NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 4200

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SSI MEDICAID-APPROVAL/DENIAL - PART THREE

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EIS 4200 – SSI MEDICAID-APPROVAL/DENIAL PART THREE


I. SSI MEDICAID APPROVAL

II. SSI DENIAL/MEDICAID DENIAL


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EIS 4200 – SSI MEDICAID-APPROVAL/DENIAL
PART THREE

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

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I. SSI MEDICAID APPROVAL

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

I.B.3.(CONT'D)(INDIVIDUAL IN EIS PENDING APPLICATION)

REISSUED 03/01/99 - CHANGE NO. 10-99

 

WHAT IS IN EIS?

EIS CREATES SSI/MEDICAID CASE

DELETE INDIVIDUAL FROM OLD CASE

PENDING 8125 OR TIMELY ACTION DELETED

REPORTS

1.

ACTIVE MAABD CASE-AUTH OR DED

MODIFY EXISTING CASE

NA

YES

SDX/EIS UPDATES REPORT

2.

ACTIVE MQB

YES, MAABD

NA

YES

SDX/EIS UPDATES REPORT

3.

ACTIVE SINGLE PERSON MAF/MIC

YES, MAABD

NA

YES

SDX/EIS UPDATES REPORT

4.

ACTIVE MULTI-PERSON MAF/MIC

YES, MAABD

YES

NO

SDX/EIS UPDATES REPORT

5.

ACTIVE HSF-AUTH OR DED

MODIFY EXISTING CASE

NA

YES

SDX/EIS UPDATES REPORT

6.

ACTIVE IAS

YES, MAD OR MAB

NA

YES

SDX/EIS UPDATES REPORT

7.

ACTIVE SINGLE PERSON-AAF PAY TYPE 1,2,4,OR S

YES, MAABD

NA

YES

SDX/EIS UPDATES REPORT

8.

ACTIVE MULTI-PERSON AAF PAY TYPE 1,2,4 OR S-

YES,

NEW MAABD CASE

YES

NO

SDX/EIS UPDATES REPORT

9.

ACTIVE AAF PAY TYPE 5, 6 OR 7-SINGLE PERSON

MODIFY EXISTING CASE

NA

NO

SDX UPDATES SHEET

10.

ACTIVE AAF PAY TYPE 5, 6 OR 7-MULTI-PERSON

YES,

NEW MAABD CASE

YES

NO

SDX/EIS UPDATES REPORT

11.

ACTIVE SAD/SAA

MODIFY EXISTING CASE

NA

NO

SDX UPDATES SHEET, SDX/EIS UPDATES REPORT

12.

MRF

NA

     

13.

RRF

NA

     

14.

MSB

YES, MAABD

NA

YES

SDX/EIS UPDATES REPORT

15.

SCD

YES, MAABD

NO

YES

SDX/EIS UPDATES REPORT

16.

MPW

YES, MAD OR MAB

NA

YES

SDX/EIS UPDATES REPORT

REVISED 03/01/99 - CHANGE NO. 10-99

I.(CONT'D)

REVISED 09/01/06 - CHANGE NO. 02-07

I.C.1.a.(CONT'D)(MAABD-INDIVIDUAL NOT ACTIVE IN EIS)

REISSUED 09/01/06 - CHANGE NO. 02-07

I.C.(CONT'D)(MAABD-INDIVIDUAL ACTIVE IN EIS IN PLA)

REVISED 09/01/06 - CHANGE NO. 02-07

I.C.1.b .(CONT'D)(MAABD-INDIVIDUAL ACTIVE IN EIS IN PLA)

REISSUED 09/01/06 - CHANGE NO. 02-07

I.C.1.b.(CONT'D) (MAABD-INDIVIDUAL ACTIVE IN EIS IN PLA)

The county must ensure CAP is posted appropriately to all previous periods of eligibility. For example, SSI/Medicaid is now authorized for months that were previously unauthorized or authorized for less than full Medicaid. See example:

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

I.C.1.b.16.(CONT'D) (MAABD-INDIVIDUAL ACTIVE IN EIS IN PLA)

BEFORE SSI Medicaid is approved EIS INDIVIDUAL ELIGIBILITY HISTORY looks like this.

AFTER SSI Medicaid is approved effective 8-1-95, EIS INDIVIDUAL ELIGIBILITY HISTORY looks like this:

Notice deductible balances are deleted and periods previously authorizied as MQB are now authorized MAD. The client’s CAP Plan of Care/FL-2 is approved effective 8-10-95. The county must post CAP using an 8125 for 8-10-95 through 9-30-95 and 10-1-95 through 10-31-95 to fill in the CAP coverage for periods now authorized for full Medicaid. If another county is involved, contact the other county to post CAP for periods of time the case was active in that county.

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

I.C.1.b.16.(CONT'D) (MAABD-INDIVIDUAL ACTIVE IN EIS IN PLA)

When CAP is posted appropriately, EIS Individual Eligibility History looks like this:

REVISED 09/01/06 - CHANGE NO. 02-07

I.C.1.c.(CONT'D)(MAABD-INDIVIDUAL ACTIVE IN EIS IN LTC)

REVISED 09/01/06 - CHANGE NO. 02-07

I.C.(CONT'D)

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

I.C.(CONT'D)

REVISED 10/01/09 - CHANGE NO. 01-10

I.D. (CONT’D)

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II. SSI DENIAL/MEDICAID DENIAL

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