Medical Assistance Training Q & A

This image indicates links open in a new window link opens in a new window

Applying | Income | Connect for Health Colorado | Household Composition | Other


# Question Answer Date Posted Last Update
1. What constitutes a complete SSAp application? If someone is filling it out and they are not required to fill out any of the worksheets (A, B, C, D, or E) and they submit the application without those blank worksheets, will the application be considered “complete” or will the application be held up to verify that the applicant intended to not fill those worksheets out? An application is considered complete if the 12 pages before the worksheets are filled out. Best practice is to include all pages of the application and cross out or write N/A on unnecessary worksheets. However, the application will not be delayed if those worksheets are not included. July 2014
2. How should the household relationship table be completed for households with more than 5 people? If this is left blank, will it be considered an incomplete application? An extended table can be provided, or a list of individuals in the household that include relationships is acceptable. The information regarding household relationships is necessary to determine eligibility, but eligibility sites should accept the application and contact the applicant by phone and/or mail to get this information. July 2014
3. Can sites pre-screen individuals to know if they might be Medicaid or CHP+ eligible? It is illegal to prevent an individual from applying for Medical Assistance, even if he/she does not appear to be eligible. Do not pre-screen individuals to prevent them from applying. July 2014
4. What is the client-facing technical support system for PEAK (e.g. how does someone applying through PEAK get technical help?) Customers can receive technical support for PEAK in several ways. July 2014
5. Can phone applications be accepted for Non-MAGI Medical Assistance? Yes, phone applications can be accepted for all Medical Assistance categories. July 2014
6. What should an eligibility worker do with an application that is provided to the eligibility site unsigned? This is not considered a valid application, and cannot be entered into CBMS until a signature is received. Contact the client, provide them with a signature page, and ask them to send it back. Once the signature page is received, move forward with determining eligibility. October
7. Who needs to sign an application for Medical Assistance? The applicant. If the applicant is unable to sign:
Someone acting responsibly on behalf of the applicant
Parent, or other specified relative, or legally appointed guardian or conservator
For a person in a medical institution for whom none of the above are available, an authorized official of the institution may sign the application
Not all tax filers have to sign.
8. Should we include household members who won’t be counted in the MBU in CBMS if they are on the application? Yes; as always, the application should be mirrored and all individuals listed should be data entered in CBMS. October
9. What does Medicaid recommend for data entry for customers who were never eligible? Example, if customer applies for Medicaid approved under a guaranteed program but was never really eligible because they hit RTE and then county adds a program and realizes that the customer was never eligible for program. If a case was incorrectly approved, we would still need to close them with 10 day noticing. November 2015

^ Top


# Question Answer Date Posted Last Update
1. Once an applicant has been deemed eligible for medical assistance, and an electronic data source hits, a discrepancy in self-attested and data source income may exist. In this case, the client will receive a Verification Checklist and letter requesting a reasonable explanation. Will clients have to provide documentation to support a “reasonable explanation,” or does the applicant just report the explanation in their own words? If the client provides a reasonable explanation for a discrepancy in self-reported information and the information that is verified by IEVS, no additional documentation is required. This explanation can be provided in person (verbally or in writing), through the mail, by fax or over the phone. Reasonable explanations include: Stopped working Hours changed Wage or salary changed Change in employment Marriage, legal separation or divorce Death in family If additional income information is needed, additional verification/documentation can be requested. July 2014
2. Can you provide more clarification on the IEVS interface and reasonable compatibility for MAGI cases? Will it interface if there is less than a 10% difference between the attested amount and the data source? IEVS will interface for all cases with a social security number. However, the record of that interface will only appear on the case if there is a discrepancy of more than 10%. If this occurs, the record will show up on the Reasonable Compatibility page; a communication will be sent to the client requesting a reasonable explanation or verification of income. October
3. If income verification is not provided for Medical Assistance, should the eligibility worker deny the Medical Assistance? Self-attestation is sufficient for verification of earned income for Medical Assistance and unearned income for MAGI. For Non-MAGI programs, unearned income should be verified. If additional verification is required, correspondence will be sent to the applicant requesting it. The medical program should not be denied for failure to provide verification at time of application. If the self-attestation is questionable or there is unearned income for a Non-MAGI program and additional verification is requested, and when verification is not submitted, then the client can be denied for failure to provide. October
4. Med says always enter wages and tips for a single job as one record in CBMS, but FA says enter them separately if the tips aren’t on the check stub. What is the correct data entry for wages with tips, whether they are included in the check or added separately (via Collateral Contact, for example? How should workers deal with FA/MA combo cases in terms of the data entry? The correct data entry for Medicaid is to enter wages and tips as one record. November 2015
5. With Report My Changes (RMC) and Real-Time Eligibility (RTE), how will eligibility sites know when information about LLC S-Corp income is entered incorrectly in PEAK by a client? If the case is an MA-only case and RTE occurs, eligibility sites will not be able to determine if data entry is correct before an eligibility determination is made; this will not change with this build. Help and hover text are available in PEAK regarding LLCs/S-Corps to help guide clients down the appropriate path.

