Viewing Medicaid Eligibility and Selecting a Managed Care Plan. Knowledge Base Article

Transcription

1 Viewing Medicaid Eligibility and Selecting a Managed Care Plan Knowledge Base Article

2 Table of Contents Overview...3 Medicaid Effective and Termination Dates...3 Medicaid Spans...4 Locating Medicaid Eligibility...4 Adding Provider Members...6 Adding Other Members...7 Selecting a Managed Care Plan...8 Changing a Managed Care Plan...9 Page 2 of 11 Last Revised: 02/15/2018

3 Overview This article provides instruction for viewing a Medicaid Eligibility record and selecting a Managed Care Plan. Medicaid Effective and Termination Dates Effective dates on Medicaid spans are always the first day of the month and termination dates are always the last day of the month. The only exceptions to this are for the child s date of birth and date of death. A Medicaid span cannot be created prior to a child's date of birth date (as documented in SACWIS) or ended after a child s documented date of death. The child s date of death must be entered on the person record. The monthly Medicaid Eligibility batch job will pick up the date of death and automatically populate that date as the child s Medicaid eligibility span end date. Medicaid spans cannot be terminated retroactively by SACWIS with the exception of the child s date of death. Therefore, if a child s custody is terminated, a child s adoption subsidy is terminated, or a termination date is entered for Ohio Medicaid on a child s ICPC/ICAMA record after the monthly Medicaid Eligibility batch job runs in the early hours of the 15 th of each month. The termination date of the Medicaid span will be populated as of the last day of the following month. It is important to note that the Medicaid termination date will not be populated on the Medicaid span in the child s Medicaid Eligibility History grid until after the Monthly Medicaid Eligibility batch job has run. Example: A worker terminated custody for a child on 10/28/17 with a Custody End Date of 9/15/17. When the monthly Medicaid Eligibility batch job runs in November 2017, the Medicaid span will be populated with a Termination date of 11/30/17. This occurs because the date the worker entered the change was after the date the monthly Medicaid Eligibility batch job had run for the month (10/15/2017). Therefore, the worker will not see an end date on the Medicaid span in SACWIS until after the monthly Medicaid Eligibility job is run on November 15, The same is true for adoption, ICPC, and ICAMA cases. Page 3 of 11 Last Revised: 02/15/2018

4 Medicaid Spans Medicaid spans will be opened daily in SACWIS through a batch job process that runs hourly between 8 am and 4 pm and again at 7 pm. Medicaid spans will be closed on the 15 th of each month when the Medicaid Eligibility batch job runs. The only exception is when a child s adoption is finalized and the worker seals and secures their record. The data fields in SACWIS that impact Medicaid eligibility spans are: The child s Legal Status The AA subsidy determination or termination The Ohio Medicaid Effective Date or Ohio Medicaid Termination Date in the ICPC/ICAMA records Sealing and securing the child s record after their adoption is finalized The child s date of birth The child s date of death Locating Medicaid Eligibility From the SACWIS Home Page: 1. Click the Financial tab. 2. Click, Eligibility. 3. In the navigation pane, click, Medicaid Eligibility. Page 4 of 11 Last Revised: 02/15/2018

5 The Child Selection grid appears. OR, 4. Enter the Person ID. 5. Click, Go. 6. Click, Person Search. Note: See the following KBA for information on the SACWIS search function: Using Search Functionality. The Child Selection Grid appears, displaying the child s Medicaid Eligibility History. From here, you can enroll the child into a Managed Care Plan. Important: Note that the Primary Information Person (PIP) is the individual who can make all medical decisions for the child, including changing the Managed Care Plan. This person s name is pulled from the primary worker assigned to the case, or, the managed care coordinator for the agency. Page 5 of 11 Last Revised: 02/15/2018

6 The Authorized Representative History grid lists individuals who are able to communicate and coordinate care with the Managed Care Plans. Adding Provider Members 1. Click, Add Provider Members. Note: Provider Members are pulled from the placement provider members. The maximum number of Authorized Representatives permitted to be listed are two (2). The Adult Provider Members grid appears. 2. Place a checkmark in the checkbox next to the appropriate individual(s). 3. Enter the Effective Date. 4. Click, Save. The Authorized Representative History grid appears, listing both individuals that were selected. The Add Provider Members and Add Other Members buttons are grayed out because the maximum number of representatives (2) have been listed. Page 6 of 11 Last Revised: 02/15/2018

7 Adding Other Members If it is necessary to add another case member: 1. Click, Add Other Members in the Authoized Representative History grid. The Other Persons grid appears. OR, 2. Enter the Person ID. 3. Click, Go. 4. Click, Person Search. Note: See the following KBA for information on the SACWIS search function: Using Search Functionality. The Other Persons grid populates information for the Person ID used in the search. 5. Enter the Effective Date. 6. Make a selection from the Representative Type drop-down menu. 7. Click, Save. Page 7 of 11 Last Revised: 02/15/2018

8 The Child Selection grid appears. Selecting a Managed Care Plan In the Managed Care Plan (MCP) Enrollment History grid: 1. Click, Add MCP Enrollment/Disenrollment. The Managed Care Plans Enrollment Information grid appears. 2. In the MCP Name drop-down menu, please select the appropriate MCP where you wish to enroll the child. Note: This is the only section that is required on this page. The MCP Enrollment and/or Disenrollment dates will automatically populate. 3. Click, Save. The Child Selection grid appears, displaying the selected MCP in the Managed Care Plan (MCP) Enrollment History grid. Page 8 of 11 Last Revised: 02/15/2018

9 Note: While the enrollment is in marked as Pending, the MCP can be changed. Once the Enrollment has been sent to the MCEC, the enrollment is no longer editable. Once SACWIS receives the enrollment back from Medicaid Information Technology System (MITS), The Enrollment Sent to MCEC will be set to Yes and the Enrollment Date will be updated. At this time, you will be able to change the MCP. Changing a Managed Care Plan From the SACWIS Home Page: 1. Navigate to the Financial tab. 2. Click, Eligibility. 3. In the navigation pane, click, Medicaid Eligibility. 4. Enter the Person ID OR, Click, Person Search. 5. Click Go. Page 9 of 11 Last Revised: 02/15/2018

10 The Child Selection grid appears. 6. Click, Add MCP Enrollment/Disenrollment. Note: The Add MCP Enrollment/Disenrollment button is only enabled when there is no MCP selected or there are Enrollment Dates next to the previously selected MCP. The button will be disabled after a MCP is selected until the Enrollment Date is received from MITS. The Managed Care Plans Enrollment Information grid appears. 7. In order to change the Managed Care Plan, select an MCP Disenrollment Reason. 8. After selecting a Disenrollment Reason, select the new MCP where you would like to enroll the child. 9. Click Save. Page 10 of 11 Last Revised: 02/15/2018

11 Note: Once you click Save, the system will return to the Child Selection page and will show the new and current Managed Care Plans as Pending (Managed Care Plan (MCP) Enrollment History grid). This means the disenrollment of the current MCP and enrollment of the new MCP have not yet been sent to MCEC. The dates will automatically populate after the system receives confirmation that the change has been received by MITS. Note: You will not be able to disenroll a child from a Managed Care Plan without enrolling them in a new plan. SACWIS will terminate the MCP when the Medicaid Eligibility is terminated for a child. If you need additional assistance, please contact the SACWIS Help Desk. Page 11 of 11 Last Revised: 02/15/2018