APPLICATION
ELIGIBILITY PROCESS
Eligibility Summary
A new failure reason of ‘PWE Fails 100 Hours’ displays in the case Status Reason List Box if Family Coverage eligibility is based on UP Deprivation and the individual indicated on the Medicaid PWE/100 Hour Rule window has 100 hours or more and is expected to continue working 100 hours or more.
Medicaid Budgeting – Offset of Recipient Liability
The offset of Recipient Liability with Unpaid Medical Bills is now limited to $15.00 starting with the Benefit Month of January 2003.
Any of these cases that may have been authorized for the benefit month of January 2003 will not be unauthorized. Cases will be identified and workers notified with the correct procedure.
Medicaid PWE/100 Hour Rule Window
This new window is added to the Eligibility Process to accommodate the policy changes for UP deprivation for Medicaid.
This window is a Medicaid only window and appears only if there are UP deprived children in the Medicaid filing unit. Note: This window will automatically display when processing the benefit month of 01/2003 for ongoing UP cases. It can be reached from the Main Menu by selecting Maintenance on the menu bar, then Eligibility Process from the drop down menu and Medicaid PWE/100 Hour Rule from the cascading menu. When running the Eligibility Process in the Initial mode for UP cases, this window automatically displays after the Income window.
This window is used to determine Family Coverage eligibility for Medicaid when the household includes both parents with children in common and there is no approved Disability or Incapacity determination.
Client Name List Box
Client Name – Lists only the names of parents with UP deprived children.
PWE – Displays ‘Y’ if the corresponding individual is indicated as the Primary Wage Earner in the PWE check box or ‘N’ if the corresponding individual is not.
PWE Hrs of Employment – Displays the number of hours from the Income window entered for Earned Income or Self Employment for the individual indicated as the PWE.
Exceed 100 Hrs Longer Than One Month – Displays ‘Y’ if the Yes check box from the PWE Hours of Employment is selected and ‘N’ if the No check box is selected. Displays ‘N’ for the individual that is not the Primary Wage Earner.
PWE Group Check Boxes
Yes – Select the Yes checkbox if the highlighted individual in the Client Name list box is determined to be the Primary Wage Earner.
No – Select the No checkbox if the highlighted individual in the Client Name list box is not the Primary Wage Earner.
Note: Only one individual may be selected as the PWE. The system allows the PWE to be changed, but should be processed according to Medicaid Policy. A work request has been written to enhance the system to follow the policy rules.
PWE Hours of Employment Group Box
Hours PWE Employed – Displays the number of hours the individual is employed for the Benefit Month as entered on the Income window for Earned Income and/or Self-Employment for the individual highlighted in the Client Name List Box that is indicated as the PWE.
Will the PWE’s hours of employment continue to exceed 100 Hours?
Yes – If the highlighted individual (PWE) expects the number of hours to continue, select the Yes checkbox.
No – If the highlighted individual (PWE) does not expect the number of hours to continue, select the No checkbox.
Make sure the ‘No’ is selected if the PWE’s hours are less than 100. If ‘Yes’ is selected and the hours are not 100 or more, the UP deprivation for Family Coverage still fails for the 100 Hour Rule. A work request has been written to enhance the system to follow the policy rules
When updating income after the Medicaid PWE/100 Hour Rule window is initially completed, this window does not display in the ongoing Eligibility Process. You must ‘Edit’ to the window to update the information and then run the Eligibility Process ongoing.
Unauthorization of UP Cases for Benefit Month of 01/2003 - Any cases with UP deprived children that are Family Coverage eligible that had 01/2003 authorized will be unauthorized with a job that will run tonight. Those cases that have all individuals in Transitional or Extended Medicaid periods and any cases that have all individuals as Medically Needy or Poverty Level will not be unauthorized.
No alert is created at this time if the case is unauthorized. Review your Caseload List to identify cases that were previously authorized and now display an ‘N’ under Medicaid in the Authorized column.
Pay special attention to your ‘MA Unauthorized’ alerts that appear on the Alerts window on Monday, December 16th.
NOTICES
The Transitional Eligibility sub form in the Medicaid Notification of Benefits Decision notice is changed to accommodate the change in policy. (Keyword – eligible individuals names) may remain eligible for Medicaid for a period of up to twelve months because of the caretaker's earnings, ‘or due to hours of employment’ is added to this sub form.
INTERFACE
There was a problem with Child Support referrals that had been DP’d (deleted) and at the time they were deleted the cooperation code was ‘NC’. This caused the Caretaker Relative to go to ‘RI’ and become ineligible for Medicaid. This problem is fixed to ignore the cooperation code on deleted referrals.
Vision User Manual
The Vision User Manual is updated to add the information for the Medicaid PWE/100 Hour Rule window.