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Status Future consideration
Categories Income Support for Medical Assistance
Created by Timothy Cozine
Created on May 25, 2016

RELATED IDEAS

Processing one member of an application without processing other members of the application

The South Carolina Department of Health and Human Services (SCDHHS) needs to be able to process one member of an application case without processing the other members of an application to be in compliance with CFR §435.952 use of information and requests of additional information from individuals, and §435.911 determination of eligibility. There are three main reasons we may need to process one member of an application without processing the other members of the application.
A. Income on the case passes Reasonable Compatibility (RC) rules for one member on a case but it does not pass RC rules for other members on the case. Since RC rules are tied to comparing the Electronic Data Source for income and the client's statement of income to the income limit for a program it is very likely that the income on the case will be considered RC for the children but not for the adults.
B. There is an outstanding verification that is needed for one member of a case but there are not outstanding verifications needed for other members on a case. We should not have to delay the processing of members of the application while awaiting the verifications of the other members.
C. SCDHHS approves Pregnant Women assumptively so that they can receive medical treatment while gathering the needed verifications for SCDHHS to process the case. In a situation where a member of the application is pregnant but there are outstanding verifications for the other members, we should be able to approve the Pregnant Woman while awaiting verifications of the other members.

Customer Name South Carolina
  • Attach files
  • Guest
    Reply
    |     Sep 8, 2016

    This request has been identified as a valid enhancement request with a potential release for 2017. A LOE review will take place after Q4 release work complete.

    John J Sweeney
    Offering Manager, Social Programs

  • Guest
    Reply
    |     Aug 3, 2016

    Identified as a valid enhancement for target release in 2017. Approach will involve elements of NC approach where ineligibility notifications will not be sent until 45-day timer expires. During which time, applicant may move to eligible determination based on updated evidence.

    John Sweeney
    Offering Manager - Curam Social Programs

  • Guest
    Reply
    |     Jun 22, 2016

    Item was discussed as part of call on 6/16.

    Request submitted to NC to review how this was implemented in NC, but it is believed that the business process in NC will not meet the requirements of SC.

  • Guest
    Reply
    |     Jun 8, 2016

    CFR attached.

  • Guest
    Reply
    |     Jun 3, 2016

    Thank you for your enhancement request. We are currently analysing the requirement and will provide another update when that analysis is complete to confirm whether or not the enhancement will be considered in a future functional release.

    John Sweeney
    Offering Manager - Cúram Social Programs

  • Timothy Cozine
    Reply
    |     May 25, 2016

    Attachment (Description)

    CFR for process...
    CFR for processing one member without processing other members.docx
    Open full size
    CFR for processing one member without processing other members.docx
  • Timothy Cozine
    Reply
    |     May 25, 2016

    Attachment (Description)

    RFE Processing ...
    RFE Processing one member without processing the other members of an application lc.docx
    Open full size
    RFE Processing one member without processing the other members of an application lc.docx