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MAGI Application Processing Field Process

This manual outlines the process of working MAGI cases in MEDES Eligibility system utilizing Current™ tasking system.

 

Tools:

MAGI App Process Flow Chart 

 

Directive #

MNH Eligibility will be processed from the Application Case (AC) when an applicant does not have an Integrated Case (IC). If the applicant has an IC, the application will be used as a change in circumstance (CIC).

 

  • An “Active IC” is an IC with at least one household (HH) member receiving active coverage. Active ICs and Product Delivery Cases (PDC) are located on the Person Page > Home sub-tab > Current Cases section.
    • An application is treated as a CIC when the HOH has an active IC
    • An application is treated as an annual renewal when the HOH has an active IC that is in the Renewal Period.

 

  • An “Inactive IC” is an IC where no HH members are receiving active coverage. Once all coverage has closed, the IC and PDC will be hidden from the Person Page. Inactive ICs and PDCs are located on the Person Page > Information sub-tab > Case folder.
    • An application is treated as a CIC when the HOH had an active IC at the time that it was received.
    • An application is treated as annual renewal when the HOH had an active IC that was in the Renewal Period at the time it was received.
      • When eligibility is reestablished on the inactive IC, it will reappear on the Person Page > Home sub-tab > Current Cases section the next day after it processes overnight.

 

When new eligibility is to be processed from the AC, this will generate a new IC/PDC rather than determining new eligibility from the inactive IC/PDC.

 

Refer to IM Resources for individual resources listed throughout this manual for help with processing. Refer to MEDES Application Life Cycle Quick Reference guide for additional MEDES case information.

 

Working in Current™ #

FSD staff will work from tasks in Current™ based on their skill sets.

 

Staff will hit ‘Get Next’ to pull a task to work. Tasks are arranged into queues. Refer to Current Queue Descriptions for a list of the most utilized queues in current and their descriptions.

 

When working tasks from NL APP MAGI queue, staff are to run Insights Engine and save the PDF to ECM.

    • Insights Engine will review the case for potential SNAP flexibility and compare income reported on the application with EOI for reasonable compatibility.
    • All participants on the AC must have a DCN before Insights Engine can be ran.
    • NOTE: Refer to Duplicate MEDES ID process when resolving Duplicate MEDES ID’s on the AC.
        • Duplicate MEDES IDs on AC with no active IC:
            • When HOH has a duplicate MEDES ID, withdraw the AC and re-register the application under the correct MEDES ID. This will create a new NL APP MAGI task. Run Insights Engine if the staff member working the application has access to the new task.
            • When a HH member(s) has a duplicate MEDES ID’s, remove the HH member(s) from the AC and add the correct MEDES ID via guided change. Run Insights Engine once duplicates have been resolved.
        • Duplicate MEDES ID’s on AC with active IC:
            • When any participants has a duplicate MEDES ID and AC is used as a CIC, DO NOT resolve ID’s on the AC for the purpose of running Insights Engine. Withdraw the AC and merge duplicate MEDES IDs. Make a comment under HOH person page that Insights Engine was not ran due to duplicate IDs and AC used as a CIC.

 

When to Process an Application for New Eligibility vs. Change in Circumstance vs. Annual Renewal #

Process Application:

Process eligibility from AC when the application HOH is:

    • New to MEDES.
    • Not HOH (or spouse) on any active ICs.
    • HOH (or spouse) of an inactive IC and application is received after case closed.
    • HOH (or spouse) of an inactive IC and application is received after Renewal Period but during the Reconsideration period.  Explore Prior Quarter on the application.
      1. From AC Dashboard, Manage Incoming Evidence, verify pending evidence and make verification comments under the evidence.
      2. Complete eligibility check and authorize or deny benefits creating new IC/PDC.
      3. Make case comments under HOH Person Page.
        • NOTE: Evidence that has been verified by the system does not need to be re-verified by the worker.  Items pending verification will have a green triangle next to it on the Evidence Dashboard and are listed under Verifications > Outstanding > Items for Verification.

 

Change in Circumstance (CIC):

Applications are used as a CIC when the application HOH is:

    • HOH (or spouse) of an active IC.
    • HOH (or spouse) of an inactive IC and application was received prior to case closing.

