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04 – Managing an Integrated Case / CIC

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Step 1: Begin the Processing of a CIC #

 

Tools:

 

Guidance:

Step A: Are the changes being reported by a new application?

        • No- Proceed to step B: Review Integrated Case Pre-Work Checklist
        • Yes- Review for multiple Application Cases (AC) or existing Integrated Cases (IC) under the same Head of Household (HOH), or spouse of the HOH, and follow the questions below to determine the correct process to use.   To view HOH, from AC/IC Evidence Dashboard > Application Filer > HOH is the participant listed as the application filer

NOTE: MEDES leaves the oldest AND most recent applications while systematically withdrawing all other application. However, if a new application has not been received prior to this system update, only the original application may still be visible.  The system adds a comment under the Person Page when the system has withdrawn an application: ‘Multiple applications received. Systematically withdrew any application(s) with received dates between the oldest and the most recent unprocessed applications. Worker must review withdrawn application(s) to address any reported changes.’  There may be multiple applications that have been withdrawn. Continue to use the approved process of only looking at the most current application for any change in information.

 

Question 1: Are there multiple pending ACs under the same HOH (or spouse as the new application? Person Page > Home sub-tab > Application Cases

                • Yes:
                    • Compare information in the most recent AC or paper application to information in the original AC. Do not register the new application. NOTE: The lower AC reference number identifies the older AC.
                    • If information is the new AC or paper application is different than the older AC, update the older AC with the changes.
                    • Withdraw all other pending ACs
                    • Process the application per the Processing an Application guide.
                • No, proceed to Question 2

Question 2: Is there an active IC under the same HOH (or spouse) as the new application? Person Page > Home sub-tab > Current Cases

                • Yes:
                    • Treat the application as a change in circumstance (CIC). Update the IC with changes reported on the application. NOTE: Refer to the Annual Renewal MAGI guide if the IC has the “under Renewal” watermark. Use the application to complete the renewal.
                    • Withdraw pending AC
                    • Continue to Step 3 within “Begin the Processing of a CIC”
                • No, proceed to Question 3

Question 3: Is there an Inactive IC under the same HOH (or spouse) as the new application? Person Page > Information sub-tab > Cases Folder > Role column > Primary Client (When the participant is listed as the Primary Client this means they are the HOH on that case)

Step B: Review Integrated Case Pre-Work Checklist.

 

Note: If action results in no longer meeting eligibility due to: Receiving Medicare and/or SSI, age 65, or disability reported, and participant does not have an active or pending Non-MAGI, explore eligibility for Non-MAGI in FAMIS.

 

Step 2: Advanced Evidence Sharing (AES)/Incoming Evidence Management #

 

Screen Help

 Incoming Evidence

 

Guidance

Question 1: Are you updating an Integrated Case (IC) with a new Application Case (AC) and all evidence can be verified on the AC?

        • Yes – Verify all evidence on the AC and use AES to broker to the IC. End date all evidence that has changed on the IC, then follow directions in the Managing Incoming Evidence guide. NOTE: AES can only be used when the HOH is the same participant on both AC and IC. If HOH is a spouse, AES will not work, and evidence must be updated manually.
        • No – Continue to Question 2

Question 2: Are you updating an IC with a new AC and there is pending evidence on the AC?

        • Yes – Update evidence that has changed on the Integrated Case, generate the IM-31A from the Integrated Case and withdraw the AC. NOTE: Do no apply evidence changes unless an address change was also reported, then follow direction in MAGI Address Change on IC guide.
        • No – Continue to Question 3

 

Question 3: Are you working with an AC or IC with Incoming Evidence?

 

Question 4: Does the Integrated Case show no evidence?

 

Step 3: See below for Specific CIC guidance #

 

Address Change #

 

Guidance

 

Question 1: Was the address changed today and needs to be corrected?

Question 2: Is the Address Change a Safe at Home Address?

Question 3: Is the Address Change regarding an Unable to Locate address change?

        • Yes
          1. If you receive returned mail with no forwarding address, review sources available to FSD for a current address on phone number. Attempt to reach the participant by phone to confirm their residency and mailing address.
          2. If you cannot reach the participant, No action is taken. The case will close or expire if the annual renewal documents are not returned. See 2.8.5 Returned Mail for more information.
        • No – See Question 4

Question 4: Is the Address Change regarding a Homeless address change?

Question 5: For the Address Change on an Integrated Case, does the change apply to all household members?

Question 6: Is the Address Change on the Integrated Case being reported along with other changes?

 

Discuss & Clarify

Always use the USPS Recommended Address, if it is not available, contact the participant to ensure that the address listed is correct.

 

Renewal

If an Address Change is reported when completing an Annual Renewal, if there are other changes reported on the Annual Renewal, you must follow direction in the Address Change on Integrated Case/(CIC) starting on Step 13.

If an Address Change is reported on an Annual Renewal with no other changes, follow direction in the Address Change on Integrated Case/(CIC) Step 1-Step 12.

 

Comment/Note

  • HOH Person Page Note Subject: Change of Address
  • Note Body: Enter the following information as it applies:

    • Date Address Change Rec’d: Date new address became known to FSD
    • Rec’d by Method (EX-Change Report IM-145)
    • New Address
    • Any change in coverage as a result of change
    • Add’l Info: explain add’l or unusual info regarding change of address
    • If there is a different mailing address from the physical address case notes should be present to explain the situation
  • See MEDES Notes and Comments SOP for more guidance

 

Add-A-Person to an Integrated Case #

 

Tools

Guidance

 

Step 1: Review Integrated Case Pre-work checklist

 

Step 2: Determine if the person being added to the IC is already known to MEDES following direction in the Search for a Person (in MEDES) guide.

 

Step 3: Is the person being added to the Integrated Case a Newborn?

Step 4: Has this person been on the Integrated Case before and returning to the MAGI Household?

Step 5: Is the person being added on the Integrated Case a child who has health insurance available to them through a state employee?

 

Discuss & Clarify

You may need to contact the participant to determine certain information or evidence that might need to be included, such as, member relationships and dependents claimed by someone outside of the household.

Ensure that any insurance, disability, and PQ Medical Bills have been added to the Integrated Case, after the person has been added through the Guided Change Wizard.

Ensure that any participant that is added to the Application Case has appropriate Authorized Representative forms completed, if needed.

When applicable, request information for medical support cooperation. See Cooperation in Pursuit of Medical Support

 

Verification

Follow FCR steps to verify.

    • Can we get it?
      • Manual State of Federal Data Sources – MODL
    • If customer needs to provide verification, common verifications are:

NOTE: This in not an all inclusive list of evidences associated with Add A Person to an Integrated Case. Depending on the specifics of the case, there may be other evidence to verify.

 

Comment/Note

    • HOH Person Page Subject Line: Add A Person
    • Comment Body should include:
      • Person being added and any coverage changes
      • Verifications included or any needed
      • any other changes such as income updates or tax filing status and relationship updates.
      • Was the finalization completed?
      • What was the outcome of the action(s)?  Approval or Denial
      • Added HH member approved or denied;
      • CiC caused a better LOC, no change in LOC, AA, or closure of HH coverage
      • Calculators ran outside of MEDES
      • Date IMES/IIVE ran and if they are included in ECM (follow Policy on what should or should not be saved to ECM)

      Follow guidance in

      for specific details on what should be included in a comment and/or verifications or MEDES Notes and Comments SOP for more guidance see Tools > CCIU Guides > MAGI.

