The Medical EDBC Summary page can be viewed during the eligibility process prior to accepting EDBC or accessed from the EDBC List page when viewing prior Medical eligibility history.
Begin Month and End Month displays the dates of the EDBC record.
NOTE: If there is no End Month – this means the EDBC is high-dated and has not ended. Since the EDBC is high-dated this is the consumer’s current eligibility. Prior Medical months are never high-dated.
Run Date displays the day EDBC was run.
Run Status displays the following Run Status values:
Not Accepted
Accepted Not Saved
Accepted Saved
Accepted By displays who accepted the EDBC result:
Worker’s Name
Manual EDBC
Batch Process
The EDBC Information block displays the type of EDBC:
Regular
Read Only – No Benefits Issued to KMMS as previous EDBC was run and accepted.
EDBC Source values include:
Online EDBC Rules –Eligibility was determined by rules.
Batch –The process of automatically running EDBC for cases that meet predetermined criteria.
Manual – Eligibility was determined off system and the outcome was recorded in KEES.
Program Status values include:
Active
Denied
Discontinued
Consumer Name Hyperlink
When clicking the name hyperlink, the Individual Eligibility Criteria page is displayed. This page shows potential eligibility for medical programs. It also displays financial and non-financial criteria used in making the determination.
Role values include:
MEM (Member).
FRI (Financial Responsible Included).
UP (Unaided Person): displays on converted programs.
FSO (Family Size Only).
Role Reasons pertain to individual eligibility and only display if the consumer is FRI. They explain why the individual is considered in the program configuration or budgeting unit.
Status is whether the consumer is:
Active - At least one eligible program person.
Denied - At initial application and all or at least one program persons are deemed ineligible.
Discontinued - After program is ‘Active’ and EDBC is recalculated determining all or at least one program persons no longer eligible due to changes in the program.
Status Reason displays the reason the consumer has been Denied or Discontinued. This will be blank for an Active status.
This block is used to determine if the program is eligible to receive assistance under the Elderly and Disabled program eligibility criteria. Fields include:
Name
Adult/Child
Aged 65 or Older
Receives Medicare
Declared Disability
Active Disability
This block displays the Medical program resource limit based on the program and the total amount of resource entered by the user.
Resource Total is a hyperlink to the Property Detail page. The Property Detail page displays a list of resources and the countable amount used in the determination.
This block only displays when a there is a Requested Medical Type of Resource Assessment Only or when a processing LTC eligibility after a resource assessment has been completed. The CSRA Determination block shows the Community Spouse Resource Allowance amount for LTC programs.
Assessment Month is the first month LTC spouse ever entered into a facility for 30 days or longer.
Resource Total is a hyperlink to the Property Detail page. The Property Detail page shows a list of resources and the countable amount used from the Assessment Month in the determination.
½ of Resources will determine the Community Spouse resource allowance. This is the Resource Total divided in half.
Resource Allowance Standard is half of the Resource Total if $27,480 or less this amount will used as the Resource Allowance. If half of the Resource Total is over $27,480 and does not exceed $137,400 half of the Resource Total will be used as the Resource Allowance for the Community Spouse. This amount will display in this section.
Person will display LTC Spouse and Community Spouse the Resource Allowance amounts will be listed on the Community Spouse name.
Individual Amounts is the Resource Total for each individual.
The Medical Summary block displays the EDBC rules result for an Eligible Budget, Potential Eligibility, Continuous Eligibility, and Failed and Overridden Budgets.
Eligible Budgets- displays the program eligibility was determined for based on medical hierarchy.
Continuous Eligibility- displays CE Begin Month, CE Actual End Month, and Aid code for each individual. Displays only for CE eligible aid codes. Otherwise, No CE Data displays.
Potential Eligibility- displays other ‘possible’ medical program eligibility.
Failed and Overridden Budgets- displays any budgets that failed EDBC rules or were overridden. If failed budgets are overridden through the Override Medical Summary budget, they will also be listed here in bold.
Select the Program Hyperlink under the Test column to access the Program Specific EDBC page. This page displays how much income was counted for that program. If there is more than one person on the program block, each budget is represented by an individual hyperlink. The Program Specific EDBC page displays:
Income Used
Deductions Allowed
Income Allocations
Protected Income Limit
Select the Income Determination Hyperlink(s) from the Program Specific EDBC page to see the Person Line Item Detail page. The Person Line Item Detail page displays the user how much income was counted for each consumer. Select Close to return to the Medical EDBC Summary page.
The Result column under the Eligible Budgets block displays pass.
The FPL% displays the percentage of income related to the federal poverty level.
The Premium/LTC Liability/Spenddown displays the specific Share of Cost amount per program.
Premium can be for Working Healthy or Chip.
LTC Liability is the Patient Liability (PL) for LTC program (IC, PACE, HCBS).
Spenddown is the spenddown amount for Medically Needy (E&D) program.
Aid Code is the state assigned classification determined by the program applied for and on the consumer’s eligibility determination. See Medical Aid Codes for more information.