MA Medically Needy Eligibility Results

Use this procedure to view the results for a Medically Needy case for which eligibility has just been run. The applicable ABD programs are:

Process Steps:

  1. The Wrapup - 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.

 

  1. Review the Eligibility information as appropriate, including:

  1. Click on the Eligibility / Service Period hyperlink to view the Eligibility Determination Group Summary results.

  2. The Eligibility Determination Group Summary page displays.

 

The bottom section of the Eligibility Determination Group Summary page displays household members who were either included in  the EDG or excluded from the EDG. The names of the household members are hyperlinked to further individual detail information.  

 

  1. Review the information in the Names section near the bottom of the page as appropriate, including:

 

A Certified Group status of "Y" indicates that the client was included in calculations for the type of assistance because they are potentially eligible. A Certified Group status of "N" indicates that the client is an EDG only member. Eligibility is not determined for EDG only members, but their income, assets, and other items may have factored into determinations for the Family Unit Certified Group.

 

 

Each household member is assigned one of the following participation statuses: Eligible Child, Included Adult, Included Child, Excluded Adult, or Excluded Child.

An Eligible Child is a person included in the EDG and eligible to receive services. A certified group member’s participation status will remain as Eligible Child even if the EDG is denied child care based on a financial requirement. However if the child is denied due a non-financial reason, the status will be changed to Included Child.

An Included Adult or Included Child is a person included in the EDG, but ineligible to receive services.

Countable Adult or Countable Child (Medical Assistance Only) a person included in the EDG (Family Unit), but ineligible to receive the assistance or benefits for the EDG Program.

An Excluded Adult or Excluded Child is a person excluded from participation in the EDG, and whose income, assets, and needs are not considered when determining eligibility for the EDG.

 

 

Coverage (Medical Assistance only) displays the coverage type (for example,  Full Scope, Restricted / Emergency) of the Medical Assistance, the individual is eligible for.

 

  1. Click on the Verification Checklist – Details page (VCL) and Other Pending Reasons page if applicable.

 

If there is pending verification checklist applicable for the Eligibility Determination Group (EDG), then the VCL link will be available for that EDG. Similarly if the EDG is pending for other Non-Financial and Financial reasons, then the link under Pending reasons will be enabled. If the Eligibility Result is not pending, the links under VCL and Other Pending reasons are NA.

 

  1. Click the Name hyperlink for any individual.

  2. Click the Resource tab to view the Medical Assistance – Client Resource page for that individual.

  1. Click the Name hyperlink for any individual.

  2. Click the Resource tab to view the Medical Assistance – Client Resource Details page.

  1. Click the Family Unit Income tab to view the Medical Assistance – Medically Needy Family Unit Income Eligibility page.

  1. Click the Budget Unit Income tab to view the Medical Assistance – Medically Needy Budget Unit Income Eligibility page.

  1. Click the pencil icon in the Income Details column to view the Medical Assistance – Medically Needy Budget Unit Deemed Spouse Income page (if applicable).

  1. Click the pencil icon in the Income Details column to view the Medical Assistance – Medically Needy Budget Unit Deemed Parents Income page (if applicable).

  1. Click the MN - Spenddown tab to view the Medical Assistance – Medically Needy Spenddown page.

  1. Review the information in the Medical Bills section as appropriate, including:

 

The spenddown Aid Category will not be sent to MMIS until the individual meets the spenddown.  

Once spenddown is authorized, the VaCMS will update all used spenddown Medical bills used in eligibility calculation as “Processed” on the Medical Expense page. If a Medical bill is not completely used for the spenddown calculation, the remaining bill amount will also be updated

 

  1. Click the Family Unit Resource tab to view the Medical Assistance – Medically Needy Family Unit Resource Eligibility page.

  1. Click the Budget Unit Resource tab to view the Medical Assistance – Medically Needy Budget Unit Resource Eligibility page.

  1. Click the pencil icon in the Resource Details column to view the Medical Assistance – Medically Needy Budget Unit Deemed Spouse Resource Eligibility page (if applicable).

  1. Click the pencil icon in the Resource Details column to view the Medical Assistance – Medically Needy Budget Unit Deemed Parents Resource Eligibility page (if applicable).

  1. Click Eligibility Summary.
  2. The Wrapup - Eligibility Summary page displays
  3. Click on Client Communication Form to generate a Client Communication Form.
  4. Click Next.
  5. The Certification page displays.
  6. Proceed to Certify Eligibility Results.

Results of the Procedure

The eligibility results are viewed for the Medically Needy case which has just been run.

Updated: 10/03/2016