Entering ESI Through Caseworker Portal – Parent Not Insured But Has Access To ESI, Child(ren) Has Access To ESI

*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 BUT HAS ACCESS TO ESI, AND CHILD(REN) HAVE ACCESS TO THE ESI

    1. Application Flow > Additional Household Information Additional Household Information Check Point section > Additional Information for Insured Household Members question no one is check as insured.
    2. Click the Next Next Button button
    3. On the screen ‘Additional Information for Access to any other Employer Sponsored Coverage’, select the adult(s) with access to ESI

NOTE: Do Not select any child(ren) with access to ESI

    1. Click the Next Next Button button
    2. In the ‘Is the policy holder a household member?’ question, click the dropdown and select Yes
    3. For the question, ‘Please choose the household member whose employment offers the insurance plan that would cover (child(ren) name(s) here) under the plan. If the member is not already listed on the application, please enter the member name’, click the radio button under the adult(s) with access to ESI.

NOTE: Do Not select any child(ren) with access to ESI

    1. Under the heading Plan Details, capture:
      1. Monthly cost of the plan. Enter the cost to insure the employed parent and the child(ren).
      2. Name of the employer
    2. Under the Family Planning Services heading, click the dropdown and select Yes or No
    3. 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. Click Next
    2. 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. Click Next Next Button button
    2. 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
    3. Click Next Next Button 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. From the Application Case > Evidence sub-tab > Dashboard folder
    2. Hover over MO Covered Member evidence and click the Add EvidenceAdd Evidence Icon 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 Next Button 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 the ESI is unaffordable, MEDES will allow CHIP coverage.