Family and Children's Medicaid Admin. Letters

DMA ADMINISTRATIVE LETTER 07-09, LOW INCOME SUBSIDY (LIS) application FOR MEDICAID

TO: COUNTY DIRECTORS

ATTENTION: INCOME MAINTENANCE DIRECTORS

MEDICAID, INCOME MAINTENANCE CASEWORKERS AND SUPERVISORS

DATE: December 18, 2009

SUBJECT: LOW INCOME SUBSIDY APPLICATION FOR MEDICAID

I. BACKGROUND

The Medicare Improvements Patient and Providers Act of 2008 (MIPPA) mandated that, effective January 1, 2010, an application for the Medicare Low-Income Subsidy (LIS) program is considered an application for the Medicare Savings Programs (MSP), known in North Carolina as the MQB programs. Since in North Carolina, an application for MQB is considered an application for Medicaid, the county must evaluate the individual for all possible Medicaid programs.

Beginning January 1, 2010, the Social Security Administration (SSA) transmits daily electronic data for each LIS application after SSA determines LIS eligibility. DMA matches the data with current Medicaid recipient data and creates an electronic North Carolina Medicaid application for individuals who are not current Medicaid/MQB recipients or do not have a pending application. The county departments of social services are notified of the electronic application on the regular Adjusted Application Management Report. We expect EIS changes to be implemented during the weekend of January 15, 2010. We anticipate the 1^st LIS Medicaid applications being available in EIS by Tuesday, January 19, 2010. A list serve message will be sent when the first applications are available.

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II. APPLICATION PROCESSING

A. LIS Application for Medicaid

The Social Security Administration (SSA) transmits electronic data daily for each initial LIS application when SSA determines that a person is eligible or not eligible for LIS. If a couple applies for LIS, separate applications are transmitted for each individual. If an individual indicates that he does not want to transmit the data to the state by answering “no” to question 15 on the initial LIS application, no application will be created.

B. Application/Processing Time Standards

1. The 45/90 day processing time standard begins when the LIS Medicaid application is created by EIS plus 2 calendar days.

2. The application date for Medicaid is the date the application was received by SSA.

3. The applicant may be evaluated for retroactive coverage for the three months prior to the month of application.

III. EIS CREATES A MEDICAID APPLICATION

An application is created by the Eligibility Information System (EIS) for any person on the LIS file who is not currently active in any Aid Program Category or who is not currently included in a pending application. Exceptions to this are: if the LIS month of application is not included in the authorized Medicaid eligibility segment, an application is created; or, if the LIS month of application is earlier than the month of application on the pending application in EIS, an application is created.

When creating a Medicaid application:

A. EIS will determine the county of residence using the address information on the LIS file.

B. County Case Number is blank.

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C. The Worker# and District# fields are coded “LIS”.

D. The application type is coded as “1”, new application.

E. The “How Application Received” indicator is “L”.

F. The aid program/category is MAD if the applicant is age 64 or younger and MAA if the applicant is 65 or older.

G. If MAD, “N” for No is indicated for ongoing disability determination.

H. Total number of people on the application is 1.

I. The Casehead/Payee included indicator is “Y”.

J. The person’s name, date of birth, social security number, and sex, is entered by EIS utilizing the information from CNDS, or from the LIS file if the person was not found in CNDS.

K. The application date is the date of application for LIS.

IV. EIS CREATES A DATE SCREEN FOR EACH LIS MEDICAID APPLICATION

A. EIS uses the Date Screen to disregard the processing time between the LIS application date and the date EIS creates the application (EIS adds 2 calendar days to this date).

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B. EIS will automatically create the date screen for all LIS applications including both MAD and MAA.

C. The exclusion reason is “LIS”. LIS will be a valid exclusion reason code that the caseworker may enter manually, if needed.

D. The date screen begin date is the date of the LIS application. EIS will automatically populate this date when the date screen is created (the same night the application is created).

E. The date screen end date is the date EIS creates the application plus 2 calendar days. EIS will automatically populate this date when the date screen is created (the same night the application is created).

F. The Date Screen in EIS will eventually be modified to allow a caseworker to utilize a second exclusion reason, begin date, and end date, in addition to the LIS exclusion reason. You will be notified when this change is implemented.

