Entering ESI Through Caseworker Portal – Parent Insured And Chil(ren) Have Access To ESI

ENTERING ESI THROUGH THE CASEWORKER PORTAL – PARENT INSURED AND CHILD(REN) HAVE ACCESS TO ESI

1. 1. Application Flow > Additional Household Information section > Additional Information for Insured Household Members question
   2. For the question, ‘Please choose any of the people below who are enrolled in employer-sponsored coverage. Coverage could be either through their own employment or as an individual related to the employee.’ Check anyone who is insured by ESI (this should only be the parent(s))
   3. Click Next
   4. In the Is the policy holder a household member? question, click the dropdown and select Yes
   5. In the ‘If the policy holder is a household member, please select from the below household members box’, click the radio button under the policy holder
   6. Under the ‘Please choose which of the following household members are currently enrolled in this plan?’ question, check all applicable household members
   7. Under the Policy Details section:

NOTE: Fields with an asterisks* are mandatory fields

1. 1. 1. Policy Number
      2. Policy Start Date
      3. Group Policy Number
      4. * Monthly premium to insure the child(ren) who have access to the ESI in addition to the amount it costs to insure the policy holder. MEDES uses this to determine if the ESI is considered affordable.
      5. * Name of the insurance company
      6. Employer Name

1. 8. Under the Family Planning Services heading, click the dropdown and select Yes or No
   9. Under the Maternity Services heading, 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. 10. Click Next
   11. In the Enrolled in Any Other Employer Sponsored Coverage question box, click the dropdown and select Yes or No

NOTE: If you select yes, complete the next screen, Employer-Sponsored Coverage Information, following the directions in numbers 4 – 10 above

1. 12. Click Next button
   13. The next question box, ‘Additional Information for Access to any other Employer Sponsored Coverage’, DO NOT check any boxes for the child(ren) who have ESI access
   14. Click Next button

When the Application Case is created (drops) you must go to the Dashboard and manually add MO Covered Member evidence for the child(ren) who have access to ESI. See instructions below.

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

1. 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 (this is the ESI plan the parent has) 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

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 ESI is unaffordable then MEDES will allow CHIP coverage.

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