 

Adoption #

 

Guidance

When working a case that involves an adopted individual, DO NOT process the case or any changes/corrections. Pause work and follow steps in the  Adoption Review guide to have an adoption review completed on the case.

 

Adverse Action #

 

Tools

The Adverse Action Overview guide gives instruction of the Adverse Action process.

 

Guidance

Question 1: Does the Adverse Action have to do with the CS-201 form?

Question 2: Does the Adverse Action have to do with pending evidence verification?

Question 3: Does the Adverse Action have to do with a case with no pending evidence verification?

 

Discuss & Clarify

During the Adverse Action (AA) period, the benefits the participant(s) will receive after the AA period displays in the Determinations sub-tab of the Product Delivery Case. The Eligibility Timeline displays the benefits the participant(s) are receiving during the AA period. The Adverse Action period or a positive change in benefits is shown, after the nightly update. The details for all participants that have coverage are displayed.

 

To view the Eligibility Timeline:

    • Navigate to Integrated Case > Eligibility Timeline sub-tab
    • Toggle to expand each Coverage Period
        • You will see a coverage period for the current eligibility coverage
        • You will see a coverage period that reflects what the eligibility coverage will look like once the adverse action(s) expire
        • NOTE: The reason for the decision will not be displayed on the screen

 

 

Age Out #

 

Guidance

Question 1: Does the case contain a newborn (Child under 1 year of age)?

        • Yes- refer to the Newborn 1 Year Level of Care guide to ensure an ex parte review is completed to determine the newborn’s continued eligibility.
        • No- see Question 2.

Question 2: Does the case contain a child 18 years of age or within 2 months of his/her 18th birthday?

        • Yes- follow directions in the Student Attendance guide to ensure the child continues to receive the correct MO HealthNet LOC.
        • No- see Question 3.

Question 3: Does the case contain a participant age 65, a female age 56 receiving UWHS or a child age 19?

        • Yes- the Age Out guide to see the steps MEDES takes to determine continued MO HealthNet eligibility through the MHABD program

 

Comment/Note

  • HOH Person Page Note:
    • Label: Age Out
    • Body: Person removed and any coverage changes to the household member(s).

 

Alternative Care/Youth Services/Long Term Care (AC/YS/LTC) #

Guidance

Follow directions in the Alternative Care/Youth Services/Long Term Care Evidence on Integrated Case guide.

 

Application Filer Consent #

 

Guidance

Application Filer Consent (AFC) Evidence, is the applicant or participant’s consent which allows FSD to access the IRS HUB to confirm the individual’s self-attestation of his/her circumstance. As FSD does not access the IRS HUB at application or renewal, this evidence is not necessary and does not need to be added or updated.

 

If the participant requests to alter/revise their consent, follow the instructions below.

 

Application Filer Consent Evidence

      1. From the Integrated Case > Evidence sub-tab > Dashboard folder
      2. Click the Application Filer Consent hyperlink
      3. Click the ToggleToggle
      4. Click the List ActionList Action Menu menu
      5. Select Edit
      6. In the Participant Details field, ensure the HoH is showing
      7. Ensure the Received Date and Start Date fields reflect the date of the most current AFC Evidence
      8. Check the Use External Data checkbox if the HoH gives permission to use information obtained electronically through external data sources
      9. In the Years To Renew Coverage field, type the number of years granted on the IM-1U or Application
      10. Click Save

NOTE: History for this piece of evidence will be available under the Corrections tab.

      1. Apply Changes, Check Proposed Determinations and Finalize Proposed Determinations

NOTE: If an IM31A is sent on the case, do not apply ANY evidence changes until the IM-31A is sent and the requested information is returned. If not, the proper Adverse Action procedures will not be followed.

      1. Make a comment on the HoH Person Page describing action(s) taken

 

Authorized Representative #

 

Guidance

 

Question 1: Is the participant requesting an Auth Rep?

          • Yes – Proceed to Question 2

Question 2: Enter a comment

Question 3 Does a notice need to be sent to the Auth Rep?

 

 

Children’s Health Insurance Program (CHIP) #

 

Tools

 

Guidance

Question 1: Is the participant reporting a change in household composition or income that may move the family to a CHIP LOC?

Question 2: Have you received information from MO HealthNet Division that the participant has failed to pay their CHIP Premium?

Certification Period #

Guidance

Question 1: Are you editing an existing Certification Period?

Question 2: Are you adding a new Certification Period?

 

Citizenship Status #

 

Guidance

These instructions are specific to editing Citizen Status and this process should NOT be used to edit any other evidence in MEDES unless given specific instructions to do so.

Edit Citizen Status

      1. From the Integrated Case > Evidence sub-tab > Dashboard folder > Participant Data section
      2. Click Citizen Status hyperlink
      3. Toggle the Participant whose status needs updated
      4. Click List Action Menu
      5. Click Edit
      6. Received Date and Start Dates must be the date the change was reported to FSD

NOTE: If the dates in step 6 don’t match, this could cause an error

      1. Click Citizen Status dropdown
      2. Select the appropriate Citizen Status

NOTE: If present, DO NOT remove any data from the Date of Entry and Exempted Immigrant Status fields

      1. Click in the Comments field and notate whose Citizenship evidence was edited and why. List any coverage changes
      2. Click Save
      3. Verify all Outstanding Evidence
      4. Apply Changes, Check Proposed Determination, Finalize Proposed Determination

NOTE: MEDES may generate an additional proposed determination, especially in cases with income changes, adding a person, or removing a person. If the system generated an additional proposed determination, you must run the Finalize Proposed Determination again.

      1.  Enter comments:
        1. HoH Page Tab > Client Contact subtab > Notes folder:
          1. i. Synopsis or the reported change and any coverage changes
          2. Follow guidance in Tools > CCIU Guides > MAGI for specific details on what should be included in a comment and/or verifications or MEDES Notes and Comments SOP for more guidance

 

Verification

Follow FCR steps to verify.

  • Can we get it?
    • IIVE showing receipt of: Medicare; SSI; or SSDI
      • Note: Receipt of SSDI/SSI does not change from non-citizen to citizen status
    • IBTH
    • Missouri Driver License System (FUSION) only if Document Verification Indicator is ‘US Citizen Verified’ or ‘US Real ID Verified’
    • SAVE
  • If customer needs to provide verification, common verifications are:
    • Ask participant to upload to mydssupload.mo.gov.
      • Birth Certificate
      • US Passport
      • Certificates of citizenship or naturalization provided by USCIS
      • A valid Driver License issued to a self-attested US citizen from a state that requires citizenship verification prior to issuing the driver license.
        • Missouri meets this criteria.

