With the May 31, 2016 release the retro-cancel reinstate functionality was introduced. Workers now have the ability to run eligibility for past months when benefits were already issued. However, retro-cancel reinstate is not available on closed cases and can only be run in Case Change/Closure case action. You may have closed cases with spenddowns for which a customer submits late bills, thereby impacting the spenddown. In order to adjust a spenddown on a closed case, the case must first be reinstated. After reinstating the case and authorizing the results, you can then select the Case/Change case action to enter the bills and/or other changes and perform retro-cancel reinstate to re-run eligibility for the past months needing adjustment. Complete the following steps to evaluate spenddowns on closed cases.

1. Reinstate the case from Case Action page.
   Note: On the Program Request page, verify the only members requesting assistance for MA are those that need to be evaluated for Medically Needy.
   1. On the Wrap Up – Run Eligibility page, verify the question Evaluate for Ongoing Spenddown is answered Yes.
   2. On the Spenddown Adjustment Detail page, verify the dropdown menu: Do not determine Spenddown for the selected period is No (if you change the selection, you must re-run eligibility).
      Note: If the individual is dually entitled, then the limited benefit EDG needs to be overridden to close as you do not want to reinstate the coverage, just the spenddown EDG.
   3. Run Eligibility.
   4. A new spenddown period will be created from the month following the closure month.
   5. Certify / Authorize the results.
   6. Suppress the Notice (this step is very important as a spenddown should not be created without an application).
2. On the Case Action page, enter the Case Number and select Case Change / Closure.
   1. Enter the change(s) that affect the spenddown.
   2. Run Eligibility.
   3. On the Spenddown Adjustment Detail page, select Yes to the dropdown menu: Do not determine Spenddown for the selected period for the invalid spenddown period.
   4. Click Approve.
   5. Run EDBC From the month in the past for which adjustments should be made.
      Note: Make sure to run retro-cancel reinstate from the earliest month in which a change occurred.
   6. If the individual meets the spenddown or there is change of spenddown liability based on medical bills provided, a Notice of Action will be generated.  If the spenddown is met, the enrollment transaction will be sent to the MMIS.
   7. Certify / Authorize the results.

Updated: 06/23/2016