Edit MO Access to Maternity Services Evidence

Based on the insurance responses entered when registering an application, MEDES creates the MO Access to Maternity Services evidence when you check eligibility for the case.

If FFM indicates the insurance is affordable MEDES will create evidence in edit which will need to verified. If you observe this, contact your supervisor for further guidance.

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.

TO EDIT MO ACCESS TO MATERNITY SERVICES

    1. Navigate to the Integrated Case > Evidence sub-tab > Dashboard folder
    2. Click the MO Access to Maternity Services hyperlink
    3. Enter the Received Date. This is the date the FSD received the evidence from the participant.
    4. Choose the participant from the drop down menu.
    5. Enter premium provided by the client in Client Quote 1 > Cost of Plan, answer yes or no to the following questions:
      1. Does this plan cover Pre-Natal Maternity Services?
      2. Does this plan cover labor and Delivery Services?
      3. Does this plan cover Post-Partum Services?
    1. Repeat step 5 for Client Quote 2 section.
    2. Click Save
    3. Verify all Outstanding Evidence
    4. 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
      1. All actions taken
      2. Participant with override entered
    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