PM 22-08-07.

When a period for eligibility is added to the medical eligibility file (MMIS) by:

  • transmittal of a Family Community Resource Center action; or
  • Request for Correction/Addition to MMIS Medical Eligibility File (Form 2958) processed by the Exception Processing Unit;

a transaction date and a type action (TA) is shown on the medical file.

The entries under "SYSDTE" (System Date) and TA indicate the date the eligibility period was added to the file and the TA used.

Example: Information on the MMIS file.

REGULAR ELIGIBILITY
DEF BEGIN DATE END DATE CLOSE CAT CTY GRP BASIC
03/22/98 03/31/98 93 233 05 490342
SPD-STATUS SYSDTE TA
1 SPD MET 03/23/98 55

In this example the Family Community Resource Center processed a TA 55 on 03/23/98 to issue a one-month only MediPlan Card. Eligibility existed (spenddown met) from 03/22/98 - 03/31/98. The SYSDTE is the date that will now be used to determine if the bill was submitted within the time period as required for payment. The letters AD would appear under TA if medical eligibility was posted by the Exception Processing Unit in response to a requested backdate by the Family Community Resource Center.

Cases enrolled for spenddown will show both met and unmet periods on the MMIS file as of the date of the inquiry. When a case is enrolled in unmet spenddown status the MMIS file will show the following:

BEGIN DATE END DATE SPD-STATUS
MM/DD/YY 99/99/99 2 SPD UNMET

The 9s indicate the case is currently enrolled in unmet status. 9s can also indicate eligibility as of the date of the inquiry if spenddown status shows as: 1 MET.

When monthly spenddown is reported as met, the system enters the begin date of the met period and an end date which is the last day of the month for which monthly spenddown was reported as met. The system also enters an end date for the unmet period which is the day before the date for which spenddown met was reported. In addition, the system enters a new unmet date which begins the first day of the month following the month for which spenddown met was reported.

Example: For an enrollment period of January thru June of 1998, monthly spenddown is reported as met by TA 55 on 03/15/98. The MMIS file will show:

BEGIN DATE END DATE SPD-STATUS
04/01/98 99/99/99 2 SPD UNMET
03/15/98 03/31/88 1 SPD MET
01/01/88 03/14/88 2 SPD UNMET

If no further period(s) of eligibility is reported as met, when the central cancellation (TA 28) occurs in June, the entry 99/99/99 is replaced by 06/30/98, spenddown status: 2 UNMET.

QMB/SLIB status is shown on the MMIS Medical Eligibility File as:

  • YES - Eligible for QMB benefits only
  • DUAL - Eligible for Medicaid/QMB benefits
  • SLIB - Eligible for SLIB benefits only
  • MDSL - Eligible for Medicaid/SLIB benefits