Each case in MEDES is created when an application for benefits is submitted through the Citizen Portal or the Eligibility Specialist Portal. It is important to understand the case lifecycle so you can properly interpret information in MEDES.

MEDES tracks an application as it evolves into a case. The stages defined below help identify the status of an application in MEDES.

See Figure 1.1 illustration of the Application Life Cycle

Figure 1.1

See information below for more information about each phase of the lifecycle.

Application

An application is submitted in the Citizen Portal or Eligibility Specialist Portal to create an Application Case.

    • Four types of applications: Paper, Phone, Online, FFM.
    • Paper application (IM-SSL)
      • IM-1SSL submitted by applicant and uploaded into ECM.
      • NL Registration MAGI task is created in Current™ for FSD staff to register application under head of household (HOH) in MEDES through caseworker portal.
      • Once application is registered, NL APP MAGI task is created in Current™ for FSD staff to process.
    • Phone application
      • Applicant calls FSD Contact Center to apply over the phone.
      • FSD Staff register application under HOH in MEDES through caseworker portal with client on the phone.
      • Once application is registered, NL APP MAGI task is created in Current™ for FSD staff to process.
    • Online application
      • Online applications automatically registered into MEDES when applicant applies through citizen portal.
      • A NL APP MAGI task is created in Current™ for FSD staff to process application in MEDES.
    • FFM application
      • FFM applications automatically registered into MEDES when applicants apply through the Federally Facilitated Marketplace (FFM). FFM transfers the application on behalf of the participant if it is determined the participant may be eligible for MHN benefits.
        • Account Transfer applications are FFM applications transferred on behalf of the participant if it is determined participant may be eligible for State based healthcare programs. The applicant cannot continue with their Marketplace application until it is determined they are not eligible for the state’s healthcare program based on eligibility factors and a rejection letter is provided.
      • NL APP MAGI task is created in Current™ for FSD staff to process application in MEDES.

Application Case (AC)

Once the application is registered, an Application case is created.

    • Online and FFM applications do not require a BPT to register.
    • BPTs validate DCNs, enter and verify evidence, check eligibility, and authorize the Application Case Program. Upon authorization, an Integrated Case and Product Delivery Cases are created. The Application Case Program closes when authorization is complete.
    • Paper application (IM-SSL)
      • Once application is registered, NL APP MAGI task is created in Current™ for FSD staff to process.
    • Phone application
      • Once application is registered, NL APP MAGI task is created in Current™ for FSD staff to process.
    • Online application
      • A NL APP MAGI task is created in Current™ for FSD staff to process application in MEDES.
    • FFM application
      • FFM applications automatically registered into MEDES when applicants apply through the Federally Facilitated Marketplace (FFM). FFM transfers the application on behalf of the participant if it is determined the participant may be eligible for MHN benefits. NL APP MAGI task is created in Current™ for FSD staff to process application in MEDES.

Integrated Case (IC)

    • Includes all case information, or evidence, and Eligibility Timeline.
    • Located on Person Page > Home > Current Cases
      • IC Name:
        • MHN Health Benefits
      • Active IC- at least one member on case is receiving active benefits per the Eligibility Timeline.
      • Inactive IC- no one on the case is receiving active benefits per the Eligibility Timeline.

Product Delivery Cases (PDC)

    • Includes current eligibility determinations, proposed eligibility determinations, determination history, and certification periods.
    • Located on Person Page > Home > Current Cases.
      • Case Name:
        • MO Health-Net for Families: MHN for Families coverage benefits
          • Includes Title XIX, Non-Premium CHIP, SHMB, and State-only coverages.
        • MO Health-Net for Kids: CHIP Premium coverage benefits
          • Includes Premium CHIP coverages.
        • Prior Quarter MO Health Net: Prior Quarter (PQ) coverage benefits
          • Includes PQ eligible coverages.