NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3451

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AID PROGRAM/CATEGORY TRANSFERS TO MEDICAID PROGRAMS

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EIS 3451 – AID PROGRAM/CATEGORY TRANSFERS TO MEDICAID PROGRAMS


I. AUTOMATED TRANSFERS

II. COMPLETING THE DSS-8125

III. KEY THE DSS-8125.

IV. OUTPUTS

V. AUTOMATED NOTICES


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TRANSFERRING FROM A-AF TO M-AF

REISSUED 10/01/12 – CHANGE NO. 01-13

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I. AUTOMATED TRANSFERS

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II. COMPLETING THE DSS-8125

REVISED 10/01/12 – CHANGE NO. 01-13

(CONT'D) (TRANSFERRING FROM A-AF TO M-AF)

REVISED 10/01/12 – CHANGE NO. 01-13

II. B. (CONT'D) (TRANSFERRING FROM A-AF TO M-AF)

      12. If the Medicaid Status “D” was entered, enter the DEDUCTIBLE AMOUNT in the “DED AMT” field. This DEDUCTIBLE AMOUNT will print on the automated notice.
      13. Enter the ongoing month for MEDICAID EFFECTIVE DATE.
      14. Enter the appropriate PAYMENT TYPE. Refer to the Codes Appendix to determine the appropriate code.
      15. Enter the CATEGORICALLY NEEDY LEVEL amount or the MEDICALLY NEEDY LEVEL amount in the MAINTENANCE AMOUNT field.
      16. Enter the first day of the ongoing month for CERTIFICATION FROM DATE.
      17. Enter the MEDICAID CERTIFICATION THRU DATE.
        a. The DATE must be no more than six months from the CERTIFICATION FROM DATE, unless the Medicaid Class is ‘C’. If class is ‘C’, date may be up to 12 months from the CERTIFICATION FROM DATE.
        b. The DATE must be the last day of the month.
        c. If the individual is incarcerated or in an Institution of Mental Disease (IMD), the DATE must be the same as the payment review period end date on the AAF case.
      18. Enter the MEDICAID CLASSIFICATION. If the transfer is due solely to the Work First time limit, Personal Responsibility Contract, or other factors specified in the Family and Children’s Medicaid Manual, the class must be ‘C’.
      19. Enter a JOBS/WORK REQUIREMENT SAVINGS REASON and AMOUNT in the case data if appropriate. See the Codes Appendix to determine the appropriate savings reason.
      20. EIS will delete any grant recoupment information on the case at the time the case transfers to M-AF.
      21. 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.

REISSUED 10/01/12 – CHANGE NO. 01-13

II. B. 21. (CONT'D) (TRANSFERRING FROM A-AF TO M-AF)

        a. AUTHORIZED REPRESENTATIVE NAME AND ADDRESS

          If a recipient 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 recipient.

        b. SECONDARY NOTICE CODE

          Do not enter for transfers.

        c. NOTICE TEXT

          This section may be used if there is no code for your situation and/or to provide additional information to the recipient. Enter Change Code “02” or “50”. If you use NOTICE TEXT, you must enter a manual citation.

      22. Enter the INDIVIDUAL ID of the affected individual and enter the following updates:
        a. Remove the “Y” or “N” from the Disability (DIS) field.
        b. Refer to Work First Manual WF700 CODES E & T

                      (Employment and Training) information.

        c. Enter “*” to delete the JOBS/WORK REGISTRATION/EXEMPTION code.
        d. Enter the RELATIONSHIP TO PAYEE code if blank. See Codes Appendix to determine the appropriate code.
        e. Enter zeroes to delete GROSS EARNED INCOME, CHILD/ADULT CARE, WORK EXPENSES, and NET EARNED INCOME if any are indicated in the INDIVIDUAL DATA on the
        A-AF Case Profile.
      23. Enter the DATE the form is completed.
      24. Sign the DSS-8125 in the WORKER’S SIGNATURE field.
      25. The county director or his designee must sign the form in the DIRECTOR’S SIGNATURE field.

