Page 16

COMAR 10.09.24.03

315 State of Maryland Medical Assistance Manual Revised July 2012 Select options “P” Process and “Q” Finalize. Note that the eligibility tests for the E-track are different than the tests performed in other MA tracks, to facilitate prompt eligibility determinations. 1. For E01, there are virtually no eligibility tests on CARES for MA eligibility. For that reason, a child must not be screened in this coverage group unless the child is confirmed as SSI or IV-E eligible. A child screened in this coverage group will not fail MA eligibility, but will be certified as federally eligible, if processed correctly with the correct corresponding valid values. Until modifications are made to CARES for E-track coverage groups, trickling should not occur. 2. For E02, CARES applies the same eligibility tests as for the FAC MN category F98, which are no longer applicable for E-track eligibility. This is why countable resources and income should not be entered for E02, except for $1 of foster care or subsidized adoption income. The MA CM must assure that CARES does not deny an E02 AU for financial eligibility reasons. If CARES denies an E02 AU for MA technical eligibility reasons (e.g. SSN, citizenship), the MA CM should “Add A Program” or “J” Screen an existing AU for a State-only E03 AU for a foster care case or E04 AU for a subsidized adoption case. 3. If retroactive MA eligibility (for at most three months period to the month of E-track application) is requested due to the child‟s unpaid medical bills, the MA CM must obtain information from the OHP service worker about the child‟s living arrangements prior to the OHP application month. The coverage group used for determining retroactive eligibility is based on those living arrangements and other factors related to eligibility. 4. It is imperative that a child placed in foster care or subsidized adoption is certified as promptly as possible, and that there is no lapse of coverage when a child is removed from another AU to be opened in an E-track coverage group. a. It is optimal to remove the child from an active AU on one day and then to open eligibility in an E-Track coverage on the following day, since two transactions (close/open) do not read over to MMIS through the interface on the same day. Check MMIS to make sure that the transactions took effect. b. All E-Track applications must be finalized as soon as practicable, with or without complete verifications. o If the IV-E eligibility has not yet been determined by the IV-E specialist, finalize the case in E02. If the child is not eligible for E02 due to MA technical eligibility requirements (e.g. verifications, SSN, citizenship), “Add-A-Program” or “J” Screen an existing AU for the State-only category of E03 for a foster care case or E04 for a subsidized adoption case. o If there are any outstanding verifications, use the valid value of “OT” for “Other” so the E03 or E04 AU will process within the 30-day timeframe. o Create a 745 alert to check on requested or outstanding verifications within a month if the child was not eligible for: o E01 because the IV-E specialist has not yet determined IV-E eligibility; or o E02 due to lack of verifications related to technical MA eligibility (e.g., SSN, citizenship).