To Re-Add/Add Eligibility for an Existing Participant on an Integrated Case

TO RE-ADD/ ADD ELIGIBIITY FOR AN EXISTING PARTICIPANT ON AN INTEGRATED CASE

NOTE: If the person you are adding or re-adding eligibility for is receiving Continuous Eligibility for Children (CEC) coverage on another case, you MUST follow direction below in Re-Add / Adding Eligibility for a Participant on an Integrated Case Using Guided Change.

If the person you are adding or re-adding eligibility for is not receiving CEC coverage, you may either follow the directions beginning in Re-Add / Adding Eligibility for a Participant on an Integrated Case Using Guided Change or follow the directions in Re-Add / Adding Eligibility for a Participant on an Integrated Case Using Application Details Evidence

Re-Add / Adding Eligibility for a Participant on an Integrated Case Using Guided Change

1. Navigate to the Integrated Case
2. Click the Page Actions menu
3. Select Guided Change
4. Select Add a Member…. This opens the Existing Participant popup
5. Date Reported must be the date coverage requested
6. If the participant is a child (ages 0 – 18) and actively receiving coverage (active, open Application Details) click the dropdown in the Active Applicant (CEC Transfer Only) – Participant has active CEC period in another household (Only for children ages 0 – 18) field and select the participant.
7. Click This opens the Are you transferring CEC eligibility for this individual from another IC? popup.
   1. Under the Integrated Cases heading, select the radio button next to the IC you are transferring the CEC benefits from.
   2. Proceed to Step 10.
8. If the participant is inactive in MEDES (Application Details are end dated) click the dropdown in the Inactive Case Participant (Previous HH member, no active app details) field and select the participant. Proceed to Step 10.
9. If the participant is currently included in the IC but was not requesting coverage, click the dropdown in the Active non-applicant participant (Currently included in the HH now requesting coverage) field and select the participant.
   1. If the participant is between the ages of 0 – 18 you will be taken to the, Are you transferring CEC eligibility for this individual from another IC?
      1. Select the checkbox next to the question, ‘If you will not transfer CEC benefits from an existing IC’ if you will not be transferring CEC coverage.
      2. If you are transferring CEC coverage, select the Radio Button next to the IC you wish to transfer coverage from and proceed to Step 11.
   2. If the participant is over the age of 18, you will be taken to the Summary screen. Proceed to Step 11.

10. Click Next. This opens the Summary popup.
11. Select Finish

NOTE: Evidence may need to be added and/or updated based on the person requesting coverage. Some mandatory evidence may not have been captured if the participant did not originally request benefits:

• Id Details: Type SSN
• Citizen Status
• MO Medicare Self-Attestation

Other evidence to check may include:

• Member relationship
• Tax Filing Status
• Tax Relationship
• Demographics
• Home/Mailing Address

12. Verify All Outstanding Evidence

NOTE:  If verifications cannot be completed, Apply Changes to addresses and send an IM-31a requesting any needed information.

13. Apply Changes, Check Proposed Determinations, Finalize Proposed Determination
14. Make a comment on the HoH Person Page to include:
    1. Person added
    2. Any coverage changes
15. Review notice queue to make sure appropriate forms generated
    1. See Notice Triggers Document

Re-Add / Adding Eligibility for a Participant on an Integrated Case Using Application Details Evidence

1. Navigate to the Integrated Case > Evidence sub-tab > Dashboard folder

2. Click on Application Details hyperlink
3. Toggle open (twice) the evidence details of the member now requesting eligibility and copy the Application ID. This will be used later in Step 12.

NOTE: If Application Details are already end dated, skip to step 10

4. From the Application Details evidence of the person requesting coverage,
5. Select the List Actions  menu
6. Select Edit
7. Enter End Date as previous day to the Received Date*
   • • (*If a participant is moving back from another IC, but was not end dated correctly on this IC, end the evidence for the date they left this IC Originally)
8. Select End Reason drop down box and select Requesting Benefits
9. Select Save
10. Select the Page Actions menu
11. Select New
12. Select Participant requesting coverage from the drop-down box
13. In the Application Details section, complete the following:
    • • Application ID (copied in step 3 above)
      • Application Date (must be after the date Application Details were ended and match the Received Date of the request)
      • Check the Applicant check box if the person being added is requesting coverage

NOTE: If the participant requesting coverage is the Head of Household (HoH), check the Primary Applicant check box

14. Click Save
15. Close the Application Details page tab

NOTE: Evidence may need to be added and/or updated based on the person requesting coverage. Some mandatory evidence may not have been captured if the participant did not originally request benefits:

• ID Details: Type SSN
• Citizen Status
• MO Medicare Self-Attestation

Other evidence to check may include:

• Member relationship
• Tax Filing Status
• Tax Relationship
• Demographics
• Home/Mailing address

16. Verify All Outstanding Evidence

NOTE: If verifications cannot be completed, Apply Changes to addresses and send an IM-31a requesting any needed information

17. Apply Changes, Check Proposed Determination, Finalize Proposed Determination
18. Make a comment on the HoH Person Page to include:
    • Person added
    • Any coverage changes

19. Review notice queue to make sure appropriate forms generated
    • See Notice Triggers Document