Role Reason Status Reason Reasons for Ineligibility EDBC Summary KEES Page

Transcription

1 Ineligibility Table Role Reason Reasons for Ineligibility EDBC Summary KEES Page Over Income Check FPL on Failed and Overridden Budgets block Check Individual Eligibility Summary Check Income Detail/Income Amount Detail (s) Not Disabled Check Individual Eligibility Criteria o Non-Financial Eligibility o The Person s Disability Type Check Medical Condition List/Detail Over Resources Check Resource Test block Check Resource List/Detail (s) Resource s do not have correct data entry Check Resource List/Detail (s) make sure all information (including Description and Value are entered correctly) No Eligible Child Check Program Configuration 1. Check All Persons Associated to Case 2. Check Program Block CSS Select Role Reason No Linkage to MA hyperlink Program Person shows CSS Non-Coop Medical List/Detail 1

2 Ineligibility Table Role Reason Reasons for Ineligibility EDBC Summary KEES Page None Failed to Verify Name/Identity Failed to Verify Name/Identity Failure to Pursue Potential Resource EDBC gives a red warning Vital Statistics Identity verification is not received the user must select to Run EDBC without verifications Role Reason hyperlink gives Status Reason Select Role Reason No Linkage to MA hyperlink This requires a Non- Compliance detail or a Refused verification to Fail EDBC This requires a Non- Compliance detail or a Refused verification to Fail EDBC List/Detail Transfer of Property Select Role Reason No Linkage to MA hyperlink List/Detail Uncertain Requested Medical Type Check Individual Eligibility Criteria RMT is uncertain See Workaround RMT of LTC with no active LTC Data Detail for the month. Individual Eligibility Criteria o Non-Financial Eligibility says No for The person is in a Long Term Care Living Arrangement o Potential Eligibility shows Yes for Medically Needy Medical Person Detail/Requested Medicaid Type Detail LTC Data List/Detail 2

3 Ineligibility Table Role Reason Reasons for Ineligibility EDBC Summary KEES Page Unrelated Primary Applicant Consumer is not related to the Primary Applicant and/or Primary Applicant does not have ability to apply for the consumer None Ineligible Applicant Consumer is not related to the Primary Applicant and/or Primary Applicant does not have ability to apply for the consumer State Residence (if all applicants fail for State Residence) Didn t Request Retro State Residence request Retro Months or Retro Months were not added on the Medical Person Detail Consumer is not a resident of KS or a nonresident with an appropriate Residency Status Selecting the Program Person s : shows Unrelated Primary Applicant and Ineligible Applicant Role and Relationship List/Detail Relationship List/Detail NOTE: In some situations the Primary Applicant can apply for the consumerhowever the due to the household composition, the Ineligible Applicant may not be compatible with the existing Program Configuration Medical Person Detail : Retro Months section Contact Summary/Address Detail &/or Residency List/Detail 3

4 Ineligibility Table Role Reason Reasons for Ineligibility EDBC Summary KEES Page Varied if not all consumers fail residency (examples: Parent, Spouse, Primary Tax Payer, Sibling, etc.) Spouse of FTP Income Child of FTP Income None (if consumer is MEM) Varied if consumer is FRI (examples: State Residence FTP Income FTP Income Institutionalized None, or Out of the Home (if a HH Status of Permanently Out of the Home exists) Consumer is not a resident of KS or a nonresident with an appropriate Residency Status Spouse of a consumer that did not provide needed income verification Child of a consumer that did not provide needed income verification Consumer is Incarcerated Consumer is Incarcerated Role and Role and Role and Selecting the Program Person s : shows Ineligible Institution Selecting the Program Person s : shows Ineligible Institution Contact Summary/Address Detail &/or Residency List/Detail List/Detail List/Detail Living Arrangement List/Detail Living Arrangement List/Detail Household Status List/Detail Deceased Deceased Consumer is deceased Role and Individual Demographics 4

5 Ineligibility Table Role Reason Reasons for Ineligibility EDBC Summary KEES Page BDA After the Month Consumer s Beginning Date of Aid is after the month Medical Person Detail Ineligible Non- Citizen None Req. Invalid Primary Applicant Consumer is an ineligible non-citizen (no documentation, inappropriate documentation or less than 5 years from date of entry) Consumer is less than 18 years of age and not Emancipated None Out of the Home Consumer is coded Permanently Out of the Home Individual Eligibility Criteria o Citizenship/Refugee Status Selecting the Program Person s Role and Non Citizenship Status List/Detail Individual Demographics Household Status List/Detail Refused Verification Value (examples: Refused Slf-Emp Verif, Refused ID Verif, Refused Residency Verif, etc) Consumer refused to provide proof of a Requested Verification Selecting the Program Person s Verification List: Verification Status Refused 5

6 Ineligibility Table Role Reason Reasons for Ineligibility EDBC Summary KEES Page FTP INS Document FTP Prudent Pers Indiv FTP Prudent Pers Pgm FTP Residence FTP School Verif provide INS Document provide documentation related to Prudent Person that would close and individual provide documentation related to Prudent Person that would close the program provide requested proof of residence provide requested school verification Selecting the Program Person s Selecting the Program Person s Selecting the Program Person s Selecting the Program Person s Selecting the Program Person s List/Detail List/Detail List/Detail List/Detail List/Detail 6

7 Ineligibility Table Role Reason Reasons for Ineligibility EDBC Summary KEES Page FTP SSN provide requested SSN Selecting the Program Person s List/Detail FTP Trust Verif Medical Subrogation Application Opened in Error Failed to Complete Determination provide trust verification cooperate with Medical Subrogation Reason of: Application Opened in Error Reason of: Failed to Complete Determination Selecting the Program Person s Selecting the Program Person s Selecting the Program Person s Selecting the Program Person s List/Detail List/Detail 7

8 Ineligibility Table Role Reason Reasons for Ineligibility EDBC Summary KEES Page Duplicate Application Refused Premium Requested Exclusion Voluntary Withdraw Reason of: Duplicate Application Reason of: Refused Premium Reason of: Requested Exclusion Reason of: Voluntary Withdraw Selecting the Program Person s Selecting the Program Person s Selecting the Program Person s Selecting the Program Person s Pending SSN Verif Whereabouts Unknown Reason of: Whereabouts Unknown SSN Status is set to SSN Provided (Pending Status) Selecting the Program Person s Role and Individual Demographics 8