 

Comment/Note

 

  • HOH Person Page Note:
    • Label: Citizenship Edit
    • Body: Notate whose Citizenship evidence was edited and why. List any coverage changes.
    • Follow guidance in Tools > CCIU Guides > MAGI for specific details on what should be included in a comment and/or verifications or MEDES Notes and Comments SOP for more guidance

 

Citizens of Federated States #

 

Tools

 

Discuss & Clarify

• Effective December 27, 2020, section 208 of the Consolidated Appropriations Act, 2021 requires states and the District of Columbia (DC) to provide Medicaid (Title XIX) coverage for individuals who are considered Compact of Free Association (COFA) migrants (also referred to as compact citizens)

• States and DC must cover COFA migrants in Medicaid as “qualified non-citizens” without a 5-year waiting period, if otherwise eligible under the Medicaid state plan or section 1115 demonstration

• The COFA Medicaid extension due to this legislation does not extend to the CHIP Program (Title XXI)

 

 

Date of Birth on an Integrated Case #

Tools

Guidance

Edit Date Of Birth

From the Integrated Case > Evidence sub-tab > Verifications folder

1. Select List Action menu next to Birth and Death Details evidence
2. Select Add Proof (this opens the Add Proof popup)
3. Select the dropdown in the Item field
4. Select the appropriate verification type
5. Select the dropdown in the Case Participant field
6. Select the participant providing the verification listed in Step 4 above

NOTE: If verifying Birth and Death Details with anything other than Self-Attestation, follow directions in the CCIU Guide > Verifications Process section to properly verify Birth and Death Details.

7. Select Save
8. Finalize Proposed Determination

NOTE: You do not have to Apply Changes if you are only editing the Date of Birth.

9. Enter Note:

a. Head-of-Household Page > Client Contact folder > Notes folder

i. State the date the Date of Birth was updated and why

Follow guidance in Tools > CCIU Guides > MAGI for specific details on what should be included in a comment and/or verifications or MEDES Notes and Comments SOP for more guidance

 

Death #

 

Guidance

Is this death misreported?

 

Verification

Self-Attestation is acceptable for Birth and Death Details evidence as the Verification Item. No notes are necessary if this Verification Item is used. If we use another Verification Item then comments must be entered to support the Verification Item selected. Follow guidance in Tools > CCIU Guides > MAGI for specific details on what should be included in a comment and/or verifications or MEDES Notes and Comments SOP for more guidance

 

Comment/Note

HOH Person Page Note
Label: Remove Participant
Comment Body should include:

      • List any participants removed, if any member relationships changed or tax status, or tax relationships were changed.
      • Verifications included or any needed
      • any other changes such as income updates or tax filing status and relationship updates.
      • Was the finalization completed?
      • What was the outcome of the action(s)?  Approval or Denial
      • Who was removed?
      • Removed person started closing process and did this affect other HH eligibility;
      • CiC caused a better LOC, no change in LOC, AA, or closure of HH coverage
      • Calculators ran outside of MEDES
      • Date IMES/IIVE ran and if they are included in ECM (follow Policy on what should or should not be saved to ECM)

 

Divorce #

 

Tools

 

Guidance

Review Integrated Case Pre-Work Checklist

When the head-of-household is the individual being removed from the home, coverage ends for household members age 19 and over. Children under 19 remain eligible due to Continuous Eligibility for Children (CEC).

 

Question 1 – Are the divorced participants living in the same household?

Question 2 – Follow direction in the Person Moved out of Household guide for the divorced participant leaving the home

 

Comment/Note

  • HOH Person Page Note:
    • Label: Member Divorce
    • Body: Include the name of the person removed and any changes in coverage.
  • Evidence Note: N/A

 

Employer Sponsored Insurance (ESI) on an Integrated Case #

 

Tools

 

Guidance

Question 1 – Is the participant reporting Employer Sponsored Insurance and the Policyholder Is a Member Of The Integrated Case?

Question 2 – Is the participant reporting Employer Sponsored Insurance and the Policyholder Is Not a Member Of The Integrated Case?

 

Extended Eligibility Evidence (EEE) #

Tools

 

Guidance

See Extended Eligibility Evidence / FAMIS Referral guide if you are working on a case with Extended Eligibility Evidence (EEE)

 

Comment/Note

HOH Person Page Note: (if applicable):
Note Subject: Extended Eligibility Evidence
Note Body: Leave a detailed note as to why the EEE has been closed.

Follow guidance in Tools > CCIU Guides > MAGI for specific details on what should be included in a comment and/or verifications or MEDES Notes and Comments SOP for more guidance

 

 

Incarceration #

 

Guidance

If the participant is in a suspended status, use the Suspended Participant guide.

 

 

Comment/Note

 

  •  HOH Person Page Note:
    • Label: Suspended participant who will no longer return to the home after incarceration
    • Body: Name of the suspended participant, how it was reported to FSD, who is the HOH, who is currently receiving MHN, other details regarding the information learned & a task was created for the Suspension Unit

 

Income #

 

Tools: 

 

Guidance

If the participant is no longer eligible for AEG due to new SSI income and does not have active or pending Non-MAGI, refer to Non-MAGI Application: Registering from the NL App MAGI Queue to explore Non-MAGI eligibility.

 

Question 1– Is this Income being reported for Transitional MO HealthNet (TMH)?

Question 2– Is there existing income that has ended?

Question 3– Is there a new income source being added?

Question 4 – Is this new income source expected to continue?

 

Discuss & Clarify

 

Review the Reasonable Compatibility guide for the process used to determine Reasonable Compatibility. When verifying income, using reasonable compatibility calculator, place a copy of the Reasonable Compatibility Calculator in the VFR.

 

When entering SSA and/or SSD Income Evidence, include the claim number. Entering Claim Numbers on SSA/SSD Income Evidence

 

Negative Income must be entered in MEDES when the participant’s self-employment income minus allowable expenses; including depreciation, equals a negative dollar amount. Follow direction in the Enter Negative Income guide to capture Negative Income.

 

When an income type is reported as ‘Other’, clarification must be gathered to determine if the income is countable or non-countable.  Use FCR to contact the applicant to clarify the type of income and obtain verification if necessary. Update the income type in the eligibility system if there is one available that is more appropriate than ‘other’. If unable to clarify income type, leave income evidence pending and Generate a Request for Information 31A for income verification.

 

Verification

 

Follow FCR steps to verify.

    • Can we get it?
        • Paystubs (trump EOI’s when there are discrepancies)
        • Electronically Obtained Information (EOI’s)
          • Federal Data Hub
    • If customer needs to provide verification, common verifications are:

Comment/Note

 

  • HOH Person Page Note (Head of Household Person Page):
    • Label: Reasonable Compatibility
  • Evidence Note: Detail of the budget for the particular source of income.
    • List the method that the income was verified, list each date of pay shown, amounts for each dates of pay, and frequency of pay. Total the income amounts for each date of pay, divide the total amounts by the number of pay dates for the average amount of income each frequency dates.
    • Example: Paystubs provided for 1/1/2020 $400.00, 1/15/2020 $400.00, and 2/1/2020 $400.00. For a total of $1200.00 paid at an average of $400.00 semi-monthly.
    • If using EOI’s and the Reasonable Compatibility Calculator was used, state why used and the percentage difference in the participant’s Self-Attested Income and the EOI’s. Also state a copy of the calculator is filed in the VFR.
    • Follow guidance in Tools > CCIU Guides > MAGI for specific details on what should be included in a comment and/or verifications or MEDES Notes and Comments SOP for more guidance

 

Legal Separation #

 

Guidance

Step 1: Review Integrated Case Pre-work Checklist

Step 2: Are the participants separating while married?

