NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 2257

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APPROVING AN M-AF, M-RF, AND M-IC ADD-AN-INDIVIDUAL APPLICATION

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EIS 2257 - APPROVING AN M-AF, M-RF, AND M-IC ADD-AN-INDIVIDUAL APPLICATION


I. GENERAL INFORMATION

II. SPECIAL SITUATIONS

III. ACTIONS THAT REQUIRE A SEPARATE DSS-8125

IV. COMPLETING THE DSS-8125

V. KEY THE DSS-8125 AND THE DSS-8126's.

VI. OUTPUTS

VII. AUTOMATED NOTICES


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EIS 2257 - APPROVING AN M-AF, M-RF, AND M-IC ADD-AN-INDIVIDUAL APPLICATION

REVISED 07/01/95 - CHANGE NO. 2-95

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I. GENERAL INFORMATION

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II. SPECIAL SITUATIONS

REISSUED 07/01/95 - CHANGE NO. 2-95

II. A. (CONT'D)

REISSUED 08/01/04 - CHANGE NO. 01-05

II. B. 3.(CONT'D)

REVISED 08/01/04 - CHANGE NO. 01-05

II. D. (CONT’D)

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III. ACTIONS THAT REQUIRE A SEPARATE DSS-8125

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IV. COMPLETING THE DSS-8125

REVISED 10/01/98 - CHANGE NO. 7-99

IV. (CONT’D)

“Y” = YES “N” = NO

REISSUED 10/01/98 - CHANGE NO. 7-99

IV. (CONT'D)

REVISED 10/01/96 - CHANGE NO. 2-96

IV. C. (CONT'D)

REISSUED 10/01/96 - CHANGE NO. 2-96

IV. E. (CONT'D)

REISSUED 07/01/10 - CHANGE NO. 01-11

IV. F. b. (CONT'D)

REVISED 07/01/10 - CHANGE NO. 01-11

IV. F. 2. (CONT'D)

REVISED 07/01/10 - CHANGE NO. 01-11

IV. (CONT'D)

      J. Enter the TOTAL NET UNEARNED INCOME.
      1. The amount must be dollars and cents.
        2. The amount must be the same as the RSDI AMOUNT plus OTHER UNEARNED, if RSDI and OTHER UNEARNED INCOME is entered.
      3. TOTAL COUNTABLE MONTHLY INCOME must also be entered.

    K. NEEDS

      1. Enter the MAINTENANCE AMOUNT.
        a. The amount must be a whole dollar amount. Enter zeroes in the cents column.
        b. The amount must be more than or the same as the TOTAL COUNTABLE INCOME.
        c. If MIC, update the MAINTENANCE AMOUNT with the NEW POVERTY INCOME LEVEL AMOUNT.

        NOTE: NOT ALLOWED IF CASE TERMINATION REASON AND DATE AREENTERED.

      2. Do not enter AMBULATION CAPACITY.
      3. Do not enter DOMICILIARY RATE.
      4. Enter the TOTAL COUNTABLE MONTHLY INCOME. (If zero, leave blank). If entered, the amount must be dollars and cents.
        a. The amount must be entered if TOTAL NET UNEARNED INCOME is entered and must be the same amount or more.
        b. The amount must be the same amount or more than the RSDI amount if RSDI entered.
        c. Do not enter if CASE TERMINATION REASON and DATE are entered.

    L. SPECIAL DATA

      1. Do not enter FOOD STAMP NUMBER.
      2. Enter a STEPPARENT INDICATOR if different than indicated on the Case Profile. This is an optional field.
      3. Do not enter GRANDFATHER STATUS CODE and DATE.

REISSUED 07/01/10 - CHANGE NO. 01-11

IV. L. (CONT'D)

      4. Mark “YES” or “NO” for VA PAYMENT.
      5. Enter SPECIAL REVIEW TYPE and DATE if needed. See the Codes Appendix to determine the appropriate special review type and date. Do not enter if CASE TERMINATION REASON and DATE are entered.
      6. Do not enter JOBS/WORK REQUIREMENT SAVINGS REASON and AMOUNT.
      7. Enter the SPECIAL USE CODE and DATA if needed. See the Codes Appendix to determine the appropriate special use code and date.

