Slide Title Introduction Presump Elig 1 <PE1> <PE2> <PE3> <PE4> <PE5> <PE6> <PE7> <PE8> <PE9> Slide Text Income 2 This HuBERT on-demand training module is provided by the MN Department of Health WIC Program. It is an overview of how to document Presumptive Eligibility and overincome scenarios in the HuBERT system. Presumptive Eligibility Presumptive Eligibility, or PE, occurs when the household's income is between 185 and 275% of the federal poverty guidelines. These participants are not income eligible for WIC but may be income eligible for one of the Minnesota Health Care Programs; Such as Medical Assistance or MN Care. The participants must be willing to apply for these programs and be determined eligible to remain on WIC. Until their eligibility is determined, they are considered presumptively eligible for WIC. Lima Bean is being certified. What do we have to do to begin our documentation of her income? Go ahead. Lima brought in her paystub showing she earns $3,040 per month. Go ahead and document her income. <pause for animation> It s just Lima in her household and she is pregnant. What is her household size? Go ahead and double-click on the Household Size field, enter her household size, and click OK to save the income record. Whenever we save an income record, HuBERT performs an assessment of eligibility based on income amount and household size. If the participant is over the income limit, this message displays The message informs us of a couple of different things. First, it lets us know that the participant is not income eligible. Second, it tells us that her certification record will be terminated based on this income record. Third, it asks us whether this information is correct. Page 1
Lastly, it warns us that by selecting the Yes button on this message, and confirming that this income is correct, any other members of the household will also be terminated. <PE10> <PE11> <PE12> <PE13> <PE14> <PE15> <PE16> <PE17> <PE18> <PE19> <PE20> We should note that any household members individually adjunctively eligible will NOT be auto-terminated since the household income does NOT affect their eligibility. Although the income information we collected is correct, we need to document it differently since Lima has agreed to apply for Medical Assistance and clicking Yes would not allow us to continue with the certification. If we click No, we return to the income calculator window Go ahead and click No. Since her income is too high, we need to delete the income record we just created. Go ahead and do so. Occasionally we may know from prescreening that the participant will be presumptively eligible. In that case, it is not necessary to assess the income in the Income Calculator; We would begin at this step, documenting Presumptive Eligibility under the appropriate program. To document Presumptive Eligibility, or PE, we select the MHCP-MA or MHCP- MNCare checkbox, depending on which program the participant will apply for. Lima said she was applying for Medical Assistance or MHCP-MA; Go ahead and click the checkbox by MHCP-MA. Now click the drop-down to see the list of proofs. The proof that applies here is Presumptive Eligibility - 90 Day. Go ahead and select it. Click OK to save the Income Contact. To complete the required documentation we need to add both an alert and a note to inform other staff of Lima s Presumptive Eligibility. We ve already completed the required fields in Demographics so go ahead and click OK to save the information. Let s add the alert first. Go ahead and click the icon to add an alert. Click the Add button......and we will type an alert that includes how many months of benefits will be issued and what we need to verify the next time we see Lima With PE, we can issue 3 months of benefits at the end of her certification. The next time we see Lima, we will need to determine the current status of her application to MA. Page 2
<PE21> <PE22> <PE23> <PE24> <PE25> <PE26> <PE27> <PE28> <PE29> <PE30> <PE31> Presump Elig 2 <PEFU1> <PEFU2> <PEFU3> <PEFU4> <PEFU5> <PEFU6> Go ahead and save the alert. Click Close. Next, we need to add a note. Click the icon. The PE note is a General Note. Go ahead and click Create General Note. We always need to select a Subject for our note. Click the drop-down list to open it. Our subject is Presumptive Eligibility so we are going to scroll down the list. Go ahead and select our subject....and we ll type a quick note. The PE note needs to include three things: the family size, the income, and the type of income proof provided. Let s save our note and exit Manage Notes. Those are the steps for documenting Presumptive Eligibility at the cert. However, presumptive eligibility follow-up must occur the next time the participant returns to WIC. At that time, we will be expected to verify the participant s enrollment in a MN Health Care Program before issuing more benefits. We will need to add a new income record into the participant folder and we will need to document our follow-up in a PE Update note. Let s take a quick look at this process. Lima Bean has returned to WIC and is now enrolled in MA. She has brought her eligibility letter as proof. We need to add this income information into her participant folder. Go ahead and do this. Lima Bean has returned to WIC and is now enrolled in MA. She has brought her eligibility letter as proof. We need to add this income information into her participant folder. Go ahead and do this. Page 3
