Personal Care: How to Process Personal Care for Online Enrollment Individuals.

The following article outlines the process for when an individual applies for Personal Care and is categorically related by being in the Online Enrollment Population. These individuals include:

  • A pregnant woman or
  • A child under 19 years old, or
  • A parent of a child under the age of 19, or
  • A caretaker relative of a child under the age of 19

Non-ABD or non-TANF individuals have to be determined Medicaid eligible through the online enrollment process as OHCA determines financial eligibility got these individuals. OHCA eligibility can be verified using the iCE or MMIS system.

Refer to article: Aged, Blind, Disabled (ABD): How to Use MMIS.

MMIS, iCE must show that the person receives a Title 19 benefit.

Scenario A: Household consists of a single mom with two children. They receive no DHS benefits. All currently receive Medicaid through online enrollment. SPPC application is for mom.

  1. Put case in application status for medical in FACS. If a closed case cannot be found for individual, create a new case.
  2. Place both Personal Care and ADvantage authorizations in application status.
  3. Submit UCAT to RN.
  4. Enter all necessary information into FACS for all household members (citizenship status, SSN’s, etc.)
  5. In the Household Tab, Interview Notebook; code the mom as M/A, and code the children as M/N.
  6. If income is over the QMBP standard (Appendix C-1: Schedule VI), it is not entered on the case. Make sure to document the income in case notes.
  7. In the Medical Gen. Tab, Eligibility Notebook; code the categorical relationship block (F190), for the mom as Categorically Related to Disabled (CND).
  8. Deny the ADvantage authorization (reason code 11) and put SPPC authorization in financial status. ELDERS will open SPPC authorization and certify the medical (D section), if RN approves the mom (applicant) as medically eligible.
  9. After case is certified, change the categorical relationship of the applicant to Categorically Related to AFDC (CNC).
  10. Send a remedy ticket requesting the Help Desk to update MMIS/iCE with CNC categorical relationship.

Scenario B: Household consists of a single mother with 16 year old son. They currently receive SNAP benefits and the 16 year old receives Medicaid through online enrollment. Household income is $1500. SPPC application is for the 16 year old.

  1. On the existing SNAP case, place medical in application status.
  2. Place both Personal Care and ADvantage authorizations in application status.
  3. Submit UCAT to RN.
  4. Enter all necessary information into FACS for all household members (deprivation, TPL, etc.)
  5. In the Household Tab, Interview Notebook; code the child as M/A, and code the parent as M/N.
  6. On the Income Tab, Interview Notebook, divert the income coded on the SNAP case for the medical section. Document this action in case notes.
  7. In the Medical Gen. Tab, Eligibility Notebook; code the categorical relationship block (F190), for the child as Categorically Related to Disabled (CND).
  8. Deny the ADvantage authorization (reason code 11) and put SPPC authorization in financial status. ELDERS will open SPPC authorization and certify the medical (D section), if RN approves the child (applicant) as medically eligible.
  9. After case is certified, change the categorical relationship of the child (applicant) to Categorically Related to AFDC (CNC).
  10. Send a remedy ticket requesting the Help Desk to update MMIS/iCE with CNC categorical relationship.

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