RMCs that affect multiple programs should be sent to the PEAK inbox to be worked. For combo cases, this information would need to be pulled from the PEAK inbox and then evaluated for verifications needed or appropriate follow-up with the household at that time. Case changes for Food and Cash programs always require an eligibility worker’s intervention before the change can be authorized, which will ensure the data entry is correct.

November 2015
6. If a client makes changes to LLC S-Corp income in ongoing mode in PEAK RMC, will that information show up on the RMC print-out? Yes, it should. Any case change reported in RMC should display on the PDF for eligibility workers to pull from the PEAK inbox. If a change does not show up, please submit a Service Desk Ticket. November 2015
7. Medical Assistance Only Household provides four paychecks from the same job but two are Not Representative. CBMS is using the actuals of those checks and adding it to the averaged Representative amount. Causing the monthly income to be really high and not what he received. Is this right? For Medicaid only, CBMS will add the two Not Representative(NR) paychecks and use the actual amount for the month the NR income is received. The two Representative checks are added and averaged by 2 then multiplied by the pay frequency. </ br>The Representative total is then added to the actual Not Representative total to determine the Earned income only for the month the Not Representative income was received. </ br>The monthly gross income for following months will only include the Representative amount. August 2017
8. MA application date of 03/25/2016. Income was entered for 07/2017. None of the checks are representative; but MA still counts actuals. For Medical Assistance, Representative checks are averaged unless the earned income began in the same month of application. </ br>Actuals are used for Not Representative checks regardless of application month and when the earned income was received. August 2017
9. Medical Assistance RRR-Ongoing Employment-Current Income Not Provided. What happens if DOLE interfaces between the last representative income entry and the RRR month? Will the manual entry supersede the DOLE interface or will the old representative income overrule the Interface? The most current income will supersede older entries. So, if a manual entry was made after DOLE interface that is what CBMS will use to calculate income. August 2017
10. I have a case that shows the frequency of Daily. Per the Income Training this field is no longer available in CBMS. What do I do? For CBMS cases where the Income records shows an-invalid Frequency (removed) you will need to enter an Effective End Date in the Income Details section of the page since the value can’t be changed/edited. </ br>All fields of that record will be greyed out except for the Earned Income Details EED, Employment End Date, Termination Reason, Verification, Source, Date Reported and Date Verified. </ br>If you are not able to EED the data because of incomplete fields that are greyed out. You can open a HD ticket to request a data fix for the case. August 2017
11. What do I do on a case where the customer reports their Pay Frequency has changed but it’s at the same job in CBMS.

Step 1.

</ br> Highlight the employer record in the Summary section of the Earned Income page. In the Earned Income Details section, enter the Effective End Date (EED) in the Earned Income section. The EED should be the last of day of the month the customer receives a full month of pay in that Pay Frequency. For example, the Customer was paid Every Two Weeks but is moving to Monthly in September; The EED for Every Two Weeks Pay Frequency Record should be 8/31/2017.

Step 2.

</ br> Click Add Earned/Self-Emp Details button to open a new record in the Earned Income Details section of the page. Enter a new Employer record with the new Pay Frequency. Refer to F1 for additional information about this process.

