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Status Future consideration
Categories Income Support for Medical Assistance
Created by Guest
Created on Jul 21, 2016

RELATED IDEAS

Require the ability to Trigger Manual Renewal Process for Medicaid/CHIP (when automatic renewal is not possible)

This enhancement describes the functionality required when the system has been unable to automatically renew a citizen's Medicaid/CHIP coverage for the next 12 months.

Requirements:
If the projected eligibility result determines that we are unable to automatically renew for another year, then the individual must manually renew their coverage. Note, in order to determine if a household must manually renew or not, the projected eligibility result needs to be compared to the most recent determination.

This scenario occurs when:
The person is no longer eligible for the same program as before
The person is not eligible for the same program for the full 12 month period
We are unable to renew for another year due to technical reasons, for e.g. if we�re unable to automatically apply the evidence because maybe some information is missing.
In a household, where multiple people are in receipt of Medicaid/CHIP, if any one individual cannot be automatically renewed for Medicaid/CHIP for any of the reasons outlined above, then nobody in the household can be automatically renewed. The whole household must go through the renewal process.
Trigger Notification
The client is notified that their Medicaid/CHIP coverage has not been renewed for the coming year & that they need to supply information to the Agency otherwise their coverage will be terminated. Note � this notification does not include their projected eligibility for the coming year, it only includes the personal information we know about the person. Refer to HCR-6224 for the data which is required for this notification.

Make Information available on Citizen's account:
The client's latest information (including any information which was polled) should be viewable within 'My Information' within the citizen's account. Any information polled should also be viewable within the Updates page of the portal where the citizen can carry out their manual renewal. (Refer to HCR-6228).

Refer to HCR-6229 for further information on the messages which are displayed on the citizen's account when they have not been renewed automatically.

Set Timer:
The citizen has 30 days to renew their coverage.
The system must start the 30-day timer from the date the notice was sent by the system.

OOTB we will start the countdown from the date the notice is sent, but this should be configurable for customers to update the number of days i.e. if customers want to update it to be 35, they should be able to do that without code changes.

Note � The 30 day period is calendar days and not business working days.

Customer Name Minnesota
  • Attach files
  • Sigitas Jakucionis
    Reply
    |     Sep 9, 2021

    This is still highly needed:

    Lack of Automatic Renewals for Pregnant Women and Auto Newborns is still a problem being faced by caseworkers in METS. Workers are employing some workarounds, none of which are desirable and are time consuming:-
    In order to ensure continued eligibility for pregnant women and auto newborns, case workers:
    · Close the entire case and re-submit a new application manually with a new application date, entering information the client attested to on the original application as well as any changes in circumstances processed since then
    OR
    · Create an application in the legacy system to ensure correct eligibility and coverage
    OR
    · Short-circuit the manual renewals process by not waiting for the Need to Renew (NTR) form to be returned from the client and manually renew the household based on attested data. Potentially handle the NTR form later as a Change in Circumstance(CiC).

  • Guest
    Reply
    |     Mar 7, 2017

    Please find 'RFE 91908 Additional Details.docx' in the 'Attachment' section for a more detailed explanation of the issue, statutory considerations, and scenarios.

    Per the Social Security Act 1902(e) [42 U.S. C. 1396a(e)], pregnant women and auto newborns are eligible through the end of the post-partum period and the month of their first birthday, respectively. They cannot lose eligibility except in very specific circumstances.
    OOTB in V7 HCR, Pregnant Women and Auto (Deemed) Newborns on Streamline Medicaid do not receive eligibility for the expected duration when they gain coverage under that category in the middle of a certification period.

    Manual renewals is one approach to dealing with the issue; but, technically this population isn't subject to renewals because they are entitled for a pre-defined period of time, irrespective of whether a certification period ends before that entitlement period. The attached document provides more details.

  • Guest
    Reply
    |     Mar 7, 2017

    Attachment (Use case): Attaching a more detailed explanation of the gap, statutory expectations, and scenarios. Please review when planning a fix approach.

    RFE 91908 Addit...
    RFE 91908 Additional Details.docx
    Open full size
    RFE 91908 Additional Details.docx
  • Guest
    Reply
    |     Aug 5, 2016

    Hi,

    We acknowledge that this is a valid enhancement request. It will be considered for inclusion in a future release of the product. Thank you for your interest in the Cúram product.

    Thanks,
    Eloise O'Riordan, Cúram SPM Offering Management team

  • Guest
    Reply
    |     Jul 29, 2016

    Due to processing by IBM, this request was reassigned to have the following updated attributes:
    Brand - Watson Health
    Product family - Cúram Social Program Management
    Product - Income Support for Medical Assistance
    Component - Functionality
    Source - IBM User Group

    For recording keeping, the previous attributes were:
    Brand - Watson Health
    Product family - Cúram Social Program Management
    Product - Social Program Management Platform
    Component - Functionality
    Source - IBM User Group