<PEFU7> <PEFU8> <PEFU9> <PEFU10> <PEFU11> <PEFU12> <PEFU13> <PEFU14> <PEFU15> <PEFU16> <PEFU17> 1 <OI1> <OI2> Over Income 1 <pause for animation> Next, we need to document our follow-up in a general note. Go ahead and open a general note. Our subject for this note is: PE Update. Go ahead and open the Subject drop-down and we will scroll down to our subject. Select PE Update. Our follow-up note just needs to indicate how the presumptive eligibility was resolved. So, we ll just type a quick note. Let s save our note. Once we have verified enrollment, added an income record, and documented our follow-up, the Presumptive Eligibility process can be considered complete. So, what happens when a participant isn t eligible for MN Health Care Programs and is income ineligible for WIC? Over Income Jay is here for a recertification appointment. We ve already add the income information, which is $48,000 per year for a family of 4. Go ahead and click OK. This is the same message we saw before but this time the family is not presumptively eligible; they are simply over the income limits and ineligible. However, the Bird family may be entitled to receive some benefits today even though they are over income for recertification. Remember if we click the Yes button, all members of the household will be terminated and unable to receive benefits today. Therefore, we need to click the No button and remove this certification attempt to see if anyone in the family meets the policy criteria to receive benefits today. Go ahead and click No. Federal guidelines specify the amount of allowable food benefit issuance when participants are found to be ineligible due to being over-income. The criterion is based on whether or not there are more than 90 days left until their certification ends. Page 4
<OI3> <OI4> <OI5> <OI6> <OI7> <OI8> <OI9> <OI10> <OI11> <OI12> Members with more than 90 days left in their current certification are eligible to receive food benefits for 15 days, which equates to providing a half package. Members with less than 90 days left are eligible to receive all of their remaining sets of food benefits. Before we can issue benefits though, we need to exit the current certification attempt. As with Presumptive Eligibility, we are going to leave the income calculator without saving the income record. Click Cancel. We also need to cancel out of Demographics since we can t save it without an income record. Click Cancel again. Lastly, we need to close our certification attempt. Click either the red X or the icon. When a certification is closed prior to completion, the folder remains in a locked mode until the certification is removed or completed. We can tell the folder is locked by the fact that all the fields are gray, or disabled. To unlock the folder, we need to remove this certification attempt. Click on Certification in the menu bar. Select Remove Incomplete Certification. A confirmation message appears to ensure we want to remove the current certification attempt. We do; Go ahead and click Yes. Many of the fields become enabled but the issue Benefits icon does not. We need to refresh the folder to enable it. Go ahead and close the folder using either the red X or the Close Folder icon. Re-open Jay s folder by double clicking on his name or clicking the open folder icon. The Issue Benefits icon is now enabled. Go ahead and click it. <OI13> Remember, issuance is based on whether there are more or less than 90 days left in our household member s certification period. The Certification Due date is displayed in the Issue Benefits Screen and can be used to determine what to issue in this scenario. For reference, today is February 26, 2014. Let s start with Blue Bird. Blue s certification due date is September 30 th, which is more than 90 days in the future. Participants with more than 90 days left in their certification period, like Blue, are eligible for 15 days or 1/2 package of food benefits. Page 5
<OI14> <OI15> <OI16> <OI17> <OI18> <OI19> <OI20> <OI21> We are able to adjust the food package of the first suggested set using the Edit First Set functionality. To enable the button, we have to select, or highlight, a first set that we want to edit. To adjust Blue s food package, click on the first set listed. Now that the Edit First Set button is enabled, let s click on it. Remember, Blue is eligible for 15 days of benefits or half a package. Go ahead and select 1/2. We also need to select a reason for editing. Go ahead and click the drop down. There are only two options available: CPA Discretion (See Notes) and Late Pickup is Clinic s fault. Only the first option applies but do we have to write a note? Since we are changing the size of the suggested food package, we need to document the reason why in a note. We ve already entered a couple of different notes so we are just going to show you an example note for this instance instead of going through the process of creating a note again. Once again, we created a General Note. The subject is Food Package. Our note text