INSTRUCTIONS:

Step 1:

Upon receiving a request to add prior quarter coverage, either in writing or verbally, review FAMIS and the ECM for verification of income, resources, and disability during the prior quarter months requested.

1. 1. If verification is not available, manually send an IM-31A requesting verification for each item, specifying for which month(s) verification is needed.
      1. Ex: If Prior Quarter months are April, May, and June, the IM-31A would state Please provide Mid America checking account statements for April, May, and June of 2020.
   2. If an MRT decision is needed for any prior quarter months, determine if an MRT packet needs to be completed. Do not notify MRT until all other verification has been received.
   3. Comment on EUMEMROL explaining the request for PQ coverage. Identify:
      1. Verified information
      2. Requested verification (include the due date for the manual IM-31A)

Step 2:

Once verification is received, manually calculate the total value of countable resources. Remember to take into consideration the $1500.00 CSV Exclusion for Pre-Need Burial Plans, Burial funds, and Life Insurance.

1. 1. If the participant’s resources are above the resource limit for the program, generate and complete an IM-33. Scan a copy of the IM-33 to the electronic record before mailing the original to the participant.
   2. Comment on EUMEMROL identifying the resources considered and that an IM-33 was sent to the participant notifying him/her of the denial.

Step 3:

Determine if any other verification, other than income, causes ineligibility for prior quarter months.

1. 1. If ineligibility exists, other than income, generate and complete an IM-33. Scan a copy of the IM-33 to the electronic record before mailing the original to the participant.
   2. Comment on EUMEMROL identifying the factor causing ineligibility and that an IM-33 was sent to the participant notifying him/her of the denial.

Step 4:

If the participant is eligible on all factors and no disability verification exists, notify MRT of the request for prior quarter benefits.

• • NOTE: Do not complete a WIBCA until the MRT determination is entered into FAMIS.

Step 5:

When ready to enter a WIBCA, fastpath to FAMISPAR/FM0D

Step 6:

Type in the participant’s Social Security Number (SSN) or DCN in the corresponding field and press CTRL.

Step 7:

Select the appropriate active ADM Eligibility Unit (EU) in the repeating group.

Step 8:

Fastpath to SELWIBCA/FMXH

Step 9:

Press F14=ADDWIBCA

Step 10:

With an A on the command line, tab to the effective month field and enter the month and year of the WIBCA needed.

Step 11:

In the Budget Type field, prompt out and select the appropriate code.

• • NOTE: To add Prior Quarter months, the Budget Type will be RTO – Retroactive.

Step 12:

In the Coverage Type field, select the appropriate MHABD Sub Program.

• • If the sub program involves an option, such as choosing between Spend Down or Ticket to Work, this must be determined by the applicant prior to entering the WIBCA.
  • For Specified Low Income Medicare Beneficiary (SLMB) WIBCAs, the Coverage Type is always QMB.

Step 13:

Tab to the EU members in the repeating group. Notice above the repeating group are descriptions of options to include EU members and the corresponding codes. Select each EU member and enter the correct inclusion code.

Step 14:

Press CTRL

Step 15:

Press F14=WIBCA

Step 16:

With an A on the command line, enter necessary income and expense amounts in their corresponding fields, and press CTRL.

• • NOTE: If the WIBCA is for TWHA, make sure to complete the SSDI Exemption field. The TWHA budget allows a $50.00 exemption for SSDI income.

Step 17:

Press F18=COMMENTS to enter a comment about why a WIBCA was completed.

Step 18:

Press F21=RETURN twice.

Step 19:

Press F14=BUDGET

Step 20:

Review the budget, and once it is correct press F23=AUTH

Step 21:

Review the screen showing Current Benefits and New Benefits. If result is correct, press F23=AUTH.

• • NOTE: If the participant wishes to receive benefits under two sub programs, two separate WIBCA will need to be completed (Ex: Spend Down and SLMB).

Step 22:

Press F21=RETURN four times to return to the Select Worker Initiated Budget Calculation Area screen, which will display each WIBCA and its saved or authorized status.

Step 23:

Fastpath to EUMEMROL and press F18=COMMENT to comment on the actions taken.

Step 24:

The following day, fastpath to MEDHIST to ensure each WIBCA is displayed. There will be a separate WIBCA, in purple, for each month and each coverage type.