Extended Medicaid - Medicaid Covered Group Screen |
Overview
VaCMS can evaluate applicable individuals for Extended Medicaid following the termination of LIFC. To reflect eligibility or ineligibility within the VaCMS for Extended Medicaid workers must complete and update the Medicaid Covered Group screen.
The Medicaid Covered Group Screen should be completed for the adults on a case who may or may not be eligible for Extended Medicaid due to the termination of LIFC because of increased support or earning. The appropriate evaluation of the adult will also result in eligible children being determined as Extended Medicaid.
This QRG includes two sections:
1. Approving Extended Medicaid
2. Maintaining an Extended Medicaid Case
Approving Extended Medicaid
If a LIFC enrollee's coverage closes, review Data Collection to verify if this closure occurred due to increased earnings/spousal support. If coverage closed due to excess income, evaluate the customer for Extended Medicaid based on MA policy.
Follow the procedure below to indicate the customer is eligible for Extended Medicaid in the VaCMS:
From the Left Navigation click Individual Information, then click Questions. The Household Clients – Questions screen displays.
Answer Yes to the Other Medicaid Covered Groups/Extended Medicaid question. The Medicaid Covered Group-Summary screen will display.
Add a Medicaid Covered Group screen for each parent/caretaker-relative that is being evaluated for Extended Medicaid using the correct information if Extended Medicaid is being evaluated for initial enrollment in the covered group, ongoing coverage, or a month in the past.
If the individual has an existing Medicaid Covered Group screen the update the existing record.
The worker should enter the Effective Begin Date that matches the first day of the first month in which the individual was eligible for Extended Medicaid
The End Date should match the renewal date for that individual based on their Extended Medicaid Eligibility as their new renewal date may not be the same as the current renewal date.
This insures that if subsequent changes are made to the case during the certification period that the individual will continue to be evaluated for Extended Medicaid.
NOTE: Depending on the information on the existing record, you will take one of two courses of action:
If the prior screen showed the individual as ineligible, extend the end date on the prior screen to the day before they became eligible for Extended Medicaid. Then save and go back and enter the new information.
If the prior screen showed the individual as eligible, be sure the End Date on the prior screen was the last day of the last month in when they were eligible for extended. Then complete another entry for the time period where they were not eligible (if a gap exists between eligible periods of Extended MA). Next complete another entry for the current period of Extended MA.
Remember when updating an existing record the worker will need to enter an effective date that is the day after the end date on the prior screen.
In both cases you will have a current screen with historical records, but the number of historical records will vary.
The individual's Medicaid Covered Group should be "LIFC", the Status should be "Terminated" and the Agreement/Status Date should match the Effective Begin Date.
NOTE: Because
VaCMS does not accept a future date, if the customer does not become ineligible
for LIFC until a future date enter the Agreement/Status
date as the current date.
The question Has the client or Parent/Caretaker correctly received LIFC three of the last six months? will be answered "YES" and the LIFC failure reason will be "Excess Earnings".
The question In what month Extended MA should have begun? should match the same month as the Effective Begin Date, and depending on the number of months in the past the Extended Medicaid should have begun, the worker will answer the follow-up code questions appropriately.
It is possible that the worker will need to send earnings reports manually to the customer to complete before they are able to authorize the Extended Medicaid coverage.
NOTE: If the information does not save after entering those responses the worker may have to go back and re-enter the information and re-save. If the information does not save after a few attempts, please document the case to reflect the correct information.
Once steps for each parent/caretaker-relative that should receive Extended Medicaid are completed Run Eligibility.
NOTE: If the Extended Medicaid needs to be evaluated for past months, RCR should be run beginning the first month in which the individual was eligible for Extended Medicaid to preserve the change was processed correctly.
Review the Eligibility Summary for Extended Medicaid coverage under the Program/TOA column, if RCR was ran the results should show Extended Medicaid "No Action Needed" as MMIS will not accept changes to move someone from one full coverage group to another full coverage group for a past month. Then Certify/Authorize the results. The following occurs upon authorization:
Document the case under Case Comments.
Maintaining an Extended MA Case
If the worker has determined a customer is no longer eligible for Extended Medicaid, use the following procedure to ensure Extended Medicaid is not evaluated on the case. Even if an individual is not eligible for Extended Medicaid, the worker will need to complete the Medicaid Covered Groups screen for each parent/caretaker-relative that is being evaluated for Extended Medicaid but is not eligible for the program.
Enter the Effective Begin Date that matches the first day of the first month in which the individual is not eligible for Extended Medicaid.
The End Date should match the next renewal date for that individual.
This insures that if subsequent changes are made to the case during the certification period that the individual will not be evaluated for Extended Medicaid.
The dates can be changed in the future should the individual become eligible for Extended Medicaid.
NOTE: If there is a prior screen already completed, the worker will need to enter an effective date that is the day after the end date on the prior screen. The worker will enter the information over the old information to create a historical record as they cannot select the Add Medicaid Covered Group button on the summary screen when a screen already exists for that individual. They can only select that button if they are completing the screen for a new individual. The following error message is received when a worker tries to enter a new Medicaid Covered Group screen for an individual with an existing screen:
The individual's Medicaid Covered Group should be "LIFC", the Status should be "Terminated" and the Agreement/Status Date should match the Effective Begin Date.
If the Effective Begin Date is in the future, the agreement status date can be the current date.
The question Has the client or Parent/Caretaker correctly received LIFC three of the last six months? must be answered "NO" for the individual to be evaluated for covered groups other than Extended Medicaid. The worker does not have to answer any more questions on the screen after this point.
When the worker runs eligibility and certifies the case, please be sure to carefully review the notice. If any information is incorrect the worker should suppress the notice, generate/send a manual notice, and upload the manual notice to VaCMS.
Document the case under Case Comments.
Updated: 11/21/2017