If the Head of Household is the participant moving out, the remaining household members must reapply to continue receiving benefits.

 

Comment/Note

  • HOH Person Page Note:
    • Label: Legal Separation
    • Body: List any participants change of coverage, if any member relationships, tax status, or tax relationships were changed.
  • Evidence Note: N/A

 

Medicare #

 

Guidance

The guide below gives the process to follow when an AEG participant starts receiving Medicare Part A or B and is no longer eligible for MAGI benefits.

    • For new SSI income refer to Income section for the process to add new income.

NOTE: If participant does not have active or pending MHABD refer to Non-MAGI Application: Registering from the NL App MAGI Queuefor MHABD referral.

 

    1. Edit MO Medicare Self Attestation evidence.
    2. From the Integrated Case > Dashboard > MO Medicare Self Attestation edit the existing evidence for any participant who are receiving Medicare Part A or B.
    3. Click Toggle
    4. Click the List Actions menu
    5. Select Edit.
    6. Select Yes For the question Is this person eligible now or will he/she be eligible within the next 12 months for Medicare Part A or Part B.
    7. Enter the date the participant became eligible for the question When did/will he/she become eligible for Medicare Part A or Part B.
    8. Click Save.
    9. Add MO Insurance Policy Details.
    10. From the Integrated Case > Dashboard > MO Insurance Policy Details create new evidence for any participant who are receiving Medicare Part A or B.
    11. Click + to add new evidence.Select the Case Participant who has Medicare.
    12. Select the Insurance Type (Medicare Part A or Medicare Part B).
        1. If participant has both Part A and B, then both insurances need to be entered.
    13. Enter Policy Start Date per IIVE.
    14. Enter Premium Amount per IIVE.
    15. Select Yes for Family Planning Services and Maternity Services.
    16. Click Save.
    17. Apply Changes, Check Proposed Determinations, and Finalize Proposed Determinations.

NOTE: Adverse Action period will start to begin closing of AEG.

 

Comment/Note

  • HOH Person Page Note:
    • Label: Medicare CIC / AEG closure
    • Body: Name of the participant receiving Medicare and AEG coverage closing, how it was reported to FSD, other details regarding the information learned & If MHABD referral is needed or actively receiving.

 

MHF and/or MPW Adult Receiving Due to PHE #

 

Guidance

The guide below gives the process to follow when a task (be it a CiC or application) is pulled that contains a Medicaid for Pregnant Women (MPW) and/or MO HealthNet for Families (MHF) adult that is no longer eligible but remains active due to the Public Health Emergency (PHE), to explore eligibility under the Adult Expansion Group (AEG) program.

 

MHF and/or MPW Adult Receiving Due To Public Health Emergency

      1. From the Integrated Case > Evidence sub-tab > Dashboard folder
      2. Add mandatory evidence for the AEG program

NOTE: Complete the following steps for all household members unless the member is a non-applicant/not receiving.

        1. MO Medicare Self-Attestation
          1. Hover over the MO Medicare Self-Attestation evidence
          2. Select the ‘+’ sign. This opens the New MO Medicare Self-Attestation popup box
          3. Received Date field must be the date adding the MO Medicare Self-Attestation evidence
          4. Select the dropdown in the Case Participant field
          5. Select the Participant you are adding the MO Medicare Self-Attestation evidence for
          6. Select the dropdown next to the field Is this person eligible now or will he/she be eligible for within the next 12 months for Medicare Part A or Part B?
          7. Select Yes or No

NOTE: If Applicable, select the When did/will he/she become eligible for Medicare Part A or Part B? field and type the date they became eligible for Medicare Part A or Part B

            1. viii. Select the Start Date field and type the date the MO Medicare Self-Attestation evidence is being added (this must match the Received Date field)
              ix. Select Save
            2. x. Complete Steps i. through vii for each adult no longer eligible for MPW and/or MHF due to the PHE
          2. MO MEC Self-Attestation for any child in the home not applying for benefits
            1. Hover over the MO MEC Self-Attestation evidence
            2. Select the ‘+’ sign. This opens the MO MEC Self-Attestation popup box
            3. Received Date field must be the date adding the MO MEC Self-Attestation evidence
            4. Select the dropdown in the Case Participant field
            5. Select the Participant you are adding the MO MEC Self-Attestation evidence for
            6. Select the dropdown in the Does this person have insurance that meets MEC? field
            7. Select Yes or No
            8. Select the Start Date field and type the date the MO MEC Self-Attestation evidence is being added (this must match the Received Date field)
            9. Select Save
            10. Complete Steps i. through xi for each child in the home not applying for benefits
      1. Select the Page Actions menu
      2. Select Apply Evidence Changes…
      3. Select each piece of evidence being applied
      4. Click Save
      5. Review Proposed Determinations on the Product Delivery Case

NOTE: If the adult(s) who were no longer eligible for MPW and/or MHF but remain active due to the PHE are now eligible for AEG, end the Extended Eligibility Evidence (EEE) from the Integrated Case > Dashboard folder by:

          1. Select the EEE, this opens the Extended Eligibility Evidence popup box
          2. Toggle open the person you are ending the Extended Eligibility Evidence with the description ‘Has an exception of type COVID-19’ for
          3. Select the Ellipsis
          4. Select Edit
          5. Select the End Date field
          6. Type the date the action is being taken (ending EEE)
          7. Select Save
          8. Complete steps a through g for each participant ending EEE for
        1. Select Page Action Menu
        2. Select Finalize Proposed Determinations (this opens the Finalize Proposed Determinations popup box)
        3.  Select Yes
        4. Make a NOTE on the HoH Person Page to include:
        5. Everyone whose Extended Eligibility Evidence was closed
        6. Any coverage changes

 

Name Change on an Integrated Case #

 

When a participant reports a name change and they are known to MEDES, follow the directions below to change their name.

 

NOTE: If the name change is due to an adoption, STOP. Follow steps in the Adoption Review guide to have an adoption review completed on their case.

**DO NOT UPDATE THE NAME(S) or SOCIAL SECURITY NUMBER(S) IN THE MEDES SYSTEM** this could cause a breach in confidentiality. Adopted names are reflected in SOVR/SUPD but not in MEDES at this time.

 

Before changing the participant’s name, FSD must have verification of the name change before making any changes in any systems. Some acceptable forms of verification are (but not limited to):

  • MODL
  • Marriage Certificates
  • Divorce Decrees

 

The participant’s name in MEDES and the Common Area must match.

