, not eligible except for prior medical coverage. This is due to the fact that the LMB program covers only Part B premiums and such persons are already covered for Part B buy-in. |
|
|
Health Insurance Premiums (any type) not being pulled into Medically Needy spenddowns |
659 |
E&D
|
An issue has been identified when using the Expense category Health Insurance Premiums (any type). These expenses are not being pulled into a Medical Needy spenddown determination. Until this issue can be resolved, please use the instructions in this workaround (WA659) to create an expense record for any Health Insurance Premiums that will be entered in KEES. |
|
661 |
E&D and LTC |
This WA is to be used when a consumer is eligible for coverage when they have a primary and secondary motor vehicle and the secondary vehicle should be countable as a resource but is not counted in EDBC. |
|
|
Post-Partum CE Extension |
660 |
EDBC |
RETIRED |
|
Medically Needy Spenddown Override for Shortened Spenddowns |
663 |
EDBC |
RETIRED |
|
Cuban/Haitian Entrants |
665 |
EDBC |
RETIRED |
|
484 |
Family Med |
When a minor mother gives birth to a child while receiving Foster Care Medical, that child needs to be authorized for Medicaid Deemed Newborn coverage on a new separate case number. KEES will not authorize coverage for the Deemed Newborn because the new case number has no adult caretakers on the case. |
|
|
496 |
Family Med |
If an applicant is filing jointly with a spouse, who is coded as Permanently Out of the Home, that spouse will be incorrectly included in the IBU of the applicant who they are filing jointly with. Policy states to add the spouse of an individual or tax filer, only if they are living together. |
|
|
TransMed and Extended Medical |
522 |
Family Med |
RETIRED |
|
Override the Primary Applicant When Only Child in Foster Care |
534 |
Family Med |
RETIRED |
|
EDBC Not Determining PLN/PW for 18-Year-Old |
535 |
Family Med |
RETIRED |
|
Incorrect IBU for 18-Year-Old Primary Applicant with Non-Filing Parent in the Home |
536 |
Family Med |
EDBC is not correctly building Non-Filer Rules IBU for an 18-year-old who has a non-tax filing parent (or parents) in the home. A filing Tax record must be added to correctly calculate the IBU. Example: Application received applying for 18-year-old only. Two parents and one minor sibling are in the home but not requesting coverage. No one is filing taxes. |
|
550 |
Family Med |
Currently there is a known issue where a child(ren) may receive CTM coverage in error. This may occur at the time of application. Children should only receive CTM coverage when there is a caretaker in the home who is actively receiving CTM Coverage. This workaround should be used in situations when EDBC incorrectly issues CTM coverage to a child when there is no caretaker in the home receiving CTM. |
|
|
674 |
Family Med |
This workaround will be overriding the entire EDBC for CHIP beneficiaries who are still within their CE period. For children currently in a penalty period, an override does not need to be completed. These CHIP beneficiaries will complete their penalty period. This override will be needed when EDBC attempts to close a CHIP recipient for premium delinquency during a CE period beginning 01/01/2024. Override would not be needed for child/children that are newly added to the case or new to CHIP coverage on the case.
|
|
|
C-N-S941 Facility General Closure Form Effective Date Incorrect |
489 |
LTC |
RETIRED |
|
507 |
LTC |
Currently KEES rules are not correctly applying the Resource test for individuals who have had a CSRA determined. An incorrect approval may result for individuals requesting LTC coverage even though their countable resources remain above the resource limit but are below their established CSRA amount. |
|
|
$20 Disregard for LTC Consumers |
554 |
LTC |
RETIRED |
|
584 |
LTC |
Currently EDBC will fail when running a current or previous month. If a late change is needed, EDBC will need to be overridden. |
|
|
Exempt Income Subtracted from Share of Cost |
623 |
LTC |
RETIRED |
|
Tier III - TALX |
498 |
MAGI |
RETIRED |
|
587 |
MAGI |
At review, if applicants have active CTM benefits that exceed the CE Date and an increase in earned income that places them over CTM guidelines, EDBC will not determine TMD when running EDBC in the soonest unpaid month. |
|
|
655 |
PPS |
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), this workaround should be used until the PPS RMT rules can be upgraded. |
|
|
Working Healthy Recipient Request To Add WORK/WORK Case Maintenance |
615 |
WORK |
This WA should be used anytime staff are running EDBC to add WORK to already existing Working Healthy coverage. This WA should also be used anytime EDBC needs to be ran after the initial WORK coverage has been established. |