August 2017
12. How do I pend a case for income verification when I’m requesting more paychecks? I used to be able to pend a case at the Employment History page. Per the Income Redesign project requirements, the fields for Verification and Source on the Employment History page were removed, and as such no longer evaluated in the eligibility determination. </ br>Since the fields were not evaluated, the case would no longer pend for invalid Source in a field that no longer existed. </ br>This eligibility outcome is the direct result of specific project requirements and further questions, concerns, requests for guidance may be directed to Program Area. August 2017

^ Top

Connect for Health Colorado

# Question Answer Date
1. When applicants apply for the Advanced Premium Tax Credit, what is the application date for financial assistance? When applying for an Advanced Premium Tax Credit (or financial assistance) through Connect for Health Colorado, an applicant must first be deemed ineligible for Medicaid. After receiving a denial from Medicaid, an applicant is then processed for financial assistance through Connect for Health Colorado. The date of the applicant’s initial Medicaid application will serve as the date of their application for financial assistance through Connect for Health Colorado. October

^ Top

Household Composition

# Question Answer Date Posted Last Update
1. Once a minor who is married turns age 18, will s/he and dependents require a new case? 18 year olds no longer need to be put on their own case as long as they still live at home. If it would not impact eligibility, the 18 year old could request to be put on his/her own case. July 2014
2. How should tax dependents living outside of the home be data entered? There is some concern that including individuals in the home because they are tax dependents could cause problems for other HLPGs in terms of Household Composition. July 2014
3. Do individuals on MAGI who are turning 19 have to be moved to their own case in CBMS? No, not anymore. October
4. Does MBU and Household Composition mean the same thing? Yes; they are interchangeable. MBU means Monthly Budget Unit, and is the group of individuals that should be included when determining eligibility based on income for a MAGI program October
5. Under tax filer rules, should the tax dependent’s spouse be included in the tax filer’s MBU even if the tax dependent’s spouse is not a tax dependent of the tax filer? No; if the tax dependent’s spouse is not a tax dependent of the tax filer, the tax dependent’s spouse should not be included in the tax filer’s MBU. For example, there is a household with a single mother who is a tax filer, her daughter, who is her tax dependent, and her daughter’s husband, who is not her tax dependent. In this case, the mother’s MBU would include herself and her daughter. The daughter’s MBU would include herself, her mother, and her husband. The daughter’s husband’s MBU would include himself and his wife (the daughter). October
6. Mom, Dad and children were on a case together receiving MA. Dad moves out of the home and then applies for MA and states that the children are his tax dependents. Mom states the children are her tax dependents. What is the policy in this situation? What would data entry look like? Since we accept client statement for tax filing status and tax dependency, both parents can claim that they claim the children at tax dependents. CBMS will calculate the household composition for each individual based on this information. Since the children are already approved under the mom, they will be denied on dad’s case for “already approved for Medical Assistance.” This will not affect the dad’s household composition as that is determined by tax relationships and not by eligibility of the children. July 2015

^ Top


# Question Answer Date Posted Last Update
1. Is CICP considered insurance under the ACA’s individual mandate? No, it is not. July 2014
2. What is considered incarcerated for the purposes of Medical Assistance? See Agency Letter 14-006. The definition of incarceration is included:Incarceration or inmate status means the temporary or permanent placement of an individual or client confined involuntarily in a City, County, State of Federal prison, jail, detention facility, or other penal facility, such as community corrections, or in a mental health institution. This includes individuals who are being involuntarily held in detention centers awaiting trial or involuntarily residing at a wilderness camp under any type of government control.If an individual is confined involuntarily, and cannot go where they want when they want (they have a curfew, etc.), they are considered incarcerated. July 2014
3. How should the following situation be handled: a client has an open FA and MA case in the county. The client has a baby and an MA site enters the baby in to CBMS and re-runs and approves the case for MA but cannot run and approve adding the baby for FA. What should the MA Site and/or county do to ensure the baby is added timely? Counties should work their alerts for Needy Newborns and add the Needy Newborn to the case using the date the MA Site reported the baby. It is recommended that the MA Site contact the county and/or let the client know to contact the county regarding the baby. July 2014
4. How will Refugee Medical Assistance (RMA) interact with MAGI? Clients will only fall into RMA if they are ineligible for all other Medicaid programs, including MAGI. July 2014
5. Is there guidance regarding how to handle incorrect noticing in CBMS? Recommended process:

