The Medical Review Type Determination batch rules have been updated to reduce the amount of Passive reviews changing to Pre-populated.
An overview of the changes are listed below:
A $5 variance (plus or minus) is allowed between what is found in the SVES or BENDEX interfaces and the Social Security (SSA) Income record in KEES.
Example 1: July review PA has a $500 SSA Income record in KEES. When the Medical Review Batch is run $505 is found by the SVES Interface. Since this is within $5, the discrepancy will not cause this to be a Pre-Populated review.
Example 2: July review PA has a $500 SSA Income record in KEES.P When the Medical Review Batch is run $513 is found by the SVES Interface. Since this is more than a $5 difference, the discrepancy will cause this to be a Pre-Populated review.
Note: It is possible for the SSA Income to be within a $5 variance and the case may change to a Pre-Populated review for another reason.
The income determination for MAGI Households will be determined by Both Below determination, rather than Reasonable Compatibility Determination.
Reviews for the non-MAGI population will have the check for 'Past Due and Owing Expenses' removed during the Medical Review Type Determination batch.
There is no longer a check for earned income on E&D reviews that are tested for a RCD. Previously, any earned income would change the review type to Pre-Populated. Now the review type will only switch to Pre-Populated if RCD fails.
Note: This is not applicable to SSI and 300 Aid Codes as they are not tested for a RCD.
The two Passive Review (also known as an Ex-Parte Review) limit has been removed. There is no limit on the amount of consecutive Passive reviews that can be received. A Pre-Populated review will only be required if the case falls out of Passive review. Prior to this change, two Passive reviews or Ex-Parte Review were allowed before a Pre-Populated review was required.
Tax dependents outside of the home and tax filers will not affect the review type determination.
The income determination is based on the Both Below Determination for MAGI review types and the income determination for non-MAGI reviews are a Reasonable Compatibility Determination.
Applicants who have and SSI Aid Code and either a MSP/QB or MSP/LM Aid Code will now automatically receive a Passive review. If the Passive EDBC fails, the review type will change to Pre-Populated.