Update the IC with changes reported on the AC, or paper application.  Utilize Advanced Evidence Sharing (AES) or manual entry for active ICs. Inactive ICs must be manually updated.

NOTE: For Active ICs, if HOH are spouses; evidence will have to be manually updated as AES will not work when HOH is not the same between both cases.

    • Updating the active IC with AC utilizing AES:
      1. Manage Incoming Evidence on AC by either ‘adding as new’, ‘ignoring’, or in very few instances, ‘accepting incoming evidence.’.
      2. Verify pending evidence on AC and broker to IC.
      3. First, end date all evidence that has changed on IC.
      4. Manage Incoming Evidence on IC by either ‘adding as new’, ‘ignoring’, or in very few instances, ‘accepting incoming evidence.’
      5. Verify pending evidence and make verification comments under the evidence.
      6. Apply changes on IC and view proposed determinations on PDC.
      7. Finalize IC to approve or deny eligibility.
      8. Review PDC for no on-hold determinations and finalize IC again if applicable.
      9. Make case comments under HOH Person Page.
    • Update the active IC with AC manually:
      1. Compare AC or application with IC for any changes.
      2. First, end date all evidence that has changed on IC.
      3. Manage Incoming Evidence on IC by either ‘adding as new’, ‘ignoring’, or in very few instances, ‘accepting incoming evidence.’
      4. Add new evidence changes from AC or application to IC, effective the date of the AC/application.
      5. Verify pending evidence and make verification comments under the evidence.
      6. Apply changes on IC and view proposed determinations on PDC.
      7. Finalize IC to approve or deny eligibility.
      8. Review PDC for no on-hold determinations and finalize IC again if applicable.
      9. Make case comments under HOH Person Page.
      10. NOTE: If updating from AC and AES was not used, withdraw AC using reason ‘Change in Circumstance’. If updating from paper application, do not register application.
    • Update the inactive IC with AC manually to re-open the case:
      1. Review the Eligibility Timeline on the inactive IC for date coverage closed.
      2. When application is received prior to the case closing, refer to Cancel Closing Integrated Cases Guide for the specific process to use the application as a CIC on an inactive IC.

Annual Renewal:

Applications are used to complete an Annual Renewal when the application HOH is:

  • HOH (or spouse) of an active IC and application is received during Renewal Period.
  • HOH (or spouse) of an inactive IC and application is received during Renewal Period but was not processed timely causing the case to close.
    1. Review date the IM-1U was sent and closure reason on the IM-33C Action Notice.
      • Person Page > Client Contact sub-tab > Communications folder
    2. Review Eligibility Timeline on the inactive IC for date coverage closed.
    3. When application is received between when IM-1U was sent and prior to the case closing due to non-return of IM-1U; refer to MAGI Annual Renewal Guide and use application in lieu of IM-1U to complete Annual Renewal.

 

How to Determine Head of Household #

HOH must be the HH member who filed the application. MEDES determines HOH as the HH member listed as the primary applicant. In most cases, the primary applicant and the application filer are same HH member. Applicants who apply online, through the citizen portal, have the option to select another adult HH member the HOH. In these cases, the primary applicant must be updated to match the application filer, so the HOH is listed as the correct HH member. Refer to Household Composition- MAGI guide for instructions to correct the HOH.

    • Applicant filer is located on both AC and IC, from Evidence > Dashboard > Application Filer.
    • Primary applicant is located on both AC and IC, from Evidence > Dashboard > Application Details.
    • For an IC to be updated with an AC, the HOH on both must be the same person or their spouse.
    • AES will only broker evidence from an AC to an IC when the HOH is the same person.
        • If the HOH are spouses, the evidence will have to be manually updated.