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V. EIS Creates THE LIS EXCEPTION LIST

When there is a ‘close’ match (name, date of birth, and sex match between LIS data and CNDS data, but the SSN in EIS is zero or different than the SSN on the LIS file), EIS creates a record on the LIS Exception List for the caseworker to resolve. (Note: Matches are limited to top 5 close matches). See VIII for instructions to access the LIS Exception List and IX for instructions to resolve the exceptions.

VI. County Procedures

A. The LIS Exception List must be worked daily. These exceptions are situations where LIS data and EIS data did not have an exact match. They will remain on the LIS Exception List until they are resolved. An application is not created until the Exception is resolved. Refer to IX below.

B. The county must review the Adjusted Application Management Report daily to find the LIS Medicaid applications and assign them to the appropriate worker. Once assigned, the worker should key her worker/district number on the DSS-8124.

C. Additional data from the LIS file, such as income and resource information, for which there is no place on the electronic Medicaid application can be found on NCXPTR report DHRWDB LIS DAILY TRANS RPT. Refer to VII below.

VII. Reports

A. DHREJ ADJ APP MANAGEMENT REP (Adjusted Application Management Report)

1. The pending LIS applications are included on the Adjusted Application Management Report.

2. Due dates for these “L” applications are based on the EIS create date on the application, NOT on the LIS application date.

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B. DHREJ ADJ SUM APP MGMT REPORT (Adjusted Summary Application Management Report)

LIS applications are included on this summary report.

C. DHRWDB LIS DAILY TRANS RPT

1. Title of the report is LOW INCOME SUBSIDY (LIS) DAILY TRANSMISSION.

2. The information on the report is sorted by county and alphabetically by the person’s name (last name/first name).

3. The following information is listed on the report:

a. County Name/Number

b. Applicant Name (Last/First)

c. Application Number and date with notation that EIS created the pending application, or

d. Application Number and date with notation that application is already pending, or

e. Case Number with notation that person is active Medicaid

f. Other information on the LIS file is displayed on the report.

g. Household size includes the number of children and not the applicant or the spouse.

4. Sorted so that the application number with notation that EIS created the pending application appears on the report along with the application that is already pending.

5. Versions of the report are kept 3660 days.

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VIiI. ACCESSING THE LIS EXCEPTION LIST

A. Access the LIS EXCEPTION LIST from the EIS MENU (UPDATE) or any screen in IMS that displays the SELECTION and KEY fields at the bottom.

1. Enter LE beside SELECTION.

2. Enter one of the following beside KEY.

a. COUNTY NUMBER (00)

• EIS displays the exceptions for the specified county.

b. COUNTY NUMBER and POST DATE (00 space MMDDCCYY)

The Post Date is the date EIS first displays the exception. This date is the day that the daily LIS/EIS update runs.

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• EIS displays the exceptions for the specified county and post date.

c. POST DATE (MMDDCCYY)

• EIS displays the exceptions for the state for the specified post date.

d. SPACES (NO ENTRY)

• EIS displays the exceptions for the state and includes all post dates.

3. Press ENTER.

B. EIS displays the LIS EXCEPTION LIST.

1. This is the list of individuals EIS could not automatically update.

2. EIS displays the following information.

a. LIS INDIVIDUAL DATA

SSN, NAME, DATE OF BIRTH (DOB), and SEX (S).

b. COUNTY (CO)

This is the county responsible for resolving the exception.

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c. POST DATE (POSTDT)

The Post Date is the date EIS first displays the exception. This date is the day that the daily LIS/EIS update runs or the date of the quarterly reconciliation.

3. To scroll forward through the LIS EXCEPTION LIST, press PF8.

4. To scroll backward through the LIS EXCEPTION LIST, press PF7.

When you PF8 to the second group of 70 exceptions, you cannot PF7 back to the original group of 70. If you wish to return to a previous group of 70 exceptions, you must enter LE in SELECTION at the bottom of the screen and the appropriate KEY for the exceptions you wish to view. Scroll forward (PF8) until you reach the desired exceptions. If you attempt to scroll backward (PF7) to a group of 70 exceptions that has already been viewed, TOP OF DATA is displayed. When the last exception is displayed, BOTTOM OF DATA is displayed.

5. Enter S in the SEL field to select the exception you wish to resolve. Press ENTER.

• ERRORS - EIS may display messages at the bottom of the screen. These messages are defined at the end of this section.

C. EIS displays the LIS EXCEPTION PROCESSING screen.

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1. This screen displays the individuals in EIS who have the same SSN as the selected LIS individual.

