MA Institutionalized Individual Eligibility Results

Use this procedure to view the results for a case for an Institutionalized Individual case which eligibility has just been run.

Process Steps:

The Wrap-up - Eligibility Summary page displays.

The Eligibility Summary page displays the results of the eligibility calculation, showing the details of the case’s eligibility or ineligibility. The unique Eligibility Determination Group (EDG) number, type of assistance (TOA), eligibility period, family unit size, potential co-payment, eligibility status, and eligibility determination date are also displayed. If the case has been certified the certification results will be displayed.

Review the Eligibility information as appropriate, including:

- EDG #
- Program / TOA
- Eligibility / Service Period
- Family Unit Size
- Potential Copay (Child Care)
- Net Benefit Amount
- Eligibility Result
- Eligibility Status
- Eligibility Determination Date
- Pending Reasons VCL Other

Click on the Eligibility / Service Period hyperlink to view the Eligibility Determination Group Summary results.
The LTC – Resource Eligibility page displays.

- Review the information in the Case Information section as appropriate, including:
- - Case Name
  - Case #
  - Case Mode
  - Case Status
- Review the information in the EDG Information section as appropriate, including:
- - EDG #
  - Program / TOA
  - Eligibility / Service Period
  - Eligibility Result
  - Eligibility Status
  - Redetermination Date
  - Interim Report Date
- Review the information in the Countable Resources section as appropriate (for Applicant and Spouse), including:
- - Vehicle
  - Real Property
  - Liquid Assets
  - Personal Property
  - Burial
  - Life Insurance
  - Total Countable Resources Amount
  - Protected Resources Amount
  - Total Resource Deducting PRA
  - Resource Limit
  - Resource Eligibility Result
  - Community Spouse Resource Allowance

Click the Name hyperlink for any individual.
Click the Resource tab to view the Medical Assistance – Client Resource page for that individual.

- Review the information in the Case Information section as appropriate, including:
- - Case Name
  - Case #
  - Case Mode
  - Case Status
- Review the information in the EDG Information section as appropriate, including:
- - EDG #
  - Program / TOA
  - Eligibility / Service Period
  - Eligibility Result
  - Eligibility Status
  - Redetermination Date
  - Interim Report Date
- Review the information below as appropriate, including:
- - Real Property
  - Vehicle
  - Liquid Assets
  - Personal Property
  - Burial
  - Life Insurance
  - Total Countable Resources

Click the Name hyperlink for any individual.
Click the Resource tab to view the Medical Assistance – Client Resource Details page.

- Review the information in the Case Information section as appropriate, including:
- - Case Name
  - Case #
  - Case Mode
  - Case Status
- Review the information in the EDG Information section as appropriate, including:
- - EDG #
  - Program / TOA
  - Eligibility / Service Period
  - Eligibility Result
  - Eligibility Status
  - Redetermination Date
  - Interim Report Date
- Review the information below as appropriate, including:
- - Real Property Gross Value
  - Real Property Countable Value
  - Real Property Exclusion Reason
  - Vehicle Gross Value
  - Vehicle Countable Value
  - Vehicle Exclusion Reason
  - Liquid Assets Gross Value
  - Liquid Assets Countable Value
  - Liquid Assets Exclusion Reason
  - Personal Property Gross Value
  - Personal Property Countable Value
  - Personal Property Exclusion Reason
  - Burial Gross Value
  - Burial Countable Value
  - Burial Exclusion Reason
  - Life Insurance Gross Value
  - Life Insurance Countable Value
  - Life Insurance Exclusion Reason
  - Home/Mobile Home Gross Value
  - Home/Mobile Home Countable Value
  - Home/Mobile Home Exclusion Reason

Click the Patient Pay tab to view the Medical Assistance – Patient Pay page.

- Review the information in the Case Information section as appropriate, including:
- - Case Name
  - Case #
  - Case Mode
  - Case Status
- Review the information in the EDG Information section as appropriate, including:
- - EDG #
  - Program / TOA
  - Eligibility / Service Period
  - Eligibility Result
  - Eligibility Status
  - Redetermination Date
  - Interim Report Date
- Review the information below as appropriate, including:
- - Total Self Employment Income
  - Total Earned Income
  - Total Unearned Income
  - Personal Needs / Maintenance Allowance
  - Spouse Allowance
  - Family Allowance
  - Dependent Child Allowance
  - Non-Covered Medical Expenses
  - Home Maintenance
  - Spenddown Liability
  - NF Monthly Medicaid Rate
  - Actual Monthly CBC Cost
  - Actual Patient Pay Amount
  - Patient Pay Cost of Nursing Facility
  - Patient Pay Cost of CBC
  - Basic Allowance Difference between NF and CBC
  - Underpayment to be Adjusted
  - Overpayment to be Adjusted
  - Adjusted Patient Pay Amount
  - Patient Pay Overridden

If Patient Pay is overridden, the Adjusted Patient Pay will display the overridden Patient Pay Amount.

If Patient Pay Overridden indicator is Yes, the Patient Pay Override Summary tab is displayed.

Click the Patient Pay Override Summary tab to view the Medical Assistance – Patient Pay Override Summary page, if appropriate (enabled only if Patient Pay was overridden on the Patient Pay – Search page).

- Review the information in the Case Information section as appropriate, including:
- - Case Name
  - Case #
  - Case Mode
  - Case Status
- Review the information in the EDG Information section as appropriate, including:
- - EDG #
  - Program / TOA
  - Eligibility / Service Period
  - Eligibility Result
  - Eligibility Status
  - Redetermination Date
  - Interim Report Date
- Review the Begin Date.
- Review the End Date.
- Review the Patient Pay Amount.
- Review the Override Date.
- Review the Override Reason.

Click the Spenddown Patient Pay tab to view the Medical Assistance – Spenddown Patient Pay page, if appropriate (enabled only if Institutionalized Individual is on Spenddown / has Countable Income greater than 300 percent of SSI).

- Review the information in the Case Information section as appropriate, including:
- - Case Name
  - Case #
  - Case Mode
  - Case Status
- Review the information in the EDG Information section as appropriate, including:
- - EDG #
  - Program / TOA
  - Eligibility / Service Period
  - Eligibility Result
  - Eligibility Status
  - Redetermination Date
  - Interim Report Date
- Review the Spenddown Liability.
- Review the Spenddown Begin Date.
- Review the Spenddown End Date.
- Review the Spenddown met Date.

Click the Resource Transfer tab to view the Medical Assistance – Spenddown Patient Pay page, if appropriate (enabled only if Institutionalized Individual has transferred resources).

- Review the information in the Case Information section as appropriate, including:
- - Case Name
  - Case #
  - Case Mode
  - Case Status
- Review the information in the EDG Information section as appropriate, including:
- - EDG #
  - Program / TOA
  - Eligibility/Service Period
  - Eligibility Result
  - Eligibility Status
  - Redetermination Date
  - Interim Report Date
- Review the Total Uncompensated Amount.
- Review the Average Monthly Cost of nursing facility services.
- Review the Penalty Begin Date.
- Review the Penalty End Date.

The Patient Pay amount will not be sent to MMIS until the individual meets spenddown.

Click Eligibility Summary.
The Wrap-up - Eligibility Summary page displays.
Click on Client Communication Form to generate a Client Communication Form.
Click Next.
The Certification page displays.
Proceed to Certify Eligibility Results.

Results of the Procedure

The eligibility results are viewed for the Institutionalized Individual case which has just been run.

Update: 10/03/2016