Override the EDBC result when the child was discontinued at review due to Premium Delinquency or a new applicant child is added when the program block has an active premium delinquency.
1. Run EDBC.
2. On the Program Configuration page, update the following fields:
· EDBC Override Reason: Administrative Decision
· Program status: If the program block has a discontinued or denied status, please update this field to Active.
Otherwise, leave blank.
· Update Reporting Type: Semi-Annual Reporting.
Note: This field is required.
3. Click the Override button next to consumer who needs information updated.
4. 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: leave blank
· Status: leave blank
· Role Reason: leave blank
· Adult Child Code: leave blank
5. Click Save and Return .
6. On the Program Configuration Override List page, click the Save and Return button.
7. On the Medical EDBC Summary page, click the Override Medical Summary at the bottom of the page.
8. The Medical EDBC Override List page displays. The next step is to override the failing budget.
9. Override the failing CHIP budget that has the Role Reason of Past Due Prem.:
· From the Medicaid EDBC Override Detail page, in the User Override section complete the following fields:
i. Test: :PLT/CHIP: MAGI CHIP
ii. Test Result: Pass
iii. Premium: amount is populated from the failing budget. Do not update.
iv. Start date: First day of the month EDBC is being ran for.
v. End Date: Last day of the month EDBC is being ran for.
vi. CHIP Start Date: date EDBC was ran for.
vii. Premium start date: month available for CHIP Premiums.
· In the Individual Budget Unit (IBU) section complete the following fields: For the individual
i. Person: Name of individual
ii. Role: MEM
iii. Aid Code: Select the appropriate Aid Code:
PLT/CHIP:
a. Title XXI – Age 1-5 (for $0 premium)
b. Title XXI – Age 1-5 Cost Share (for a $20, $30, $50 premium)
c. Title XXI – Age 6-18 (for $0 premium)
d. Title XXI – Age 6-18 Cost Share (for a $20, $30, $50 premium)
iv. Note: Be sure to include all people that will be part of the individual’s IBU:
1. Person: Name of individual
2. Role: FRI
3. Role Reason: Sibling (for all other children that should be considered in the IBU), Primary Tax Payer (PA), or Spouse (SP)
4. Aid Code: Leave Blank
· Click the Save and Return button to go back to the Medicaid EDBC Override List page.
· 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.
10. The Continuous Eligibility Override Detail page displays.
· Enter the CE End Month using the <MM/YYYY> format or the calendar icon. The CE End Month should follow KFMAM 2451.
· Select the Adjustment Reason: New Policy/Regulation Change
· Repeat step 10 for all applicants requiring a CE End Month adjustment.
11. The EDBC Medical Summary page now displays showing the newly created budget for our consumer.
Click the Accept button.
12. The EDBC List page displays. Click Save and Continue.
13. Run EDBC through the KEES come-up month.
14. Create a Journal entry using the following approved Journal language:
· Work around WA 237324 has been applied.
.15 Create a manual Form, using the Standard Copy and paste spreadsheet as an overridden EDBC will never create an NOA.