In this example, there is more than one Individual ID with the same SSN as the LIS individual and the name of the person who seems to match the LIS individual does not exactly match the data on the LIS File.

2. EIS displays the following information.

a. LIS DATA

EIS brings this data forward from the LIS File.

b. EIS DATA

The data under this heading is the data in the Common Name Database for the individuals who have the same SSN as the selected LIS individual. They may or may not be the same person as the LIS individual.

• SSN, NAME, INDIVIDUAL ID, DATE OF BIRTH (DOB), SEX (S). This data always displays.

• COUNTY (CO) - The county number displays if an application is entered in EIS or a case is entered in FSIS.

The following data displays only if the individual has applications/cases in EIS. If this data does not display, this person has never been on an application in EIS as a recipient or an application was denied or withdrawn, the history has been purged, or the individual only has FSIS history. You must inquire in FSIS to view Food Stamp history.

When the data below does not display, the ID cannot be combined with another ID.

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• CASE/APP - The EIS case ID or pending application number.

• AID PROGRAM/CATEGORY (APC) - The aid program/category from the EIS case or pending application.

• COUNTY CASE (COCSE) - The county case number from the EIS case or pending application.

3. To return to the LIS EXCEPTION LIST (at any time) without resolving the exception, press PF3.

4. Follow the instructions in IX. below to resolve the exceptions.

IX. RESOLVING THE EXCEPTIONS

A. Research each of the individuals listed under the “EIS DATA” section of the screen.

1. Use the case record, FSIS, and any other available information.

2. Determine which of the individuals listed, if any, is the same person as the LIS individual.

3. If one or more of the individuals is in another county, contact the other county for assistance.

B. Review the information in the “EIS DATA” section of the screen.

HOW MANY DIFFERENT INDIVIDUAL ID NUMBERS ARE LISTED?

• Only One

This indicates the SSN for the LIS individual occurs only once in the Common Name Database but the name and/or date of birth in the Common Name Database do not match exactly the information on the LIS.

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Follow the instructions in C. below.

• More Than One

This indicates the SSN for the LIS individual occurs more than once in the Common Name Database.

Follow the instructions in D. below.

C. SSN FOR THE LIS INDIVIDUAL OCCURS ONLY ONCE IN the Common Name Database BUT THE NAME AND/OR DATE OF BIRTH IN the Common Name Database DO NOT MATCH EXACTLY THE DATA ON THE LIS File.

EXAMPLE:

1. THE INDIVIDUAL IN THE Common Name Database AND THE LIS INDIVIDUAL ARE THE SAME PERSON.

Assume in this example that Tina Sullivan on the LIS File and Tina Rogers in the Common Name Database are the same person.

a. Enter S beside the individual's data listed under EIS DATA to select her as a match to the LIS individual.

b. Press ENTER.

The EIS/CNDS information is retained.

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2. THE INDIVIDUAL DISPLAYED UNDER EIS DATA AND THE LIS INDIVIDUAL ARE NOT THE SAME PERSON.

EXAMPLE:

Assume in this example that Tina and Mary are not the same person.

a. Enter S beside ASSIGN NEW ID.

b. Press ENTER. EIS displays a message, 002 DUPS - CHG SSN(S) OR COMBINE W/SEL INDV USING OPT “C” AND PRESS PF1.

c. Correct the SSN of the EIS individual displayed on the screen.

d. Press PF1.

D. SSN FOR THE LIS INDIVIDUAL OCCURS MORE THAN ONCE IN THE Common Name Database.

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EXAMPLE:

1. ALL EIS INDIVIDUALS ARE THE SAME PERSON AS THE LIS INDIVIDUAL.

Assume in this example that these are all the same John J. Smith and he is not an active recipient in EIS or FSIS.

a. Enter S to select the matching individual's data.

There may be more than one individual displayed who matches the LIS individual. Always select the individual who has EIS history as the match. If either Individual ID is active in EIS, choose it as the match. If neither is active, it does not matter which one you choose. In the example above, you may select the John J. Smith on the first or second line of EIS matches, since the EIS Case ID displayed indicates he has eligibility history with that Individual ID.

If the Individual ID(s) not selected as a match is active in FSIS, change the Individual ID on the Food Stamp case to the same ID as the one you selected as a match. This ensures the individual has the same individual data in all cases.

b. Press ENTER. EIS displays a message, 002 DUPS - CHG SSN(S) OR COMBINE W/SEL INDV USING OPT “C” AND PRESS PF1.