 

Name Change in MEDES

 

    1. In the Common Area, always correct any incorrect customer information, such as name, date of birth, etc. on Common Client Data Update (SUPD).
      1. Use Correcting Information in the Common Area guide to Correct Name in the Common Area
    2. In MEDES, update the participant’s name on their Person Page > Evidence sub-tab > Evidence folder > Names evidence  NOTE: Only enter Legal names in MEDES. Any name change must be verified before changing. MODL, IBTH and any legal documents listing the new name may be used as verification.
      1. Select the List Action menu
      2. Select Edit
      3. In the Edit Names pop up box, type the correct the name in the required fields
        1. When entering names:
          1. Enter the Legal or complete first name (i.e. Bob’s legal name may be Robert, or he may go by his middle name James Robert).
          2. If last name is hyphenated, enter as one name with no dashes or spaces (i.e. Smith-Jones is entered SmithJones)
          3. Enter the complete middle name if known. This helps identify the individual, which is extremely important with multi-cultural and common surnames, who may only have differing middle names. If only the middle initial is known, enter it.
          4. Enter suffixes when known (i.e. Senior (Sr.), Junior (Jr.), III, etc.). This helps to identify specific members of the same family.
      4. Select Save
    3. Open the Integrated Case. The name change should display for the participant.

NOTE: If the name change does not display, stop. You will need to submit a MEDES Incident Ticket.

    1. Leave a NOTE on the HoH Person Page > Client Contact sub-tab > Notes folder stating:
      1. Date the name change reported
      2. Participant’s former name and new name
      3. What was used to verify the name change and where it is stored
      4. That the corresponding name change was made in the Common Area also

 

Newborn #

 

Tools

 

Guidance

Newborns can be reported as part of an application, change report, or MEDES Form 6 received.

 

Question 1 – Is the newborn being added using a manual process?

Question 2 – Has the newborn been searched for and found in the common area?

        • Yes– Continue Question 3
        • No–  Follow directions in the Full DCN Guide to search for and assign a DCN if needed. Then continue Step 3

Question 3 – Are participant(s) information correct in the Common Area?

Question 4 – Has the Newborn been searched for in MEDES?

Question 5 – Are there multiple applications registered for the Newborn?

Question 6 – Check for Missing Information:

Question 7 – Is participant’s mother receiving a qualifying Level of Care (LOC)?

        • Yes– Continue to Question 8
        • No– Use Add A Person Guide

Question 8 – Is the participant mother and newborn child living in the same household?

 

Verification

Follow FCR steps to verify.

      • Can we get it?
        • ID Details: Type SSN When Newborn NOT Born to Woman With Active Title XIX at Time of Baby’s Birth
          • Manual or State Data Sources – FAMIS, MACCS, SUPD, IIVE, etc
          • 90 Day Reasonable Opportunity
        • Citizenship Status without Identity
          • IBTH
          • 90 Day Reasonable Opportunity
        • Identity
          • Manual or State Data Sources – MODL
      • If customer needs to provide verification, common verifications are:
        • Ask participant to upload to mydssupload.mo.gov.
          • ID Details: Type SSN When Newborn NOT Born to Woman With Active Title XIX at Time of Baby’s Birth
            • Social Security Card
          • Citizenship Status without Identity
          • Identity
            • Driver’s License
          • US Passport

NOTE: This in not an all inclusive list of evidences associated with Add A Newborn. Depending on the specifics of the individual case, there may be other evidence to verify.

 

Comment/Note

  • HOH Person Page Subject: Adding Newborn
    Comment Body should include:
      • newborn being added and any coverage changes
      • Verifications included or any needed
      • any other changes such as income updates or tax filing status and relationship updates.
      • Was the finalization completed?
      • What was the outcome of the action(s)?  Approval or Denial
      • Added HH member approved or denied;
      • CiC caused a better LOC, no change in LOC, AA, or closure of HH coverage
      • Calculators ran outside of MEDES
      • Date IMES/IIVE ran and if they are included in ECM (follow Policy on what should or should not be saved to ECM)
      • Follow guidance in Tools > CCIU Guides > MAGI for specific details on what should be included in a comment and/or verifications or MEDES Notes and Comments SOP for more guidance

 

Pregnancy #

 

Tools

 

Guidance 

Pregnancy can be reported as part of an application, change report, or MEDES Form 1 received.

Question 1– Is there a new pregnancy?

Question 2– Is this an existing pregnancy needing edited?

Question 3 – Is the participant requesting MPW after the pregnancy has ended?

Question 4– Has this pregnancy ended?

 

Comment/Note

 

  • HOH Person Page Label: Pregnancy (added, edited, ended)
  • Note Body: Pregnancy evidence is typically verified by Self-Attestation. When we use Self Attestation as a Verification Item no comment is necessary. If we use any other Verification Item for Pregnancy evidence a comment explaining this must be added or it will result in an error. See Tools > CCIU Guides > MAGI pregnancy for more information.

 

Prior Quarter #

 

Tools: 

Guidance: 

If an IM-1SSL, web app, or a phone application is received, PQ is only pursued if requested by the participant.

 

When an application is received for an individual who has active MO HealthNet, do the following:

 

    • Determine if the individual has full coverage MO HealthNet. If so,
    • CiC’s that are reported timely, within ten (10) days of the change, are acted on back to the date the change occurred.
    • CiC’s that are reported non-timely, more than 10 days after the change occurred, are acted on based on the date the change is reported.

Note: If the individual is receiving a full benefits package during the requested PQ months, PQ cannot be granted even if eligibility exists.

 

If the individual is requesting MPW and received UWHS during the requested PQ months do not enter PQ evidence, as this will cause an overlap of existing benefits and PQ benefits resulting in downstream issues.  Review the Pregnancy evidence to make sure the start date is the 1st day of the PQ month the pregnancy began, or the 1st day of the month conceived, whichever is later based on the due date.

 

Question 1: Are you working with a participant who is requesting Prior Quarter on an existing Integrated Case?

Question 2: Are you working with a participant who has requested both Ongoing Health Benefits and Prior Quarter (PQ) Benefits, and you have authorized only one of these (Ongoing or PQ), but still need to authorize, withdraw, or deny the remaining benefits from the Integrated Case?

 

Reasonable Opportunity #

 

Tools

Guidance

  • RO is the period of time participants are allowed to provide documentation of citizenship status, ID or SSN for Newborns if status cannot be verified at application or before approval. If Verification is not provided, then MEDES will trigger an Adverse Action to close coverage.
  • The RO period begins the date the MHN application is approved. The Reasonable Opportunity Evidence tracks the due date and is automatically end dated once the verification is received and entered.

 

Question 1 – Are you editing existing Reasonable Opportunity evidence?

Question 2 – Are you creating new Reasonable Opportunity evidence?

 

Discuss & Clarify

    • If Citizenship verification is received and entered before the 90-day expiration of Reasonable Opportunity evidence, MEDES closes the task.
    • Continue to allow an RO period for Newborns without an SSN.
    • If the reasonable opportunity period is extended, MEDES will find the original task and extend the deadline to 12 days before the new deadline set in Reasonable Opportunity evidence.
    • If the reasonable opportunity period is not extended, MEDES will initiate the Adverse Action process.  When the IM-33C is sent, MEDES will close the task.