 

MAGI Application Registration Queue- ‘NL REGISTRATION MEDES’ Current™ Task #

    1. Search for applicant in MEDES utilizing person search function, then select to view person page.
        1. Complete a wide search before adding applicant into MEDES. This will avoid creating duplicate participants.
    2. Are there any active ICs that have the same HOH (or spouse of each other) as the application?
        1. YES– Continue to step 3.
        2. NO– Skip to step 4.
    3. Does active IC have the Under Renewal watermark?
        1. YES– Refer to MAGI Annual Renewal Guide and use application to complete the renewal.
        2. NO– Do not register application, process as CIC.
          1. Run Insights Engine.
          2. NO– Do not register application, process as CIC.
            1. Run Insights Engine.
            2. Compare new application with IC and update IC with any changes reported, Manage Incoming Evidence, apply address changes if any, verify pending evidence.
              1. If no verification is required, apply rest of evidence changes, view proposed determinations on PDC, finalize IC to approve or deny eligibility, check PDC for any on-hold determinations and finalize again if necessary.
              2. If verification is required, DO NOT apply in edit evidence, besides addresses. Send 31A from IC, make case comments, and complete Current™ task.
              3. NOTE: If an address change was reported, and verification is required, follow directions in the Address Change Reported with Another CIC guide.
            3. Make case comments under HOH Person Page.
            4. Add outcome to Current™ task and complete.
              1. If not trained to process changes, update Current™ task for ‘NL CHANGE MAGI’ and re-queue per the Incorrectly Queued Current Tasks guide.
    4. Are there any inactive ICs that have the same HOH (or spouse of each other) as the application?
        1. YES– Continue to step 5.
        2. NO– Register application then process eligibility from AC.
          1. Run and save Insights Engine.
          2. From AC Dashboard, Manage Incoming Evidence, verify pending evidence, check eligibility, authorize to approve or deny eligibility and create new IC/PDC.
          3. Make case comment under HOH Person Page.
          4. Add outcome to Current™ task and complete.
            1. If not trained to process, register application only, enter case comment under HOH Peron Page, and mark Current™ task as completed.
    5. Did inactive IC close for failure to return IM-1U?
        1. YES-Continue to step 6.
        2. NO– Skip to step 8.
    6. Was application received during the Renewal Period?
        1. YES– Refer to MAGI Annual Renewal Guide and use the application to complete the renewal.
        2. NO– Continue to step 7.
    7. Was application received during the Reconsideration Period (AR Recon Prd)?
        1. YES– Refer to the Processing Annual Renewal during the Reconsideration period. Register application then process eligibility from the AC. Explore PQ.
          1. If not trained to process, register application only, enter case comment under HOH Peron Page, and mark Current™ task as completed.
        2. NO– Register application then process eligibility from AC.
          1. Run and save Insights Engine.
          2. From AC Dashboard, Manage Incoming Evidence, verify pending evidence, check eligibility, authorize to approve or deny eligibility and create new IC/PDC.
          3. Make case comment under HOH Person Page.
          4. Add outcome to Current™ task and complete.
            1. If not trained to process, register application only, enter case comment under HOH Peron Page, and mark Current™ task as completed.
    8. Was application received prior to the case closing?
        1. YES– Do not register the app, refer to the Cancel Closing Integrated Cases Guide and use the application to complete a CIC.
          1. If not trained to process, register application only, enter case comment under HOH Peron Page, and mark Current™ task as completed.
        2. NO– Register application then process eligibility from AC.
          1. Add and work a MAGI Change Task in Current™
            1. This will bundle the application tasks, so Insights Engine is available.
          2. Run Insights Engine.
          3. From AC Dashboard, Manage Incoming Evidence, verify pending evidence, check eligibility, authorize to approve or deny eligibility and create new IC/PDC.
          4. Make case comment under HOH Person Page.
          5. Add outcome to Current™ tasks and complete.
            1. If not trained to process, register application only, enter case comment under HOH Peron Page, and mark Current™ task as completed.

 

