Edit MO Covered Member Evidence

If a household member is covered by Employer Sponsored Insurance (ESI), evidence is created on the MO Covered Member screen. Use the following to edit MO Covered Member evidence.

By policy, SMHB eligibility is granted as continuous coverage. However, if you enter a CiC that enrolls the participant in, or grants access to insurance that covers all three phases of maternity services, MEDES will end SMHB coverage. If this happens, follow the steps in Adding MO Override Eligibility Evidence to grant SMHB coverage through the applicable end date.

Related Evidence: MO Covered Member

TO EDIT MO COVERED MEMBER INSURANCE

    1. Navigate to the Integrated Case > Evidence sub-tab > Dashboard folder
    2. Click the hyperlink for MO Covered Member
    3. Toggle open the participant to edit
    4. Click the List Action menu icon
    5. Click Edit
    6. Enter the Received Date
    7. Select the participant covered under the ESI coverage from the Participant drop down menu
    8. Select either Enrolled or Entitled from the Coverage Status drop down menu
    9. Enter the date the participant was either enrolled or entitled to the ESI coverage in the Start Date
    10. Enter the Monthly Cost to Enroll Participant in the plan

NOTE: When the premium amount is captured from the client, system creates a verification item upon submission of application and the ES verifies this item as self-attested.

    1. Click Save
    2. Verify all Outstanding Evidence
    3. Apply Changes, Check Proposed Determination, Finalize Proposed Determination

NOTE: MEDES may generate an additional proposed determination, especially in cases with income changes, adding a person, or removing a person. If the system generated an additional proposed determination, you must run the Finalize Proposed Determination again

    1. Make a comment on the HoH Person Page to include any Coverage Changes
    2. Review Notice Queue to make sure appropriate forms generated
      1. IM-80PRE: Generates in the event of coverage changes
      2. IM-80: Generates in the event of coverage changes
      3. IM-33C: Case Action Notice