Comment/Note

 

Notes can also include:

    • Date information was requested and why
    • Reason requested
    • Date verifications rec’d/list of what was received
    • Additional Information: Explain add’l or unusual information regarding 90 day reasonable opportunity.

Notes should be entered on the 90-Day Reasonable Opportunity Verification Item to
explain why we are using this Verification Item.

 

 

Participant Moved out of Household – Integrated Case #

 

Tools

 

Guidance

Review: Integrated Case Pre-Work Checklist

If household member(s) moves out of the Head of Household’s (HOH) home, it may be necessary to move that person from the Integrated Case. Follow the guide below to remove person(s) from an Integrated Case

 

TO REMOVE A PERSON FROM A HOUSEHOLD 

If completing this task as part of a returned IM-1U, or if the case is Under Renewal, you must first follow steps to To Create a Manual Renewal and To Complete Manual Renewal.

 

When a child with active coverage has moved out of the home, but is NOT being applied for under another HH, contact the Help Desk to complete the process to ensure the child’s coverage stays active per CEC.

 

      1. Navigate to the Integrated Case > Evidence sub-tab > Dashboard folder
      2. Click on Application Details hyperlink
      3. Toggle open the participant to be removed from the Integrated Case
      4. Click the List Actionsmenu
      5. Click Edit
      6. Enter End Date (The End Date is the Report Date)

NOTE: If the person being removed from the Integrated Case is being moved to another case, the End Date must be the date prior to the date reported.

      1. Select End Reason from the drop down box
      2. Click Save Save Button
      3. Close the Application Details page tab
      4. Navigate back to the Dashboard folder
      5. Click on Addresses hyperlink
      6. Toggle open the participants Home Address to be ended
      7. Click the List Actions menu
      8. Click Edit
      9. Enter the appropriate end date in the TO field
      10. Click Save
      11. Select the USPS Recommended Address
      12. Click Save
      13. Toggle open the participants Mailing Address to be ended
      14. Click the List Actionsmenu
      15. Click Edit
      16. Enter the appropriate end date in the To field
      17. Click Save
      18. Select the USPS Recommended Address
      19. Click Save
      20. Repeat steps 1-25 for each person being removed from the Integrated Case
      21. Verify All Outstanding Verification
      22. Apply Changes; Check Proposed Determinations; Finalize Proposed Determinations

NOTE: MEDES may generate an additional proposed determination, especially in cases with income changes, adding a person, or removing a person. If the system generated an additional proposed determination, you must Finalize Proposed Determinations again.

      1. Check each person’s Person Page Address Evidence to ensure the end date has come over.
          1. Navigate to the person’s Person Page> Evidence Subtab> Evidence folder
          2. Check the Period Column for and end date on ALL Addresses evidence

NOTE: If addresses evidence from Source: Person Record exists but is not ended, end it as above, using the same date.

    30. Make a comment on HoH Person page to include

          1. Person Removed
          2. Any change in coverage

31. Review Notice Queue to make sure appropriate forms generated

      1. IM-80PRE: Generates in the event of coverage changes
      2. IM-80: Generates in the event of coverage changes
      3. IM-33C: Case Action Notice

 

Comment/Note

  • HOH Person Page  Note:
  • Note Subject: Person moved out of household
  • Comment Body should include:
      • List any participants removed, if any member relationships changed or tax status, or tax relationships were changed.
      • Verifications included or any needed
      • any other changes such as income updates or tax filing status and relationship updates.
      • Was the finalization completed?
      • What was the outcome of the action(s)?  Approval or Denial
      • Who was removed?
      • Removed person started closing process and did this affect other HH eligibility;
      • CIC caused a better LOC, no change in LOC, AA, or closure of HH coverage
      • Calculators ran outside of MEDES
      • Date IMES/IIVE ran and if they are included in ECM (follow Policy on what should or should not be saved to ECM)
      • Follow guidance in Tools > CCIU Guides > MAGI for specific details on what should be included in a comment and/or verifications or MEDES Notes and Comments SOP for more guidance

 

Show Me Healthy Babies #

 

Guidance

 

NOTE: The evidences below introduced in Step 2 are for SMHB only and will not affect anything regarding regular CHIP rules.

 

Question 1 – Is the SMHB participant a Non-Qualified Immigrant?

        • Yes – Identity/Citizenship/SSN documentation is a requirement for MPW but not for SMHB for non-qualified immigrants. Do not require Citizenship/Identity/SSN verification of nonqualified immigrants for SMHB. Follow Directions in Non-Citizen Lawful Presence guide, then see Question 2.
        • No – Question 2

Question 2 – Are you adding Employer Sponsored Insurance (ESI)?

Question 3 – Are the household members covered by or have access to ESI created in Question 1?

Question 4 – Is there a participant entitled to ESI and not listed in the MO Covered Member Evidence?

Question 5 – Are you working with a participant(s) whose ESI coverage has changed?

Question 6 – Are you working with a participant enrolled or entitled to ESI whose coverage has changed?

Question 7 – Are you working with a participant eligible for or enrolled in, private insurance?

Question 8 – Are you working with a participant covered by an insurance plan not employer sponsored?

Question 9 – Are you working with a pregnant household member who has provided self-attested insurance information?

Question 10 – Are you working with a pregnant household member that self-attested to no enrollment but has gained access to maternity insurance?

Question 11 – Do you need to edit maternity services evidence the FFM indicates affordable?

Question 12 – Has a Change in Circumstance (CiC) been completed that enrolled the participant in or granted access to insurance that covers all three phases of maternity services? If so, this will end SMHB coverage?

 

SSN Details #

 

Tools

IIVE

 

Guidance

 

Question 1: Do you need to add a Social Security Number to a participant’s Person Page:

Question 2: Are you Editing ID Details Evidence with Type Social Security Number on the Integrated Case?

 

Tax Filing Status & Tax Relationship #

 

Tools

 

Guidance

 

Question 1: Are you entering and application, adding a person to and Application or Integrated Case and do not know their Tax Filing Status or Tax Relationships to other household members?

Question 2: Are you changing a participant’s tax filing status?

 

Discuss & Clarify

When a Participant’s Tax Filing Status changes from the Tax Filer to any other status, the ES must end-date all tax relationships where the participant is listed as the filer.

If an individual is claimed as a tax dependent by a non-custodial parent or someone outside of the home they fall under non-filer rules.

 

Comment/Note

    • HOH Person Page Note:
      • Label: Tax Status and/or Tax Relationship Change
      • Body: Note who in the household’s tax status and/or relationship has changed, explanation of the change and any changes in coverage
    • Evidence Note: N/A

 

 Telephone Number #

 

Guidance

When a participant with an active IC reports a new phone number, use the directions below to add the phone number.

 

This is a two-step process; you must first add the phone number to the Person Page and then accept it as incoming evidence on the IC.

 

NOTE: Only add the phone number to the person reporting the change. DO NOT add the phone number for other household members.

 

Example: Mom, Dad and their two children receiving MHK. Mom calls in to report she has a new cell phone number. You only add the phone number to mom’s Person Page. Do not add the phone number to Dad or their children.