MAGI Application Processing Queue- ‘NL APP MAGI’ Current™ Task #

  1. Search applicant in MEDES utilizing person search function, then select to view their person page.
    • If person page does not have a DCN, use the DCN Search Guide to complete a thorough DCN search prior to creating a new DCN in the Common Area and assigning the DCN in MEDES. This will avoid creating duplicate DCN’s.
  2. Are there any active ICs that have the same HOH (or spouse of each other) as the application?
      1. YES– Continue to step 3.
      2. NO– Skip to step 4.
  3. Does active IC have the Under Renewal watermark?
      1. YES- Refer to the MAGI Annual Renewal Guide and use the application to complete the renewal.
      2. NO– Process as a CIC
        1. Run and save Insights Engine.
        2. Compare AC with IC and update IC with any changes reported, Manage Incoming Evidence, apply address changes if any, verify pending evidence.
          1. If no verification is required, apply rest of evidence changes, view proposed determinations on PDC, finalize IC to approve or deny eligibility, check PDC for any on-hold determinations and finalize again if necessary.
          2. If verification is required, DO NOT apply in edit evidence. Send 31A from IC, withdraw AC, make case comments, and complete Current™ task.
        3. NOTE: If an address change was reported, and verification is required, follow directions in the Address Change Reported with Another CIC guide.
        4. Withdraw AC.
        5. Make case comments under HOH Person Page.
        6. Add outcome to Current™ task and complete.
  4. Are there any inactive ICs that have the same HOH (or spouse of each other) as the application?
      1. YES– Continue to step 5.
      2. NO– Process eligibility from AC.
        1. Run and save Insights Engine.
        2. From AC Dashboard, Manage Incoming Evidence, verify pending evidence, check eligibility, authorize to approve or deny eligibility and create new IC/PDC.
        3. Make case comments under HOH Person Page.
        4. Add outcome to Current™ task and complete.
  5. Did inactive IC close for failure to return IM-1U?
      1. YES-Continue to step 6.
      2. NO– Skip to step 8.
  6. Was application received during Renewal Period?
      1. YES– Refer to MAGI Annual Renewal Guide and use the application to complete the renewal.
      2. NO– Continue to step 7.
  7. Was application received during the Reconsideration Period (RECON Prd)?
      1. YES– Refer to the Processing Annual Renewal during the Reconsideration period. Process eligibility from the AC. Explore PQ.
      2. NO– Process eligibility from AC.
        1. Run and save Insights Engine.
        2. From AC Dashboard, Manage Incoming Evidence, verify pending evidence, check eligibility, authorize to approve or deny eligibility and create new IC/PDC.
        3. Make case comment under HOH Person Page.
        4. Add outcome to Current™ task and complete.
  8. Was application received prior to the case closing?
      1. YES– Refer to the Cancel Closing Integrated Cases Guide and use the application to complete a CIC.
      2. NO- Process eligibility from AC.
        1. Run and save Insights Engine.
        2. From AC Dashboard, Manage Incoming Evidence, verify pending evidence, check eligibility, authorize to approve or deny eligibility and create new IC/PDC.
        3. Make case comments under HOH Person Page.
        4. Add outcome to Current™ task and complete.

 

When an Applicant has Multiple Applications #

New Application Processing:

    1. Compare evidence between newest application/AC and oldest dated AC.
    2. Treat newest application/AC as a CIC and update oldest dated AC.
    3. Process eligibility from oldest AC.
    4. Withdraw all other AC’s per the MAGI Withdraw an Application
        1. If registering and processing, do not register new application.
        2. If not trained to process, do not register new application. Update Current™ task for NL CHANGE MAGI and re-queue per the Incorrectly Queued Current Tasks

 

CIC processing:

    1. Compare evidence between newest application/AC and IC.
    2. Treat newest application/AC as a CIC and update IC.
    3. Process eligibility from IC.
    4. Withdraw all AC’s.
        1. If registering and processing, do not register new application.
        2. If not trained to process, do not register new application. Update Current™ task for NL CHANGE MAGI and re-queue per Incorrectly Queued Current Tasks

NOTE: When updating an inactive IC and pending for verification, do not withdraw the AC. Send system 31A from AC. If verification is provided AC is withdrawn and IC cancel closed, if verification is not provided system will deny the application and send a rejection notice leaving the IC inactive.

 

Cancel Close/Re-Open Process #

Follow instructions in the Cancel Reject / Cancel Close in MEDES guide to manually re-open case.  An AC/IC can be re-opened under specific conditions:

  • Agency Error: If denial was due to an error made by the agency.
  • A hearing decision requires the case be re-opened.
  • IM-SSL or CIC received with in the certification period prior to the case closing not processed timely.
  • Annual Renewal received prior to the case closing not completed timely.
    • When the ‘AR Recon Prd’ watermark is present, refer to the CCL AR Not Processed Timely to systematically cancel close the case and complete the renewal. When the ‘AR Recon Prd’ watermark is no longer present, the case must be cancel closed manually.

 

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