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c. Enter C to combine and cross reference the other Individual ID(S) with the selected individual. Press PF1.

In this example, enter C to the left of the Individual ID on the second line of EIS matches to combine those IDs with the selected ID.

IDs cannot be combined unless there is eligibility history in EIS for one Individual ID. If one ID has history in EIS and the other ID has history in FSIS only, they can be combined. In this example, the individual with no data listed after County Number cannot be combined with the selected individual because there is no EIS eligibility history associated with the Individual ID. You must zero out the SSN in the ID on the LIS Exception Processing screen. Remember, changes on this screen update the Common Name Database, the EIS Individual ID, the EIS case, the active Food Stamp case, ACTS, the individual’s record in any other DHHS division using the CNDS ID as its recipient identifier and any pending applications and forms DSS-8125, as appropriate. DO NOT ZERO OUT THE SSN WITHOUT COORDINATING WITH THE APPROPRIATE WORKER.

2. ONE OR MORE INDIVIDUALS ARE THE SAME AS THE LIS INDIVIDUAL AND ONE OR MORE ARE NOT THE SAME AS THE LIS INDIVIDUAL.

EXAMPLE:

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Assume both John Smiths are the same as the LIS individual and Marjorie Johnson is not the same as the LIS individual.

a. Enter S to select the matching individual's data.

There may be more than one individual displayed who matches the LIS individual. Always select the individual who has EIS history as the match. If either Individual ID is active in EIS, choose it as the match. If neither is active, it does not matter which one you choose. In the example above, you should only select the John J. Smith on the first line of EIS matches, since the EIS Case ID displayed indicates he has eligibility history with that Individual ID.

If the Individual ID(s) not selected as a match is active in FSIS, change the Individual ID on the Food Stamp case to the same ID as the one you selected as a match. This ensures the individual has the same individual data in all cases.

b. Press ENTER. EIS displays a message, 002 DUPS - CHG SSN(S) OR COMBINE W/SEL INDV USING OPT “C” AND PRESS PF1.

c. Enter C to combine and cross reference other EIS individuals listed on the screen with the selected individual. Press PF1.

IDs cannot be combined unless there is eligibility history in EIS for one Individual IDs. If one ID has history in EIS and the other ID has history in FSIS only, they can be combined. In this example, the John Smith with no data listed after County Number cannot be combined with the selected individual because there is no EIS eligibility history associated with the Individual ID. You must zero out the SSN in the ID on the LIS Exception Processing screen.

Since Marjorie Johnson is not the same person as John Smith, do not combine her ID with his. Correct her SSN.

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Remember, changes on this screen update the Common Name Database, the EIS Individual ID, the EIS case, the active Food Stamp case, ACTS, the individual’s record in any other DHHS division using the CNDS ID as its recipient identifier and any pending applications and forms DSS-8125, as appropriate. DO NOT CORRECT OR ZERO OUT THE SSN WITHOUT COORDINATING WITH THE APPROPRIATE WORKER.

3. NONE OF THE EIS INDIVIDUALS ARE THE SAME AS THE LIS INDIVIDUAL.

EXAMPLE:

a. Enter S beside ASSIGN NEW ID.

b. Press ENTER. EIS displays a message, 002 DUPS - CHG SSN(S) OR COMBINE W/SEL INDV USING OPT “C” AND PRESS PF1.

c. Correct the SSN of the non-matching EIS individuals displayed on the screen.

d. Press PF1.

E. EIS ACTIONS

• EIS processes resolved exceptions immediately. EIS immediately removes the resolved exception from the list.

• Each night, the resolved exceptions will process and create Medicaid applications and update reports as required.

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• When you select ASSIGN NEW ID, EIS assigns a new (unique) individual ID for the LIS individual. The name, date of birth, race, and sex in the Common Name Database reflects the information on the LIS File. The default Ethnicity and Race code is “U” and the default language value is “EN”.

• When you correct or zero out the SSN for an individual on the exception list, EIS updates the Common Name Database, the EIS Individual ID, the active or inactive EIS case, the active Food Stamp case, ACTS, the individual’s record in any other DHHS division using the CNDS ID as its recipient identifier and any pending applications and forms DSS-8125, as appropriate. DO NOT CHANGE OR ZERO OUT AN SSN WITHOUT COORDINATING WITH THE APPROPRIATE WORKER.

