Scenario 1: When a pregnant woman meets her spenddown, eligibility should continue until 60 days postpartum. However, if a woman gives birth before the end of the spenddown, there are instances in which her added two months of postpartum cause the spenddown period to exceed six months. For example, if a woman gives birth in the fifth month of the spenddown period, she is eligible for two more months (the sixth month of eligibility plus an additional seventh month) to account for the postpartum period. The VaCMS does not recognize this so a manual override is necessary to provide the additional month.

Scenario 2: Conversely, a spenddown can be shortened if a woman gives birth and reaches the end of her postpartum eligibility before the end of the six month period. For example, if a woman gives birth in the second month of eligibility, she has 60 days of postpartum and eligibility ends in the fourth month. In this case the worker would need to update the case to reflect the birth of the child and re-run eligibility at the end of the postpartum period to close the case or evaluate for other programs.

Scenario 1:

Update the case with the information related to the mother giving birth. Then, run eligibility and determine if the spenddown is ending earlier than it should. If you determine that a woman is eligible for additional coverage, follow the steps below for a manual override:

Within the VaCMS:

1. Click the Override Summary tab located at the top of the Eligibility Summary page.
2. Click Add.
3. On the Override Details tab, select the appropriate EDG # from the dropdown menu.
4. Select the Eligibility Service Period.
5. Enter the Override Begin Date for the EDG you want to override.
6. Enter an Override End Date (if necessary).
7. Enter an Override Reason.
8. Keep Approved in the EDG Status dropdown menu.
9. Keep Eligible Adult in the Participation Status dropdown menu for the eligible individual(s).
10. Select the appropriate aid category # from the Aid Category dropdown menu for the eligible individual(s).
11. Click Approve.

Scenario 2:

In cases where the postpartum period ends before the end of the six month spenddown period, the worker will need to set a manual task and reminder to rerun EDBC at the end of postpartum (second month of postpartum) for the VaCMS to close the case or determine if the woman meets another Aid Category for Medicaid (such as LIFC).

TBD

Updated: 09/17/2016