    M. SPECIAL COVERAGE GROUP DATA

      NOTE: FOR M-AF ONLY; DO NOT ENTER FOR M-RF AND MIC.

      1. Enter the correct code in the SPECIAL COVERAGE GROUP CODE field if applicable. Refer to EIS 4000, codes appendix for valid codes.
      2. Enter the six digit SPECIAL COVERAGE GROUP BEGIN DATE.
        a. The BEGIN DATE cannot be before the application date.
        b. The BEGIN DATE must be the first day of the month.
        c. If a CASE TERMINATION DATE is entered, the BEGIN DATE cannot be before the CASE TERMINATION DATE.
      3. If Open/Shut, enter the date coverage ends in SPECIAL COVERAGE GROUP END DATE. This must be the last day of the month.
      4. Do not enter SPECIAL COVERAGE GROUPS 2 and 3.
      5. Do not enter SPECIAL NEEDS.

    N. SUPPLEMENTAL NOTICE INFORMATION

      The following three data elements have been added to the DSS-8125 Data Entry screen. A recommended form in which to enter the information can be found at the end of this section. This form should be attached to your DSS-8125 when submitting to Data Entry for keying.

      1. AUTHORIZED REPRESENTATIVE NAME AND ADDRESS

        If an applicant had an authorized representative acting in his behalf, the authorized representative's name and address

        may be entered for the purpose of mailing an automated notice to the authorized representative in addition to the applicant.

REISSUED 07/01/10 - CHANGE NO. 01-11

IV. N. (CONT'D)

      2. SECONDARY NOTICE CODE

        This code may be used in addition to the disposition code at approval time only. You may use it in situations when additional information is needed. Refer to Secondary Notice Codes in the Codes Appendix.

      3. NOTICE TEXT

        This section may be used to provide additional information to the applicant when a Secondary Notice Code is not applicable.

    O. INDIVIDUAL DATA

      The casehead name and the individual data for the individual(s) included on the case will be brought forward from the case or the application and cannot be changed. When a DSS-8125 is keyed, EIS reads the common name database to retrieve the individual assigned to the case id with a casehead/payee status of “P”. If any of the individual(s) data is incorrect, use the NAME CHANGE screen to make the appropriate correction(s).

      Enter the following data:

      1. Enter an INDIVIDUAL TERMINATION DATE when:
        a. Multiple individuals are added with different MEDICAID EFFECTIVE DATES. Use the DB/PML transaction to authorize individual benefits. See EIS 3105, Deductible Balance/Patient Monthly Liability Transaction for instructions.
        b. One or more individuals are not eligible for ongoing benefits.

          NOTE: DO NOT ENTER AN INDIVIDUAL TERMINATION DATE WHEN ENTERING A DATE OF DEATH.

      2. Do not enter CASE STATUS. The system generates this code.
      3. Enter the RSDI CLAIM NUMBER if the individual receives Social Security benefits or has Medicare coverage.
      4. Enter “Y” or “N” in MEDICARE A to indicate whether or not the individual has Medicare A. If “Y” is entered, the RSDI CLAIM NUMBER must also be entered.
      5. Enter “Y” or “N” in MEDICARE B to indicate whether or not the individual has Medicare B. If “Y” is entered, the RSDI CLAIM NUMBER must also be entered.