simply indicates the size of the food package and why. OK. Back to issuance. Go ahead and select CPA Discretion (See Notes). Click OK to save our change. Notice the edited proration displays next to the set. Next, let s take a look at Jay who was supposed to be recertified today. Jay s Certification Due date is the end of this month. So, with less than 90 days until his certification ends, he can get all of his remaining sets, which is only one. Lastly, let s look at Momma whose Certification Due date is at the end of next month. Her cert end date is also within 90 days but she has two remaining sets available; both of which she is eligible to receive. Right now, the system is only default-suggesting the first set, and we want to issue both of them, so go ahead and click the checkbox next to the second set as well. At this point, we would typically issue the benefits. Page 6
<OI22> <OI23> <OI24> <OI25> <OI26> <OI27> <OI28> <OI29> <OI30> <OI31> <OI32> <OI33> <OI34> <OI35> However, since the focus of this module is Income, we are going to skip the rest of the benefit issuance steps and return to Jay s folder. So we ve issued all the benefits the household members are eligible to receive based on the amount of time they have left in their certifications. However, we still need to document the income and provide the ineligibility notice. To do that, we need to start the certification process again. How do you think we do that? Go ahead. Since we canceled the last income record, we will need to re-enter it. Go ahead and open the income calculator. This time, we ll enter the income and household size since we ve already done this at least once already in this module. Click OK to save the new income record. Remember this message? This time let s click the Yes button. The Income Calculator automatically closes and we are back in the Demographics screen. To save our income record, we would first need to complete all the required fields. We have already done this so go ahead and click OK. The Mark Applicant as Ineligible window displays and we have one last chance to cancel if we need to. Notice the Create Ineligibility Notice checkbox is automatically selected. We are required to provide this documentation to the participant so always leave this checked. Go ahead and click OK. The last step in HuBERT captures the CPA signature to acknowledge that the final ineligibility determination has been made. Click Capture Electronic Signature to initiate the process on the signature pad. We ll do the necessary steps to sign the signature pad Click Save Signature. The CGS closes and we are back in the Participant Folder. Notice the fields are not locked, indicating the certification attempt is complete. The Ineligibility Reason and Date are displayed on the Demographics AdditionalInfo2 tab. Let s take a look. Click on the tab. Page 7
<OI36> <OI37> <OI38> <OI38A> <Spanish1> <Spanish2> <OI39> <OI40> End Slide The Ineligibility Reason and the Ineligibility Determined Date display at the bottom of the screen. Notice the Certification icon is still enabled. Let s see what happens if we try to start another certification for Jay. Go ahead and click the Certification icon. We ve already determined Jay is ineligible today. If we made an error and determined Jay to actually be income eligible for WIC at this point, we would have to wait until tomorrow to start a new certification for him. Next let s take a look at the Notice of Ineligibility that we printed. The Notice of Ineligibility is addressed to the participant found ineligible and displays the information we recorded to determine he was over income. Since both Momma and Blue are no longer eligible for WIC, we will write their names on the notice as well. <pause for animation> The Fair Hearing information also displays along with our agency information. We need to note that this letter is one of the few notices that will print in Spanish if Spanish is selected as the Correspondence Preference in the Demographics AdditionalInfo2 tab. There is one last thing to look at in the Participant List. Notice in the Details panel for Jay, all the certification information for Jay is listed as N/A. This can be an indication that he has been determined ineligible. Since he was determined ineligible, not terminated, no termination information displays. Let s take a look at Blue s details. Click on Blue. Remember that the message said all other eligible household members would be terminated. Blue was certified until 9/30/2014. However, his certification, and Momma s, were automatically terminated by the system when the Bird household income was determined too high to meet WIC income guidelines. Since they weren t determined ineligible during the certification process, their certifications are considered terminated and the Termination Date and Termination Reason display. This is an important distinction since Momma and Blue s certifications could simply be reinstated if an error was made but since Jay was determined ineligible, we would not be able to start a new certification for him until the following day. We appreciate you taking the time to review this HuBERT on-demand training module presented by the MN Department of Health WIC Program. Page 8