• When you select an individual as a match to the LIS individual, EIS/CNDS information is retained. If appropriate, EIS creates an application.

SCREEN MESSAGES

EIS displays the following messages on the exception processing screens.

CANNOT CHANGE SSN AND SELECT INDIVIDUAL

EIS displays this message when you have selected an individual as a match and then attempted to change or zero out the social security number for that person.

You are not allowed to select the person as a match and then change the social security number.

If you selected the person correctly, rekey the “s” to select the person as a match. DO NOT change the social security number for that person. Press ENTER.

If you selected the person incorrectly, key the “s” to make a different selection. Press ENTER. Correct or zero out the social security number of all other entries or key “c” in the SELECT field to combine the ids. Press PF1.

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CANNOT COMBINE WHEN INITIAL MATCH SELECTION IS ASSIGN NEW ID

EIS displays this message when you attempt to combine individuals after assigning a new ID to the LIS individual.

This is not appropriate. You should only assign a new ID when none of the EIS individuals listed on the screen are the same person as the LIS individual. If none of the individuals are the same as the LIS individual, IDs should not be combined.

If you indicated ASSIGN NEW ID incorrectly, press PF3 to return to the LIS EXCEPTION LIST and start over.

If you indicated ASSIGN NEW ID correctly, delete or EOF (erase) the C's you have on the screen and PF1 again.

DUPS-CHG SSN(S) OR COMBINE W/SEL INDV USING OPT "C" AND PRESS PF1

EIS displays this message when an individual is selected as a match and other individuals remain on the screen with the same SSN. This indicates there are duplicate SSNs in EIS that match the SSN of the LIS individual.

Change the SSN to a unique number, enter zeros, or combine the EIS individuals with the LIS individual by entering C in the SEL field. IDs can only be combined when there is EIS eligibility history associated with each ID. See examples above for instructions. Press PF1.

INDIVIDUAL 000000000X IS SSI - CANNOT CHANGE THIS SSN

EIS displays this message when you have attempted to change the social security number of a person who currently receives SSI/Medicaid.

You are not allowed to change the social security number of a person who currently receives SSI/Medicaid.

If this person is the same as the person on the LIS, key “s” to select this person as a match and press ENTER. DO NOT CHANGE THE SSN.

If this person is NOT the same as the person on the LIS and you have received the above error, call DMA/EIS staff for assistance.

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INDIVIDUAL MUST HAVE SAME SSN TO COMBINE

EIS displays this message when you attempt to combine individuals with the selected individual after changing the SSN to a number that is not the same as the SSN of the selected individual.

The SSNs must be the same in order to combine the individual(s) with the selected individual.

If you have keyed a SSN incorrectly, correct it and press PF1.

If you have keyed C for someone incorrectly, delete or EOF (erase) the C and press PF1.

INVALID COMBINE-ONLY ONE INDIVIDUAL MAY BE ACTIVE

EIS displays this message when you attempt to combine individuals with the selected individual and more than one of the individuals is active in EIS.

PF3 back to the LIS EXCEPTION LIST.

Terminate all but one of the individuals and resolve the exception the following work day.

INVALID KEY FOR EXCEPTION PROCESSING

EIS displays this message when you enter an invalid KEY to view the LIS EXCEPTION LIST. See II. for the valid entries for this field.

MUST CHANGE TO VALID SSN OR ENTER ZEROS

EIS displays this message when individuals remain on the LIS EXCEPTION PROCESSING screen and the SSN matches the SSN of the LIS individual.

Enter a different SSN, enter zeroes for the SSN, or enter C to combine the individuals with the selected individual. The SSNs must be different (or changed to zeroes) or the individuals must be combined.

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Press PF1.

MUST PRESS PF1 TO PROCESS CHANGES OR PF3 TO RETURN TO THE FIRST SCREEN

EIS displays this message when an invalid key is pressed. Refer to the manual instructions for the correct key.

SSN ALREADY EXISTS IN NAME CLEARANCE

EIS displays this message when a SSN is changed to a number that already exists in EIS.

Perform a SSN search. Correct the invalid number or enter zeros if a valid number is not available.

Press PF1.

Initiate the process to obtain a valid SSN if the individual is active in EIS.

Please contact your Medicaid Program Representative if you have questions.

Craigan L. Gray, MD, MBA, JD

Director

(This material was researched and prepared by Wanda McLeoud, EIS Consultant.)