 

Issue: Currently there is a known issue that adding any Type of phone number other than Personal/Home, will not update the phone number in the context section of the Person Page. If an existing phone number listed as Personal/Home is ended and a new phone number added with any Type other than Personal/Home, the ended personal/home number continues to display in the contest section of the Person Page.

Mitigation: If an existing phone number is correct but the Type is anything other than Personal/Home, end date the existing phone number and reenter with the Type as Personal/Home. When adding a new phone number, ensure the Type is entered as Personal /Home and explain in the Note.

NOTE: This is a known issue so no Salesforce ticket is needed.

 

Add A Phone Number To An IC

Add Phone Number To Person Page

1.  From the Person Page > Evidence sub-tab
2. Ensure there are no other phone numbers showing in the Evidence list

NOTE: If there is already a phone number showing in the Evidence list, make sure it is not the number being reported. If it isn’t, you must end date it before adding the new phone number. If there is no phone number listed, proceed to step 3.

a. Select the List Action menu
b. Select Edit
c. In the To field, type the day prior to the day the new phone number was reported
d. Select Save

3. Select the Star Action menu
4. Select the List Action menu next to Phone Numbers
5. Select Add
6. In the New Phone Numbers popup box:

a. In the Area Code field type the Area Code
b. In the Phone Number field type the Phone Number
c. In the Phone Type field click the drop down and select the type of phone number
d. In the From field, click the calendar icon and select the date the new phone number was report.

NOTE: The Received Date and From Date must match

e. Select Save

NOTE: Refresh the screen and the new phone number should display in the Context section of the screen

Accept The New Phone Number On The IC As Incoming Evidence

1. From the Integrated Case > Evidence sub-tab > Incoming Evidence Folder > Identical tab
2. Locate the phone number you just added to the Person Page and select the List Action menu
3. Select Accept
4. In the Accept Evidence popup box, select the Yes button

NOTE: If you end dated any other phone numbers on the Person Page, you must also complete steps 2 – 4 above for that number(s) also

NOTE: There may be other evidence in the Incoming Evidence folder, Identical tab. Do Nothing with this evidence if you are only adding or changing a phone number

5. Apply Changes, Review Proposed Determinations, Finalize Proposed Determinations
6. Make a comment on the HoH Person Page to include:

a. Details regarding phone number addition

b. Any coverage changes

 

 

Transitional MO HealthNet #

 

Guidance

Refer to Transitional MO HealthNet (TMH) for the following situations:

    • Participant reporting a new source of income or an increase in earned income
    • You are working with a Transitional MO HealthNet quarterly report form
    • A case has resulted in an Incorrect Transitional Mo HealthNet determination

 

 

Voluntary Closing #

Tools

Guidance

The following guide gives instructions on how to close a case when a participant either requests the closure in writing or verbally or when closing AEG due to Non-MAGI participation.

 

NOTE: This is potentially a two-day process. Please review the NOTE after Step 16 to determine if this will be a two-day process.

 

Closing AEG due to Non-MAGI will be a two-day process.

 

Voluntary Closing

    1. From the Integrated Case > Evidence sub-tab > Dashboard folder
    2. Select Application Details hyperlink
    3. Toggle participant(s) the HoH is requesting coverage closed for
    4. Select List Action menu
    5. Select Edit (this opens the Edit Application Details popup box)
    6. Select End Date field
    7. Type the date the participant requested the case closed
        1. If closing AEG due to Non-MAGI, use the date prior to the current date
            1. A second set of Application Details will be needed, see NOTE after Step 10
    8. Select Dropdown in the End Reason field
    9. Select the appropriate End Reason
        1. Voluntarily closed – Notified in Writing, when the participant submits a written request
        2. Voluntarily closed – Not Notified in Writing, when the participant makes the request over the phone
        3. “AEG eligible for Mandatory Coverage” when the participant is approved for Non-MAGI and AEG needs to close
    10. Select Save
    11. If the participant is a specific member being closed but will remain in the home, complete the items within this step to create a second set of Application Details:
        1. Toggle the participant you are adding the second of Application Details for and make note of the Application Case ID Number. You will need this later.
        2. From the Application Details Page Tab
        3. Select Page Action Menu
        4. Select New (This opens the New Application Details popup box)
        5. Select the Received Date field
        6. Type date following the date the Application Details were ended
        7. Select dropdown in Case Participant field
        8. Select participant adding New Application Details for
        9. Select the Application ID field
        10. Type Application ID Number from Step A above
        11. DO NOT select the Applicant checkbox
        12. Select the Application Date field
        13. Type the date following the date the Application Details were ended (This must match the date in the Received Date field)
        14. Select Save
    1. Check for EEE and end as necessary
        1. Select the Extended Eligibility hyperlink
        2. Toggle participant(s) the HoH is requesting coverage closed for
        3. Select List Action menu
        4. Select Edit (this opens the Edit Application Details popup box)
        5. Select End Date field
        6. Type the current date
        7. Select Save
    2. Check for MOOE and end as necessary
        1. Select the MO Override Eligibility hyperlink
        2. Toggle participant(s) the HoH is requesting coverage closed for
        3. Select List Action menu
        4. Select Edit (this opens the Edit Application Details popup box)
        5. Select End Date field
        6. Type the current date
        7. Select Save
    3. If AEG is being closed due to Non-MAGI, check for any disability evidence and Medicare part A/B for the participant requesting the closure.
        1. Delete, do not end date, any Disability evidence.
        2. If the participant is now receiving Medicare part A/B, this must be entered under MO Insurance Policy Details and MO Medicare Self-Attestation
    4. Verify Outstanding Evidence (if applicable)
    5. Apply Changes, Review Proposed Determinations, Finalize Proposed Determinations

 

NOTE: Two-day process needed: If the participant voluntarily closing the case (whether in writing or verbally) has Disability and/or SSI Income Evidence, MEDES will create Extended Eligibility Evidence with the Exception Type ‘Referral to FAMIS’ overnight. For these cases, the processing worker must go back into the case the next day and end the Extended Eligibility Evidence with the Exception Type ‘Referral to FAMIS’, Apply Changes, Review Proposed Determinations, Finalize Proposed Determinations.

 

    1. Make a Note on the HoH Person Page:
        1. Change in household
        2. Change in any LOC’s

 

NOTE: When using the closing reason, ‘Voluntarily Closed – not notified in writing’ generates the IM-80PRE, IM-80 and IM-33C. DO NOT delete these notices as deleting will prevent the closure altogether.

 

Step 4: Verify Outstanding Evidence and/or Remove Evidence Verification #

Tools

 

Guidance

 

Question 1: Are you verifying evidence on the Integrated Case?

Note: If approving a child(ren) for non-premium MO HealthNet and one or both of the parents are not in the home, see Cooperation in Pursuit of Medical Support

 

Question 2: Do you need to remove/delete any evidence verifications on the Integrated Case?

        • If Yes:
          1. From the Integrated Case > Evidence sub-tab > Verifications folder
          2. Select the All tab within the Verifications folder
          3. Toggle open the evidence piece you wish to remove evidence verification from
          4. Scroll to the Verification Items Received section
          5. Select the List Action menu
          6. Select Remove
          7. Select Yes

NOTE: This piece of evidence has now been moved back to the Outstanding tab of the Verifications folder.