  1. Send information to Lead worker/Supervisor to review
  2. Submit a Service Desk Ticket
  3. Either send the notice out if it is at least partially correct or suppress/pull it
  4. Contact the client to explain what the appropriate notification should say
  5. Add a Case Comment explaining
July 2014
6. Does Real-Time Eligibility (RTE) take up to 72 hours? No, it is instant. It used to take 72 hours for eligibility to be communicated to MMIS so that providers could see it. However, MMIS is now updated the next business day. October
7. If a client enters a change of address in PEAK Report My Changes (RMC) that makes his or her case transfer to another county, will that client’s Food or Cash programs transfer as well? No, only Medical Assistance programs will transfer due to PEAK RMC. Food and Cash program changes should be handled as they are now. In the future, this may change. October
8. If a person marks that they are disabled on the SSAp, does the county/MA Site have to send a disability packet? If not, are there any steps they need to take (e.g. call the client)? The county or MA Site should complete data entry in CBMS and run EDBC. Once the case is run in CBMS, a disability packet will be sent to the client automatically. The county or MA Site should not have to perform any extra steps before this occurs. October
9. Parents who claim a child every other year on taxes, how is this data entered into CBMS so the eligibility determination is accurate? It would be up to the parents to accurately report when they are claiming the child in the home which year for their taxes. July 2015
10. What is the best practice for requesting Self Employment ledgers? How many months of income do we need to request? Medicaid determines eligibility point-in-time, so clients really need to provide at least month prior and current months’ income. If the individuals’ income fluctuates throughout the year, they are responsible for reporting the change in income. July 2015
11. Pregnant mom currently is eligible for CHP+ but not receiving, she is working and has other health insurance so this is making her ineligible. She would like to drop her employer coverage but the employer will not let her end the coverage until she can provide proof that she is eligible for another health care. How should this be handled? We can’t advise clients to apply for CHP+ while they have other health insurance. There is not a procedure for this. The CHP+ rules are that a client cannot have other health insurance and be eligible for CHP+. July 2015
12. Do clients have to verify that they are no longer receiving Medicaid in another state prior to receiving Medicaid in Colorado? The clients should only be approved for Medicaid in Colorado while still covered in another state if the client is in need of urgent medical care and cannot receive the care without being approved here. The individual, of course, must meet all of the eligibility criteria for the assistance as established by HCPF. The request to close the case in the other state still needs to be made but eligibility should not be held up in cases of urgent medical need.If the individual is not in urgent need of care, the Medical Assistance case here should not be opened until the case in the other state is closed.We don’t need verification that the coverage in the other state has closed. We have interfaces (PARIS reports) that will run behind the scenes that will pick up if the client is approved for Medicaid in more than one state. July 2015
13. What date should be used for Override Date in Programs Requested Details for a Service Desk Ticket? CBMS Help says “When you need to Pend a program because the eligibility results are not correct and you or another user has submitted a State Service Desk Ticket, you should select the Override Reason ‘Pending State Help Desk Ticket’. When the ticket is resolved, remove the Reason in order to process the Application for Public Assistance (Application).”The problem is that the override date becomes required once the reason is selected. There is no guidance on what override date should be entered so this needs to be answered by PA. The user does not know how long a resolution will take. July 2015
14. Does the Tax Info page need to be completed for OAP Med or Non Magi Programs? Yes, the Tax Information page should be filled out regardless if the case is MAGI or Non MAGI. On the application the client is applying for Medical Assistance therefore part of Medical Assistance running the individual through the hierarchy and placing the client on the appropriate category. However, if the client doesn’t provide their tax information on the application the worker is responsible to attempt to reach out and explain to the client why we need it (so they are placed in the correct MA category). If they cannot reach the client or the client refused to provide the information we CANNOT deny a MA case for not having tax information. A data conflict will be displayed letting the worker know that this information has not been entered into the Tax Information page in CBMS. July 2015
