NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEMS EIS 2600

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EIS 2600 – HEALTH COVERAGE FOR WORKERS WITH DISABILITIES (HCWD)


I. INTRODUCTION

II. HCWD Policy

III. COMPLETING THE DSS-8125

IV. HCWD INQUIRY


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EIS 2600 – HEALTH COVERAGE FOR WORKERS WITH DISABILITIES (HCWD)

REVISED 01/01/10 - CHANGE NO. 02-10

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I. INTRODUCTION

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II. HCWD Policy

    A. To qualify for HCWD an individual must:

      1. Be age 16 through 64;
      2. Meet the Social Security Administration definition of disability or blindness, except for earnings, or be eligible in the Medically Improved Group;
      3. Be Employed;

REISSUED 01/01/10 - CHANGE NO. 02-10

II.A. (CONT’D)

      4. Have countable resources equal to or less than the minimum community spouse resource allowance;
      5. Meet the income requirements for his coverage group; and
      6. Meet all the other eligibility requirements applicable to Adult Medicaid coverage groups.

    B. Authorization

      Eligibility under HCWD can be authorized as MAB or MAD with Medicaid classification N, G, B, or Q and can begin no earlier than November 1, 2008.

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III. COMPLETING THE DSS-8125

    HCWD coverage can be authorized, changed or terminated using a DSS-8125. Use the following instructions to add, change or terminate HCWD coverage.

    A. Enter the CASEHEAD/PAYEE NAME at the top of the form for filing purposes.

    B. Enter the COUNTY NAME.

    C. Enter the CASE ID from the current Case Profile when authorizing HCWD for an existing Medicaid recipient. When approving an applicant, follow the instructions in EIS 2251, Approving M-AA, M-AB, and M-AD New Applications or Reapplications, and the instructions below.

    D. Enter your assigned WORKER NUMBER.

    E. Enter the COUNTY NUMBER.

    F. Enter the DISTRICT NUMBER.

    G. Enter the appropriate AID PROGRAM/CATEGORY. M-AB or M-AD.

    H. Enter the CERTIFICATION PERIOD FROM and THROUGH DATES.

      1. For application approvals, the CERTIFICATION PERIOD is six months.
      2. For existing recipients:

REVISED 01/01/10- CHANGE NO. 02-10

III.H.2. (CONT’D)

        a. HCWD Applicant in a Full Coverage Program

          Where an HCWD applicant currently has full coverage and has more than six months left on an existing certification period, send a manual timely notice and shorten the certification period. Reenter the certification from date as the first day of the month of HCWD eligibility. The certification through date will be six months from the certification from date.

        b. HCWD Applicant Receiving MQB Only

          Where an HCWD applicant currently has MQB coverage only and has more than six months left on an existing certification period, send a manual adequate notice and shorten the certification period. Reenter the certification begin date as the first day of the month of HCWD eligibility. The certification through date will be six months from the certification begin date.

        c. HCWD Applicant With Less Than Six Months Left on Existing Certification Period

          Where an HCWD applicant has less than six months left on an existing certification period, use the existing certification period for HCWD eligibility.

    I. Enter the SUB PROGRAM (SP) GROUP code. The appropriate HCWD codes are:

      Health Coverage for Workers with Disabilities (HCWD)

      1. B1 – Basic Coverage Group equal to or less than 150% Federal Poverty Level (FPL).
      2. M5 – Medically Improved Group equal to or less than 150% of the Federal Poverty Level (FPL). A/R must be in the Basic Coverage Group before they can be in this group.
      3. B2 – Basic Coverage Group 151% through 200% of the Federal Poverty Level (FPL).(Suspended Effective 12/01/2009)
      4. M6 – Medically Improved Group 151% through 200% of the Federal Poverty Level (FPL). A/R must be in a Basic Coverage Group before they can be in this group. (Suspended Effective 12/1/2009))

        Note: For B2 and M6, there is an enrollment fee of $25 at application and $25 at redetermination the applicant must pay to the county DSS before they can be authorized.

REVISED 01/01/10 - CHANGE NO. 02-10

III.I.4. (CONT’D)

        For applications, the time the applicant has to pay the enrollment fee can be excluded from the application processing time. Enter the exemption using the Date Screen. Refer to EIS 2400, Application Processing, for further information.

    J. Enter the %FPL FEDERAL POVERTY LEVEL indicator

      The %FPL is entered on the 8125 immediately after the sub program codes are entered. The appropriate %FPL codes are:

      1. 2H = %FPL is equal to or less than 100% FPL. Can be B1 or M5.
      2. 3A = %FPL is 101% up through 150% FPL. Can be B1 or M5.
      3. 4A = %FPL 151% through 200% FPL. For B2 or M6. (Suspended Effective 12/1/2009))

    K. Enter the SUB PROGRAM (SP) GROUP BEGIN DATE.

      1. Enter the date coverage begins. Must be MMDDYY.
      2. HCWD cannot be posted to a period of time that is authorized in an aid program/category that is not eligible for HCWD (i.e. MQB, MAA, MAF, etc.). Only MAD and MAB are correct for HCWD.
      3. The Begin Date must be the first day of the month and cannot be later than the ongoing month.
      4. For B1 and M5, the Begin Date can be retroactive but cannot be earlier than November 1, 2008.
      5. For B2 and M6, the Begin Date can be retroactive but cannot be earlier than May 1, 2009, or after 12/1/2009.
      6. An A/R can have a different SUB PROGRAM in the retroactive period than in the ongoing period.

    L. Enter the SUB PROGRAM (SP) GROUP END DATE when the individual ceases to be eligible for the existing HCWD SUB PROGRAM.

      1. When HCWD ends, enter the SUB PROGRAM GROUP code, the FPL indicator, the BEGIN DATE, and the END DATE. The END DATE must be after the BEGIN DATE and must be the last day of the month.

ISSUED 05/01/09 - CHANGE NO. 03-09

III.L. (CONT’D)

      2. For an open/shut approval, the END DATE may be retroactive to the current date but must be the last day of a month.
      3. For an ongoing case, the END DATE must not be earlier than the last day of the month prior to the ongoing month. The END DATE cannot be retroactive.
      4. When HCWD coverage changes from one SUB PROGRAM to another, for instance, changing from B1 to M5, use the following instructions:
        a. To end coverage in the old SUB PROGRAM, enter the old SUB PROGRAM code and FPL indicator, BEGIN DATE, and END DATE. The END DATE must be after the BEGIN DATE and must be the last day of the month prior to the ongoing month.
        b. Enter the new SUB PROGRAM code, FPL indicator, and BEGIN DATE. The BEGIN DATE cannot be earlier than the first day of the ongoing month.

    M. Enter the SPOUSE INDICATOR. Refer to the Codes Appendix to determine the appropriate code.

ISSUED 05/01/09 - CHANGE NO. 03-09

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IV. HCWD INQUIRY

    To view the posted Sub Program on Case Data (CD) screen, key “CD” in the SELECTION field and the eight digit Case ID in the KEY field. The Sub Program is displayed at the bottom of the screen.

To view the posted Sub Program and FPL for an individual, enter “IE” Individual Medicaid Eligibility in SELECTION, key the Individual ID number, and press ENTER. The following screen is displayed:

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