Entering ESI Through Caseworker Portal – Parent Not Insured With No Access To ESI But Child(ren) Have Access From A Person Outside The Home

*The following is a mitigation guide to be used until CHIP functionality is updated in MEDES.

*MO Employer Sponsored Insurance and MO Covered Member evidence will be used for CHIP determinations. Please do not use Employer Sponsored Insurance or Covered Member evidence located under Income evidence.

ENTERING ESI THROUGH THE CASEWORKER PORTAL – PARENT NOT INSURED WITH NO ACCESS TO ESI BUT CHILD(REN) HAVE ACCESS FROM A PERSON OUTSIDE THE HOME

1. Application Flow > Additional Household Information section > Additional Information for Access to any other Employer Sponsored Covereage question
2. For the screen with the first question, ‘Please select household members who have access to employer sponsored insurance plans through either their own employment or as an individual related to an employee’. Select No one on this screen
3. Click Next button
4. For the question, ‘Please select household members who have access to employer sponsored insurance plans through either their own employment or as an individual related to an employee. Please click the check box below only when the plan information has not already been indicated’ Check ONLY the child(ren) who has access to ESI through a non-household member.
5. Click Next button
6. In the Access to Other Employer Sponsored Insurance question:

1. 1. In the Employer Sponsored Insurance Plan Information heading, Is the policy holder a household member? question
    1. Click the dropdown and select No
    2. Capture the non-household member information

1. Under the Plan Details heading:
  1. For the question ‘Please enter the monthly cost of the plan to cover under the policy’ capture the cost of ESI to insure the child(ren) who have access to ESI and policy holder
  2. Capture the name of the employer in the ‘Name of the Employer’ field
2. In the Family Planning Services field, click the dropdown and select Yes or No
3. In the Maternity Services field, click the dropdown and select Yes or No

NOTE: Selecting Yes for the question ‘Does this plan provide access to Maternity Services?’ will generate 3 additional questions. Click the dropdown next to each question and select Yes or No

1. Click Next button and continue the application flown

When the Application Case is created (drops) the child(ren) should show as the policy holder under MO Employer Sponsored Coverage evidence. DO NOT enter MO Covered Member evidence for the child(ren).

NOTE: IF the applicant does show as the policy holder under MO Employer Sponsored Coverage evidence, you must create (add) MO Covered Member evidence for the child(ren).

Add MO Covered Member Evidence For Child(ren) With Access To ESI

1. From the Application Case > Evidence sub-tab > Dashboard folder
2. Hover over MO Covered Member evidence and click the Add Evidence icon
3. In the New MO Covered Member evidence pop up box, click the radio button next to the MO Employer Sponsored Coverage evidence type
4. Click Next button
5. In the Person field, click the dropdown and select the child who has access to ESI
6. In the Coverage Details field:
  1. In the Coverage Status field, click the dropdown and select Entitled
  2. The Start Date is the date the child had access to the ESI plan

NOTE: Do Not enter anything in the Monthly Cost to Enroll Participant in the plan field

1. Click Finish button

When the Eligibility Check is ran, if the income puts the child(ren) who have access to affordable ESI at a CHIP Level of Care (LOC), the child(ren) will show as ineligible. If the ESI is not affordable MEDES will allow CHIP.

A corrected rejection notice must be sent stating (insert P&P approved verbiage here). DO NOT delete the system generated IM-33.