15. (MEQC) Undocumented who has never had employment history, how does the user get this to pend to stop the auto enrollment? Verification is not required if they stated they were unemployed. Verification IS required if the undocumented individual is working. July 2015
16. MAGI, do we need a self-employment ledger turned in or can we take the information over the phone and consider this a ledger? Yes, self-employment is self-attested and information can be taken over the phone, as long as case comments are entered indicating self-employment has been verified and taken by phone. July 2015
17. (MEQC) If the auditors notice an older month had an error, would that be an audit finding or observation? If it’s a finding, how could the county “clean-up” or correct that finding if they have already fixed the problem? Yes but case comments need to be entered. July 2015
18. (MEQC) Is a Class Code required for non-citizen data entry in CBMS? For all programs? Eligibility determinations based upon non-citizen status can be established by a class code and /or documentation of their non-citizen status. July 2015
19. (MEQC) Can you take a client’s verbal statement of the self-employment ledger, or does it need to get written down? Yes, self-employment is self-attested and information can be taken over the phone, as long as case comments are entered indicating self-employment has been verified and taken by phone. July 2015
20. (MEQC) What happens with MAGI auto re-enroll casesthat don’t have their tax information completed? In the cases where there is no income and when there is actually income in the HH? They will auto reenroll and non-flier rules will apply. Income would remain the same as previously reported. July 2015
21. There was a Mass Report in January for Private Retirement. If the RRR is due 9/2015 do they need to verify or is the information in January sufficient? Verification would be requested for private retirement if nothing was received. July 2015
22. Ongoing PEAK case, tax filer information not entered, case continues to auto re-enroll yearly since CBMS accepts no entry of Tax Filer info. Error cited since we did not make the correct MAGI determination. Will the error be a County error or State error? This will not be an error because the RRR sent out to clients will notify them to report changes. Tax filer info is included in this. If the client does not report then they are telling us there are no changes so the tax filer will remain as is. July 2015
23. Workers would like to know the difference behind the RRR, what order do the words go and what is the difference? From CBMS glossary: Redetermination, Recertification and Reassessment July 2015
24. (MEQC) If an application is submitted through PEAK, approved RTE, and there are errors on the case, and the audit occurs before an RRR, would the finding fall on the county? The error would be on the system if no one has touched the case or the error would be on the client if the client reported incorrectly. August 2015
25. There are many documents in the PEAK Inbox in the Uploaded dropdown and we are not sure why. Is it due to real time eligibility? We have not been looking in this menu,we just look in the submitted for new applications, changes, docs, and RRRs. Why are these automatically uploaded? When you are in the PEAK Inbox you do not have to select the Submitted dropdown in order to view documents that have been uploaded. In the June 2015 CBMS build all EDMS docs uploaded by clients will display in the PEAK Inbox and you will identify them by looking at the App Type column in the Search Results area; it will say’ Doc Upload’. All uploaded documents will be displayed regardless of the Application Status (Submitted, Uploaded). The ‘Submitted’ and ‘Uploaded’ you are talking about is referring to the Application Status and not necessarily the EDMS docs. August 2015
26. Are the EDMS docs we receive in PEAK in the Submitted drop down, such as drivers licenses and social security cards legitimate even though we have not seen the original to stamp as a true copy? If these are good, can we accept copies from clients coming into the office rather than requiring to see the original documents? Per rule citizenship and identity must be verified by showing original documents. If a client uploads these types of documents (not originals) then these verification and sources should be ‘Client statement’ and the Acceptable Doc field should be ‘No’ in CBMS. If the client is otherwise eligible for MA, then the case will pass MA and provide ROP (Reasonable Opportunity Period) and give the client 90 days to provide originals. If they do not provide originals then the MA for that individual will end. Note that a client is not required to provide original social security cards and these do not need to be stamped as original. They only need to provide the SSN number, not the card itself. The only original documents that need to be verified are for citizenship and identity (birth certificates, Driver’s license, Id, Passport etc.) August 2015
27. If an audit finds an error, and later another type of audit is done and the second audit finds the error, will it be a separate “ding” against the county? Yes, if the error is still there it will be another “ding.” November 2015

^ Top