    C. DO NOT ENTER the following information on the DSS-8125 when completing a transfer from A-AF to M-AF.

REISSUED 10/01/12 – CHANGE NO. 01-13

II. C. 1. (CONT'D) (TRANSFERRING FROM A-AF TO M-AF)

      1. Case Data
        a. VERIFICATION INDICATOR
        b. APPLICATION NUMBER
        c. ONGOING DISPOSITION REASON and DATE
        d. RETRO DISPOSITION REASON and DATE
        e. CASE TERMINATION REASON and DATE
        f. OLD CASE TERMINATION REASON and DATE
        g. PAYMENT AMOUNT
        h. PAYMENT EFFECTIVE DATE
        i. PAYMENT REVIEW PERIOD
        J. RETRO MA 1 and RETRO MA 2 fields
        k. AMBULATION CAPACITY
        l. DOMICILIARY RATE
        m. GRANT RECOUPMENT DATA
        n. SPECIAL NEEDS DATA
      2. Individual Data
        a. JOBS/WORK REQUIREMENT SAVINGS DATA
        b. EDUCATIONAL EMPLOYMENT
        c. EDUCATIONAL LEVEL

    D. Update other information using the DSS-8125 or Name Change function if necessary. Refer to Making Changes To Active Cases, EIS 3101, for instructions.

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III. KEY THE DSS-8125.

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IV. OUTPUTS

    When the DSS-8125 processes successfully, the following are received:

    A. A Case Profile is produced the night the transfer processes and is mailed to the county the following workday.

REISSUED 10/01/12 – CHANGE NO. 01-13

    II. A. 1. (CONT'D) (TRANSFERRING FROM A-AF TO M-AF)

    B. The aid program/category transfer is reported on the Caseworker Supervisor Report. The number of aid program/category transfers completed is determined from the WORKER NUMBER.

    A. General Information

      1. An automated notice (DSS-8110A) is produced the night the
      A-AF to M-AF transfer processes in the system unless “Y” is entered for “NOTICE OVERRIDE”. A sample of the DSS-8110A is located at the end of this section.
      2. The CHANGE CODE entered on the DSS-8125 determines the text of the notice and whether the notice is adequate or timely.
      3. The system calculates the 60th calendar day for the notice.
      4. 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 not mailed to the county.
      5. 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 3556 for more information regarding the Notice Register Report.

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V. AUTOMATED NOTICES

    B. Adequate Notice

      1. “Adequate” is clearly indicated at the top of the notice.
      2. The system calculates the 60th calendar day for the notice.
      3. The action indicated on the DSS-8125 takes place in EIS the same night the adequate notice is produced.

    C. Timely Notice

      1. “Timely” is clearly indicated at the top of the notice.
      2. To produce an automated timely notice, you must complete the DSS-8125 and have it keyed into EIS at the same time you would have completed the manual DSS-8110.

REISSUED 02/01/11 – CHANGE NO. 03-11

V. 7. C. (CONT'D) (TRANSFERRING A-AF TO M-AF)

      3. The system calculates the tenth county workday and the 60th calendar day for the notice.
      4. The action takes place in EIS eleven county workdays from the date of the notice.

        For example: A DSS-8125 indicating a termination effective July 1996 and a timely reason code is keyed June 12, 1996. The eleventh workday is June 28, 1996. The keying deadline is June 25, 1996. EIS changes the payment effective date to August 1996.

      5. No further action is required by you for the action to occur.
      6. An updated Case Profile is produced the night the action takes place in EIS.
      7. Deleting the Action

        Because the action does not actually process in EIS until the eleventh county workday, it is possible to stop the action. To do so, you must delete the action that is on hold in EIS. The deletion must occur no later than the eleventh county workday from the date of the notice.

        Delete the pending action using one of the following methods.

        a. Submit a copy of the DSS-8125 you sent originally to request the change. Write “DELETE” in red across the top of the form; or
        b. Submit a county form developed for this purpose. This form must contain the form ID number of the original DSS-8125 and a message to Data Entry to delete the form.
        c. See EIS 4900, Data Entry Appendix E.

          NOTE: FORM ID NUMBERS ARE LISTED ON THE NOTICE REGISTERS AND ARE AVAILABLE THROUGH INQUIRY IN XPTR FOR THREE DAYS AFTER THE DSS-8125 IS KEYED.

REISSUED 02/01/11 – CHANGE NO. 03-11

V. 8. C. (CONT'D) (TRANSFERRING A-AF TO M-AF)

          This action is reported on the Notice Register for that day. The information related to the automated

          notice is displayed with “DELETED” noted in the “COMMENTS” column of the register.

      8. Rescinding the Action

        It is important to note that there is another situation where an action pending in EIS is stopped.

        If a subsequent DSS-8125 is keyed by the eleventh county workday from the date of the notice and the subsequent
        DSS-8125 causes a new notice to be produced, the pending action is stopped. In this situation, EIS “rescinds” the pending action and produces an automated notice for the new action.

        Both actions are reported on the Notice Register for that day. The information related to the first automated notice is displayed with “RESCINDED” noted in the “COMMENTS” column of the register. The information related to the subsequent automated notice is also displayed with no entry in the “COMMENTS” column.

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