In C�ram denials functionality, a gap was identified that impacts all FFM states around not being able to view the ineligibility determination on the caseworker view. This relates to the scenario where an entire household is deemed ineligible for Medicaid and CHIP, as no PDC will be created for this scenario. If at least one person is eligible, there will be a PD case, on which eligibility for other applicants will be available. In addition to this, the customer has a requirement to add the household income used for eligibility determination onto the notices sent to the clients.
We want C�ram to store denial information with full details like non financial and income & deduction calculation in every scenario including when the whole household is ineligible for any program. Since the state is a determination state we have turned off QHP and UQHP which is not a state program offered by the state. We have noticed that if household in not eligible for streamlined medicaid and CHIP then C�ram does not store any determination result. We want C�ram to always store the full determination results with all information like non financial details and Income deduction calculation for every program and every member even if the member is not eligible. Another scenario if if household is applying for Medicaid for every one and adults are denied and child is eligible for Chip we want C�ram to store all the eligibility determination results for the Adults for streamline medicaid program.
Additional comments:
The state is a determination state and only has Streamlined Medicaid PDCs enabled. The QHP and UQHP rules are not being run, but instead, the data is being transferred to the FFM for determination and benefits. Since the state doesn't need the QHP/UQHP functionality, the determination functionality must be built into the Streamlined Medicaid PDC.
* Workers need a place to view the determination result and reason for ineligibility and this information needs to be stored for retrieval
* The determination result and reason for ineligibility need to be stored for multiple uses; Worker look up, Notices and Reporting
* Data stored needs to include information per person on financial and non-financial determinations, including deductions and calculations that were used to determine a households income
* The data stored needs to be present for each household member, eligible and ineligible
* Households where the entire household is ineligible for Streamlined Medicaid/Chip is the biggest issue, since there isn't a determination tab present and therefore no ineligibility information is available.
* For households where only the children are eligible for CHIP benefits need to provide and store the ineligibility reasons for the ineligible adults and other household members
Since the states have been provided guidance on how to do this locally, raising this as a low priority candidate for a future enhancement to the product.
Hi Richard,
As part of our efforts to be transparent about our intentions with each enhancement suggestion, the offering team has initiated an annual process to carefully review the list of open enhancements.
We acknowledge the benefit of your suggested enhancement however other features are taking a priority in our planning at this time. Since we will not be addressing this item in the near term, we are closing this request. Although we will not take any further action at this time your suggestion will be available in our ideas repository for future consideration.
We value your feedback and thank you for allowing us the privilege of partnering with you in developing our products.
Regards,
Shane McFadden, SPM Offering Management team
You can find more information on the request process here.
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