Procedures

Follow the steps below to determine ABD Medicaid eligibility under the EDWP COA.

Step 1 Accept the A/R’s Medicaid application. Step 2 Conduct an interview. Step 3 Verify that the A/R is under EDWP care coordinator and receiving waivered service(s) by receipt of the Elderly and Disabled Waiver Communicator (CCC). The CCC should indicate the beginning date of care coordination and the service date. Step 4 Determine basic eligibility, including Length of Stay (LOS) and Level of Care (LOC). Refer to the Chapter 2200, Basic Eligibility Criteria. Step 5 Determine financial eligibility. See Chapter 2500, ABD Financial Responsibility and Budgeting, for procedures on whose resources to consider and the resource limit to use in determining resource eligibility. Complete a Medicaid CAP budget to determine income eligibility. Refer to the 2510 Medicaid Cap Budgeting . If client’s income exceeds the Medicaid CAP, then client must establish a QIT in order to be determined eligible. Step 6 Determine the A/R’s cost share for EDWP services. Refer to 2559 Patient Liability / Cost Share Budgeting and 2553 Protection of Income . Step 7 Approve EDWP Medicaid if the A/R meets all the above eligibility criteria. DO NOT approve Medicaid under the EDWP class of assistance for any month earlier than the month of the service date. Step 8 Notify the A/R of case disposition and cost share. Step 9 Notify the care coordinator of the disposition and cost share by entering the care coordinator’s name and address in the system as the Authorized Representative. This will enable the care coordinator to receive system generated notices giving dates of eligibility and cost share information. Step 10 Complete a review of the case in the month in which the EDWP LOC expires as indicated in Field 45, L.O.S, of the LOC form. If a new LOC form extending the stay is received from the EDWP care coordinator, continue Medicaid eligibility under the EDWP COA. If the new LOC form stating that the LOC has NOT been extended is received from the care coordinator OR a new LOC form is not received from the EDWP care coordinator by the end of the month the LOC expires, complete a CMD. Refer to the 2052 Continuing Medicaid Determination . Notify the EDWP care coordinator of the outcome of the CMD and any change in cost share. If LOC form or CCC is not received within two weeks from the end of the approved EDWP stay, send a CCC to the care coordinator requesting information on whether the stay has been extended. If Medicaid eligibility is terminated as a result of the CMD and a new LOC form is subsequently received within 30 days of the termination date on the system, reopen the case as closed in error. If a new LOC form is received more than 30 days after the system termination date, process a new application. The month the new LOC form is signed is the earliest month for which the case can be reopened under the EDWP COA.