WAG 15-08-10-a: Authorizing One-Month Only Eligibility Period

revised textAuthorize a one-month only eligibility period for community or long term care spenddown cases when monthly spenddown is met. This may be done:

  • for an active case - any month in the current enrollment period, or
  • for a canceled case in unmet spenddown status:
  • for the month coverage is requested,
  • if new application has not been registered, and
  • if the client is still on the Client Database (CDB).

revised textDo not authorize a one-month only eligibility period if:

  • there is an active cash or regular Medical case, or
  • the case is not on the CDB.

NOTE: Send a Request for Correction/Addition to MMIS Medical Eligibility File (Form 2958) to the Exception Processing Unit in Springfield to request backdating (see WAG 17-02-05-a).

  1. (FCRC) Complete Form 552.
    Items 1, 5, and 6 Complete.
    Item 2 Enter date (MM/YY). This is the month that monthly spenddown is met.
    Item 3 Enter code 55.
    Items 8, 9, 10 Enter the client's current address.
    Item 33 Enter the correct code:
    • Code 95 -If a new split bill day needs to be established in MMIS in addition to one reported before.
    • Code 96 -If the date in Item 77 is a split bill day.
    • Code 97 -If spenddown has been met through carryover.
    Item 77 Enter the day, month, and year the monthly spenddown was met. Medical coverage will end on the last day of the month and year entered here.

    NOTE: If code 97 is entered in Item 33, the day entered here must be the first day of the month.

    When code 97 is used, the action may be transmitted beginning with the day after the terminal entry cut-off date for the current month. deleted text

    When code 95 is used, MMIS shows 2 split bill days. A Split Billing Transmittal (Form 2432) is required for payment of any bills incurred on either split bill day. No split bill is needed if code 97 is used. If a code 96 was previously submitted for the same month, only the code 97 shows in MMIS. A split bill is not required for any services incurred during the month. 

  2. revised text(System) Updates eligibility in MMIS. Coverage starts with the date entered in Item 77 and ends on the last day of the same month. The MEDI system will inform providers that all bills for split bill day require Form 2432 if code 96 was entered. (The date will be the date from Item 77. The message does not appear for code 97.)

revised textIf the client thinks they will have a medical need before MMIS is updated, update the Interim Recipient Data Base (IRDB), see WAG 22-08-18. A Form 552 is not produced. To confirm that medical eligibility is updated, access the ACID clearance in BlueZone. If the action has been completed, the last day, month, and year of the period authorized appears following "ID EXP DATE". This entry always shows the last day of the last medical eligibility period approved by the FCRC or Pay-in Unit. The action shows on the Mercury payroll.

NOTE: To provide medical coverage to a canceled case in unmet spenddown status from the date spenddown is met through the remainder of the enrollment period, see WAG 18-05-14.