533 B. TEFRA Conversions

533 B. TEFRA CONVERSIONS

When a child is eligible for another category of Medicaid, such as SSI Supplemental Security Income or MAGI Modified Adjusted Gross Income , and has been determined to meet on of the three LOC Level of Care categories, the case is referred to as a deferred TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case. It is important that parents are given a choice of the category of Medicaid they wish their child to receive. Take the following steps for a potential deferred TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case and current cases:

SSI Children

When SSI Supplemental Security Income starts, the case must be converted to an SSI Supplemental Security Income Medicaid case with the DC-54 MERE coding.

Comagine Health must be notified that the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case has been changed to an SSI Supplemental Security Income Medicaid case and advised to close the Comagine Health case. Comagine Health can be emailed at AKTefra-Waiver@Qualishealth.org .

Document the LOC Level of Care renewal date and set an alert that this was a former TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child.

The SSI Supplemental Security Income case is then transferred to the appropriate local office.

If the child's SSI Supplemental Security Income benefit stops, the caseworker must evaluate the child's eligibility for MAGI Modified Adjusted Gross Income Medicaid, TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 , and a Continuous Eligibility Period (CEP).

If there is no MAGI Modified Adjusted Gross Income Medicaid, TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 , or a CEP continuous eligibility period , the case must be closed and a new application is required.

If there is eligibility for MAGI Modified Adjusted Gross Income Medicaid but not TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 , open the MAGI Modified Adjusted Gross Income Medicaid case and let the parents know that they can pursue TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 if they wish.

If there is no eligibility for MAGI Modified Adjusted Gross Income or TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 but the child has a CEP continuous eligibility period , the Medicaid case will continue until the CEP continuous eligibility period ends. The case should be referred to the LTC Long Term Care unit to determine TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility. In order for a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case to be opened, the case must meet the LOC Level of Care and disability diary date requirements. The LTC Long Term Care unit will work with the parents and Comagine Health. The LTC Long Term Care unit will check the LOC Level of Care and email Comagine Health at AKTefra-Waiver@Qualishealth.org to reopen the LOC Level of Care case if there is a current LOC Level of Care in place. If there is no LOC Level of Care , the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case will be pended for LOC Level of Care to be determined. The LTC Long Term Care unit will check the disability diary date. If there is no disability diary date, the case must be pended for a disability determination.

TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 and MAGI Modified Adjusted Gross Income

With every TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 application, the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 caseworker must screen for potential MAGI Modified Adjusted Gross Income Medicaid eligibility. If there appears to be MAGI Modified Adjusted Gross Income eligibility, the family should be notified of this and be allowed to pursue this coverage. The family should be advised that there may be a lapse in coverage after MAGI Modified Adjusted Gross Income ends while pursuing TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility. Parents should be offered the opportunity to pursue TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 and maintain TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility as a backup. If the parent chooses to pursue TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 :

Register a new case with the child as PI,

Pursue a disability determination,

Refer the child for a LOC Level of Care determination by Comagine Health, and

Transfer the MAGI Modified Adjusted Gross Income case to the LTC Long Term Care unit.

If LOC Level of Care and disability are approved, the parent must be contacted and given the choice of having the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case opened or maintaining the child's Medicaid eligibility within MAGI Modified Adjusted Gross Income . If the parent opts to continue eligibility with MAGI Modified Adjusted Gross Income , the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 caseworker will close the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case and document eligibility via MAGI Modified Adjusted Gross Income .

If MAGI Modified Adjusted Gross Income closed for earned income or failure to renew, the MAGI Modified Adjusted Gross Income caseworker should notify the LTC Long Term Care unit to review TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility and take the following actions:

Review case for LOC Level of Care status and DDS Disability Determination Service status.

If both LOC Level of Care and disability status are current, open the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case and notify Comagine Health that the case is now open and to reactivate the case in the Comagine system.

If LOC Level of Care or disability status has lapsed, pend the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case for current disability approval and LOC Level of Care .

The EIS Eligibility Information System case notes and alert system must clearly indicate which child is the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligible child in the home.

Institutionalized Children

Children may go between their home and inpatient treatment. This happens most often with the IPH Inpatient Psychiatric Hospital - LOC Level of Care .

TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Recipients

If a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child enters an inpatient facility, the caseworker must contact the family to determine the anticipated length of stay. If the stay will be for more than six months, Comagine Health must be notified to close the LOC Level of Care case.

If the say is expected to be more than 30 days, convert the case to a child only MAGI Modified Adjusted Gross Income case and transfer the case to the appropriate local office.

When the child is ready to return home, the MAGI Modified Adjusted Gross Income caseworker must notify the LTC Long Term Care unit. The LTC Long Term Care unit must review LOC Level of Care and disability status for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility. If disability and LOC Level of Care are not current, the LTC Long Term Care unit must initiate the process for both.

New Applications and Institutionalized Children

A TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 application may be received at the same time that the family is pursuing inpatient care for their child. If the child is institutionalized prior to TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility being established and the stay is anticipated to be greater than 30 days, take the following actions:

Open a child only MAGI Modified Adjusted Gross Income case and transfer the case to the appropriate local office,

Set an alert and case note alerting the MAGI Modified Adjusted Gross Income worker that this is a potential TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child, and

Notify the family to contact their case coordinator, the LTC Long Term Care unit, and Comagine Health when a discharge date is determined so the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 process can be initiated prior to the child's return.

Note: A new application is not needed to go between one category of Medicaid and another. Caseworkers must use the alert and case note system to identify these children and make appropriate referrals to maintain coverage and ensure there are no breaks in service.

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