MAGI HH Individual Determinations: Verification Required

 

Follow the below instructions when eligibility can be determined for part of the HH but verification is required to determine eligibility for the rest of the HH when processing an Application Case in MEDES.

 

Case Example: Application includes 3 HH members: Mom, Dad, and 1 in common child. Coverage is requested for Mom and Child only. Mom and Dad are not spouses. Dad is the only HH member with income. His income was found to not be reasonably compatible (RC) for the child’s eligibility. Mom is eligible, but child’s eligibility is pending income verification.

 

  1. Pend evidence requiring verification.
  2. Generate a Request for Verification (IM-31A) regarding the pending verification and leave application pending.
  3. Enter case comment on the HOH Person Page of all actions taken on case to include:
      1. HH member(s) whose eligibility can be determined.
      2. HH members(s) pending verification to determine eligibility.
      3. What evidence is pending, and verification requested.
  4. Complete Current™ task as Pending.
  5. Send email to Kelsey Walker and Amy Blankenship and CC Brandy Johnson.
      1. Subject Line: 31A Follow Up
      2. Body of email:
          1. HOH DCN
          2. A brief explanation supporting the need for the 31A and who is eligible regardless of the 31A.
  6. Follow Up:
      1. If verification is provided prior to 31A expiration date:
          1. Current™ NL VERF MAGI task is created.
          2. NL VERIF MAGI task is worked.
          3. AC is updated and authorized.
          4. Enter case comment on the HOH Person Page including all actions taken.
      2. If verification is not provided prior to 31A expiring:
          1. Kelsey and Amy will review to have the application processed.
          2. Change the app details to not requesting coverage for the applicant(s) whose eligibility cannot be determined without the verification.
              1. Evidence Dashboard > Application Details > toggle open applicant > select Edit from action menu > uncheck Applicant.
          3. Determine if the pending evidence will need to be removed or verified to finish processing for rest of HH.
              1. Examples:
                  1. SSN needed for HH member(s) and was not provided, change SSN evidence to ‘Not Applied For’. Add evidence comment that SSN or proof applied for was requested but participant failed to respond so evidence was changed to ‘Not Applied For’. Verify evidence with Other.
                  2. Income is not RC and verification is not provided. Income only effects part of the HH. Delete the income evidence and approve LOC for HH members(s) income did not effect.
          4. Check Eligibility for correct determinations and authorize AC for rest of HH.
          5. Send manual Notice of Case Action IM-33, with the below language, informing of the applicant being denied for failure to provide requested verification.
              1. IM-33 Language:
                  1. You have not sent the information we asked for which was needed to determine <participants name> eligibility for <level of coverage>. Since you did not provide the requested information <participant’s name> does not qualify. RSMo 208.010.1; RSMo 208.990.4; 13 CSR 40-2.010(2)(A)-(B)
          6. Make a comment on the HOH Person Page including all actions taken.