Override to Remove TMH Coverage

Use this guide when a case action results in an incorrect TMH determination

Training Materials: TMH – Initial Eligibility (on-demand lesson); TMH – Income Reporting (on-demand lesson); TMH 2.2 webinar recording; TMH Take 10

TO REMOVE TMH COVERAGE

NOTE: MO Override Evidence to Remove Coverage must be completed for each participant that transitioned to TMH.

    1. Navigate to the Integrated Case > Evidence sub-tab > Dashboard folder
    2. Hover cursor over MO Override Eligibility hyperlink > click the Create Evidence icon
    3. Received Date should be the same as Coverage Start Date
    4. Select Case Participant from drop down menu
    5. Select Manual as Type from drop down menu
    6. Select ‘Other’ as Reason from drop down menu
    7. Input “Incorrect TMH Determination” in the field Other (Reason)
    8. Coverage Start Date should be the first date the TMH eligibility for that participant (See EXAMPLE below).
    9. Coverage End Date should be the last day of TMH eligibility for that participant (See EXAMPLE below)

NOTE: Do not use an “infinity” end date of 12/31/9999

    1. Select ‘Remove Coverage’ as the action from the drop down menu
    2. Select the appropriate ME Code (TMH Adult or TMH Child must be correctly selected based on the participant, see EXAMPLE below)
    3. A comment MUST be made with a brief explanation of why the override is necessary
      1. “Participant incorrectly granted TMH coverage during finalized determination.”

EXAMPLE: A case action results in a mother (UWHS) and a child (MHK) incorrectly receiving TMH eligibility. The mother’s TMH coverage began 3/1/2017 ending 8/31/2017. The child’s coverage began 4/1/2017 ending 9/30/2017.

      1. The mother’s Override to Remove TMH ADULT coverage would be for the period 3/1/2017-8/31/2017
      2. The child’s Override to Remove TMH CHILD coverage would be for the period 4/1/2017-9/30/2017
      3. Click Save

NOTE: If the certification period for the case ends the last day of the incorrect TMH eligibility, Add New Certification Period to go out one year past the income start date.

    1. Verify all Outstanding Evidence
    2. 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. The case action taken
      2. The participants incorrectly granted TMH coverage
      3. The start and end date of TMH coverage
    2. Review notice queue (see NOTE below). Ensure TMH notices are removed

NOTE: Follow the below steps only if any children should have transitioned from a non-premium LOC to a premium LOC

    1. Delete the Adverse Action notices to prevent MEDES from closing the case
    2. Manually generate an IM-80 informing the participant of the change in coverage
    3. Follow bypass entry steps to continue the existing eligibility prior to the incorrect TMH determination (do not include an end-date)
    4. After 10 days, manually generate an IM-33C informing the participant of the change in coverage
    5. Follow steps to Request for 60-day Transition; Non-Premium to Premium
      1. The program administrator will then adjust the bypasses as necessary and follow up on any communication with MHD