REISSUED 07/01/10 - CHANGE NO. 01-11

IV. (CONT'D)

      6. Enter a FAMILY STATUS CODE.
      7. Enter a LIVING ARRANGEMENT code. See the Codes Appendix to determine the appropriate living arrangement code.
      8. Do not enter a SPECIAL REPORT CODE.
      9. Do not enter JOBS/WORK REGISTRATION/EXEMPTION.
      10. Enter SPECIAL USE CODE and DATA if needed. See the Codes Appendix to determine the appropriate special use code and dates.
      11. Enter a REFUGEE STATUS CODE and U.S. ENTRY DATE (in MMCCYY format), if applicable. See the Codes Appendix to determine the appropriate Refugee Status code.
        a. The U.S. ENTRY DATE must be the month and year the individual entered the UNITED STATES.
        b. All individuals added must have the same U.S. Entry Date, and the date must be the same as the individual(s) already in the case. If the date is more than 12 months before the date of application, the form does not process. (MRF only).
      12. Enter DATE of DEATH if the individual is deceased. If the add individual is deceased before the application is approved:
        a. The DATE of DEATH must be before or the same as the current date.
        b. The DATE of DEATH must be after or the same date as the application date.
        c. The DATE of DEATH must be before or the same as the CASE TERMINATION DATE if CASE TERMINATION DATE entered.
        d. When entering DATE OF DEATH, do not enter an INDIVIDUAL TERMINATION DATE.
      13. Enter the two digit CITIZEN/ID code and the date (in MMDDCCYY format), if applicable. Enter Citizen/ID codes for refugee, asylee, Cuban/Haitian status, Amerasian, trafficking victim or special immigrant. See the Codes Appendix to determine the appropriate Citizen/ID code and what the date reflects.
      14. Enter Alien ID number, if applicable. Key only the numeric parts of the Alien ID number. Do not enter the alpha “A”.
      15. Enter the RELATIONSHIP TO PAYEE code. See Codes Appendix to determine the appropriate code.

REISSUED 07/01/10 - CHANGE NO. 01-11

IV. O. (CONT'D)

      16. Do not enter E&T (Employment/Training).
      17. Do not enter JOBS/WORK REGISTRATION/EXEMPTION.
      18. Do not enter ED. EMPL (Education Employment).
      19. Do not enter INCOME.
      20. Do not enter EXPENSES.
      21. Do not enter CHILD/ADULT CARE.
      22. Do not enter NET INCOME.
      23. Do not enter EDUCATIONAL LEVEL.
      24. Enter type and date of EDUCATION provided. (Not allowed for MRF). Refer to EIS 4100, Community Care of North Carolina, for more information.
      25. Enter “Y” or “N” for ISSUE CARD. If the individual has an annual Medicaid card from a prior time, enter “N”. A new card will not be issued. If the individual states they do not have an annual Medicaid card, enter “Y”. A new card will be produced the night the approval processes and mailed the following workday.
      26. Enter COMMUNITY CARE OF NORTH CAROLINA (CCNC) Provider or exempt number. (Not allowed for MAF-D/Family Planning), or MRF). Refer to EIS 4100, Community Care of North Carolina, for more information.
      27. Complete the DSS-8126, Continuation Sheet, using instructions in III. K. as a continuation of the DSS-8125 to enter individual data when there is more than one person added. If there are more than three individuals, complete a second DSS-8126(s). A sample of the DSS-8126 is located at the end of this volume.

    P. SIGNATURES AND DATE

      1. Enter the DATE COMPLETED.
      2. Sign the DSS-8125 in WORKER'S SIGNATURE field.
      3. The county director or his designee must sign the form in the DIRECTOR'S SIGNATURE field.

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V. KEY THE DSS-8125 AND THE DSS-8126's.

REISSUED 10/01/09 - CHANGE NO. 01-11

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VI. OUTPUTS

    When the DSS-8125 has processed successfully, the following are received;

    A. CASE PROFILES

      A Case Profile is produced the night the add individual approval processes and is mailed to the county the following work day.

    B. CASEWORKER SUPERVISOR REPORT

      The application approval is reported on the Caseworker Supervisor Report. The number of approvals completed is determined from the WORKER NUMBER

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VII. AUTOMATED NOTICES

    A. An automated notice (DSS-8108A) is produced for each MAF, MRF or MIC Add-individual approval the night the DSS-8125 processes in the system unless “Y” is entered for “NOTICE OVERRIDE”.

REISSUED 10/01/96 - CHANGE NO. 2-96

VII. (CONT’D)

    B. The DISPOSITION REASON CODE, the SECONDARY NOTICE CODE, and the NOTICE TEXT entered on the DSS-8125 determines the text of the notice.

    C. The system calculates the 60th calendar day for the notice.

    D. The date of the automated notice is the next state workday after the DSS-8125 processes. This is the date the notice is mailed to the recipient. A copy of the notice is mailed to the authorized representative if the Authorized Representative Name and Address are entered on the DSS-8125. A copy of the notice is not mailed to the county.

    E. A Notice Register Report is produced each night and is mailed to the county the following workday. This report lists vital information related to all automated notices produced for that day. See EIS 2304 for more information regarding the Notice Register Report.

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