Determining (Running) Eligibility is the step in processing an application or evaluating redetermination that happens just before creating a service authorization and co-payment. Running Eligibility should be done after all case information is documented in CCMS and verifications are received. This page can only be accessed if the Received all necessary documents checkbox on the Document Checklist page is selected and fields throughout the Case pages with the double asterisk (**) next to the field are complete. This step should also be completed anytime there is a Change of Information processed for an existing case.
Review the results carefully after running eligibility. If you believe the results are incorrect, you can navigate through the CCMS Case pages, correct the inaccurate information, and re-run eligibility. Eligibility is not recorded, benefits are not issued, and correspondence is not generated until you Deny/Cancel the eligibility results (for a Denied or Cancelled case) or complete the Service Authorization and Co-Pay pages (for an Approved case).
- Review the information on the Eligibility Results page.
- The Case Summary section of the page displays case information documented on other CCMS pages.
- Family Size: This is the total number of persons counted in the child care household, documented on the Parent/Guardian Information and Family Information page as defined in policy 01.01.02.
- # of Children Receiving Care: Each record on the Family Information page which selects Yes for the Does this person need Child Care assistance? field will be counted toward the number of children receiving care.
- Case Status: The stage where the case is in the application processing. The first time eligibility is run, this status will be "Pending". This status will be "Approved" if eligibility is confirmed and the Service Authorization and Co-Pay pages are completed.
- Earliest Start Date: This is the earliest date care can be approved for the case. Documented on the Income Information page.
- Actual Start Date: This is the actual date care begins for the case. Documented on the Income Information page.
- End Month of Service: This is the end month of service for the case Documented on the Income Information page.
- RPY Case: Indicates if the case is an RPY case. Documented on the Case Information page.
- Collab Case: Indicates if the case is a collaboration case. Documented on the Case Information page.
- Active Military: Indicates if the case is an active military case. Documented on the Case Information page.
- Total Income: The total income amount for the case used to calculate eligibility. Documented on the Income Information page.
- Reason for Child Care: Indicates the reason for child care. Documented on the Case Information page.
- Click [Run Eligibility] to determine the current eligibility of the case.
- Review the results carefully after running eligibility. If needed, you can navigate through the CCMS Case pages to modify information and re-run eligibility.
- The Eligibility Results page refreshes and information now displays in the Parent Results and Children Results sections of the page.
- The names of each parent and child on the case display in the Name column. The eligibility status of each person displays in the Status column. If the client and child are eligible the Start and End Date of their eligibility also displays.
- If the status of the parent(s) and child(ren) are eligible, proceed to the Co-Pay and Service Authorization pages. If the status of the parent(s) and child(ren) are ineligible, proceed to the next step (below).
- You can view the reason for a parent or child's ineligibility by clicking the hyperlink that is found on each underlined name.
- The Ineligibility Reasons display on the Reasons for Cancellation pop-up window with a checkbox next to the reason CCMS has determined the case is ineligible. EAch name on the case will have a separate pop-up windo with the name displayed in the orange header of the pop-up box. Confirm the reasons are accurate,, and select additional reasons as needed. To add a reason, select the [Other] Checkbox and add text in the textbox.
- Click [OK]. The Reasons for Cancellation pop-up window refreshes for the next person on the case.
- Complete Steps 8 and 9 for each family member on the case until the pop-up window closes.
- Complete the following steps, depending on the Eligibility Status of the parent and child(ren).
- If the Application should be denied: Click [Deny]. The Case Status changes to Denied. Navigate to the Generate Document page to generate the appropriate correspondence.
- If the case should be canceled: Click [Cancel]. The Case Status changes to Canceled. Navigate to the Generate Document page to generate the appropriate correspondence.
- If the case should be approved: Complete the Service Authorization and Co-Pay pages for the case. After you click the [Approve] button on the Case Summary page, the Case Status changes to Approved on the Eligibility Results and Case Summary pages.
Results of the Procedure:
Case Eligibility is determined and reviewed.
Frequently Asked Questions
- How is Family Size calculated?
- Each active parent living in the home and each individual with a current record on the Family Information page is included in the Family Size.
- I am receiving ineligibility reason "You are ineligible for child care assistance due to failure to provide required documents". My clinet submitted all their documents, why am I receiving this reason?
- If you are receiving this ineligibility reason, navigate to the Document Checklist page and click the Received All Necessary Documents checkbox. Once you have saved the page, re-run eligibility.