 

Step 5: Verifying Income Deductions #

There are certain types of deductions FSD will allow from a participant’s income. Deductions allowed for the calculation of MAGI income must be verified before allowing the expense.
Explore all available electronic data sources for verification prior to requesting this from the participant. If the participant does not provide the requested verification, authorize the Application Case without it. DO NOT reject the Application for failure to provide.

Policy References: 18.3.2 MAGI MO HealthNet – Flowcharts & Additional Texts

Related Evidence: Income

TO VERIFY INCOME DEDUCTIONS

    1. Review all evidence and check for completeness and Accuracy
    2. Review Application Prework Checklist to prevent potential Authorization Failed errors
    3. Verify all outstanding evidence

NOTE: Do not verify income source(s) until deductions are also verified. This allows MEDES to still pend while requesting proof of income deductions.

    1. Generate an IM31A to request information regarding the deductions claimed

NOTE: If the verification is not returned, authorize the Application Case without allowing the deduction

      5.  Review Case Details. Navigate to the Integtated Case page > Evidence sub-tab > Dashboard folder > click each evidence’s hyperlink to review for accuracy

 

Step 6: Request Verification #

Is there any evidence that is unable to be verified?

    • NOTE: If a Bypass is needed, see instructions below

 

Step 7: Close a Case Without Pending Verification for Non-Cooperation #

When an IM-31A is generated for a case without pending evidence verifications, the system will generate the IM-80 and IM-33C. However, On the expiration of the 31A the system will take action by discarding the IM80, 33C, and EEE as there is no Pending Evidence to close these case’s on.

If the participant does not cooperate, the ES must close the case manually.

NOTE: If the verification is for a CS-201, follow steps found in Adverse Action and CS-201

NOTE: DO NOT DELETE ANY NOTICES WITHOUT SUPERVISOR APPROVAL

IF PARTIAL OR NONE OF THE INFORMATION HAS BEEN RECEIVED

      1. After the IM-31A has expired, update any received evidence in edit
      2. Follow steps to Remove Eligibility From A Person On An IC for all participants using closing reason “Other”
        1. NOTE: This will cause the system to generate the Pre-80 (this gives the client 10 extra days), IM80, and IM33C to start closing the case
      3. Verify, Apply Changes, Review Proposed Determinations, and Finalize Proposed Determinations
      4. Though the closing reason will be incorrect, do not delete any notices
      5. Generate a Manual Notice to have the correct closing reason of Non-Cooperation

NOTE: MEDES will send the IM-33C on the scheduled date

IF THE CLIENT COOPERATES DURING THE CLOSING PROCESS

      1. Do not delete notices
      2. Follow steps to Cancel Close An Integrated Case

 

Step 8: Apply Changes, Review Proposed Determinations, Finalize Proposed Determinations #

Once a change or update is completed on an Integrated Case there is a process which must be completed in order and explore new eligibility redeterminations and commit those changes to MEDES.

 

If at any point you don’t see the correct determination, receive system errors, or incorrect notices stop and submit a MEDES Incident Ticket.

 

Before you can Apply, Review and Finalize Changes, ensure everyone on the Integrated Case has a DCN.

 

If you are sending and an IM31A with unverified evidence, follow the directions in the guide When To Apply Evidence On An IC When An IM31A Needs Sent

 

TO APPLY CHANGES, REVIEW PROPOSED DETERMINATIONS AND FINALIZE PROPOSED DETERMINATIONS

 

    1. Apply Changes
        1. Navigate to the Integrated Case page> Click  Page Actions  Menu
        2. Select Apply Evidence Changes
        3. Click checkbox beside each Type of evidence you want to apply
        4. Click Save  Save Button

NOTE: Do not apply changes made by another worker without thoroughly reviewing those changes and determining how it may affect ongoing eligibility

 

    1. Evaluate Anticipated Outcome
        1. Navigate to the Product Delivery Case> Determinations sub-tab > Current Determination folder
        2. Click  Open Toggle for the current coverage period and review all participants current benefits
        3. Navigate to the Proposed Determination folder
        4. Click  Open Toggle for the creation date
        5. Click Coverage Period date range starting with the creation date
        6. Evaluate Coverage Information for each participant to confirm the Category displayed is the same as your expectation of eligibility.
        7. Evaluate Excluded Members to confirm your expectation of ineligibility

NOTE: If MEDES does not display the eligibility you anticipated STOP! Review case or see troubleshooting guide. If unable to resolve, please submit a MEDES Incident Ticket. Otherwise, proceed to Step 3

 

NOTE: If anyone is receiving Alternative Care (AC) coverage through Children’s Division or Presumptive Eligibility (PE) coverage, follow the direction in the Closing Presumptive Eligibility Alternative Care Field Process prior to finalizing the proposed determinations.

 

NOTE: If you are completing a CIC, proceed to Step 3. If you are completing an Annual Renewal in conjunction with a CIC, proceed to Step 4.

 

    1. Finalize Determination
        1. Navigate to the Integrated Case page> Click Page Actions  Menu
        2. Select Finalize Proposed Determination…
        3. Click Yes Yes Button

 

    1. Finalize and Complete Annual Renewal
        1. Navigate to the Integrated Case page> Click Page Actions  Menu
        2. Select Finalize and Complete AR
        3. Click Yes Yes Button

NOTE: MEDES may generate an additional proposed determination, especially in cases with income changes, adding a person, or removing a person. If the system generated an additional proposed determination, you must Finalize Proposed Determinations again.

 

    1. Return to original CIC guide to complete necessary actions.

 

 

Step 9: Note/Comment #

HOH Person Page Label: Annual Renewal or Change in Circumstance

Comment Body should include:

    • Actions that were taken on the case
      • Annual Renewal
      • Processed Provided Verification
      • Address Change
      • Add-A-Person or Remove-A-Person
      • A Change in Circumstance such as income updates or tax filing status and relationship updates.
      • If staff do not have enough room to explain the PQ Income situation in the verification note, a HOH Person Page comment should be added to discuss the PQ income
    • Outcome of the action (approval/denial, etc)
    • Verifications included and/or requested
    • Calculators ran outside of MEDES
    • What was sent to the ECM/VFR (follow Policy on what should or should not be saved to ECM)

Follow guidance in Tools > CCIU Guides > MAGI for specific details on what should be included in a comment and/or verifications or MEDES Notes and Comments SOP for more guidance

 

Step 10: Review Notice Queue #

Tools:

Guidance:

Review Notice Queue to make sure appropriate forms generated based on actions taken

 

 

Bypass And Override #

 

Guidance

 

Question 1: Have you reviewed the Tips for using Override vs. Bypass guide?

Question 2: Will you be submitting a Bypass?

        • Yes – Review Bypass Entry guide
        • No – continue to Question 3

Question 3: Will you be entering MO Override Eligibility Evidence?

Question 4: Will you be editing MO Override Eligibility Evidence?

MAGI CIC, MEDES MAGI
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