Policy states Pregnant Women open on a met spenddown at the time of their pregnancy are eligible to continue on met spenddown coverage through 12 months post-partum (PP) period.
Follow the instructions below to set up a new $0 spenddown when the member has met their initial PW spenddown and their spenddown base period has ended.
These instructions will need to be used each time a new base period is set up within the 12 month PP period. Following the 12 month PP period, normal processing instructions apply.
NOTE: This assumes the worker has already checked KMMS and verified the member had a met spenddown or $0 spenddown during their current pregnancy. If the member did not have a met or $0 spenddown during the current pregnancy, do not follow these instructions as they do not apply to an unmet spenddown during pregnancy.
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 $0 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: If you are approving a current spenddown, the base period should be for a six-month period.
Select the individual’s name from the Person drop-down.
Set their Role to MEM.
Select the Aid Code, Medically Needy – Pregnant Women (MDN/PW/N/N)
Click the Save and Return button.
On the Medical EDBC Override List page, click the check box next to the overridden budget and Save and Return button.
On the Medical EDBC Summary page, confirm the individual’s aid codes 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.