Currently, the VaCMS does not build SSI individuals into the Medicaid Works aid category. Additionally, SSI individuals are subject to a resource test when evaluated for Medicaid Works (AC 059). Currently, the VaCMS only evaluates resources for SSI individuals when the individual has contiguous property, then all resources will be evaluated

If the SSI individual is eligible for Medicaid Works, you will need to perform a manual override to assign the correct AC code.

Workers should follow the process below to enroll an eligible SSI individual into Medicaid Works.

If you’re processing a new case (Intake / Screening):

1. Complete Data Collection. You must select Medicaid Works as the Medicaid Covered Group on the Medicaid Covered Group – Details screen and answer all required questions related to Medicaid Works.
   Note: Be sure to evaluate the SSI individual’s resources for AC 059.

2. Run eligibility.

3. The Eligibility Summary page will display an Approved Eligibility Result with Program / TOA as MA-SSI.

4. Click the Override Summary tab located at the top of the Eligibility Summary page.

5. Click Add.

6. On the Override Details tab, select an EDG # from the dropdown menu.

7. Select the Eligibility Service Period.
   Note: This period should be the month after the Medicaid Works Agreement Date documented on the Medicaid Covered Group – Details screen. For instance, if an applicant signed the agreement on 08/01/2015, then you should update the following month’s AC 059 Eligibility Service Period.

8. Enter the Override Begin Date for the EDG you want to override.

9. Enter an Override End Date (if necessary).

10. Enter an Override Reason (“Client did not correctly build into Medicaid Works”).

11. Select Approved from the EDG Status dropdown menu.

12. Select 059 from the Aid Category dropdown menu for each individual eligible for Medicaid Works.

13. Click Approve.

14. The Override Summary screen displays a “Submit Successful” message.

15. From the Left Navigation menu, select Run Eligibility.

16. Click the hyperlink for the overridden Eligibility Service Period and ensure it displays the correct aid category (059).

17. Authorize the correct results, refer all eligible individuals to MMIS, and print and mail your forms (if necessary).

If you’re editing an existing case (Case Change / Closure):

1. Manually calculate earned income (be sure to include any disregards) to ensure the income is within 200 percent of the FPL.

2. Document the manual calculations in case comments.

   1. Do not enter manually adjusted calculations into the income fields, as the VaCMS will then use these during eligibility determination, potentially altering the aid category.

3. Run eligibility.

4. The Eligibility Summary page will display a Denied result because the VaCMS currently screens at the 80 percent FPL limit.

5. Click the Override Summary tab located at the top of the Eligibility Summary page.

6. Click Add.

7. On the Override Details tab, select an EDG # from the dropdown menu.

8. Select the Eligibility Service Period.

9. Enter the Override Begin Date for the EDG you want to override.

10. Enter an Override End Date (if necessary).

11. Enter an Override Reason (“Client did not correctly build into Medicaid Works”).

12. Select Approved from the EDG Status dropdown menu.

13. Select 059 from the Aid Category dropdown menu for each individual eligible for Medicaid Works.

14. Click Approve.

15. Authorize the correct results, refer all eligible individuals to MMIS, and print and mail your forms (if necessary).

TBD

Updated: 09/08/2015