Transcript NC FAST Best Practices and Tips

NC FAST Best Practices & Tips
North Carolina
Department of
Health & Human Services
Agenda
Welcome
Keys to Understanding MAGI Application Processing
Finding Helpful Resources
Intro to Trainer Office Hours
Q&A
Please note: The information included in the following presentation is subject to change based upon business guidance and
functional releases.
Last Updated: 3/20/2014
Introduction
Photo: geograph.org.uk
Introduction
Photo: wikipedia.com
Introduction
• Unlike the Traditional Application, the Streamlined (MAGI)
application is designed to require very little evidence
management by the user.
• In many situations, unnecessary changes to evidence
submitted through the Streamlined Application may interfere
with successfully processing the application, and can result
in incorrect eligibility decisions.
• This presentation will review the basic principles, as well as
helpful tips, for managing evidence on the Streamlined
Application.
Process Differences
Income Support
Insurance Affordability
Long IEG Script  Submit App
Streamlined IEG Script  Submit App
Match Client
Find Match
Edit and Adjust Evidence
Edit Evidence
Add Evidence
Add Evidence
OVS & Add Verifications
OVS & Add Verifications
Check Eligibility
Validate Change*
Apply Changes
Check Eligibility
Ready for Determination
Authorize Eligible Decision (Or ineligible decision)
Review Eligibility Result
Authorize (or Deny)
Open PDC (one for every product)
Active PDC (one includes multiple products)
Submit for approval
No need to Activate Online (some exceptions)
Activate Online
*Validate Change is not a required step to process the app, but may assist
in uncovering issues with evidence before the case is authorized.
P7 Insurance Affordability – Authorize Eligible Decision
Once the MAGI Application is submitted…
Insurance
Affordability
Application Case
When an Eligible decision is Authorized…
Insurance
Affordability
Application Case
Insurance
Affordability
Integrated Case
Family & Children’s Medicaid
Or NC Health Choice
Product Delivery Case
P7 Insurance Affordability – Authorize Eligible Decision
Once the MAGI Application is submitted…
Insurance
Affordability
Application Case
When an Ineligible decision is Authorized…
Insurance
Affordability
Application Case
Insurance
Affordability
Integrated Case
Product Delivery
Case
Account transfer
to the FFM
P7 Insurance Affordability – Authorize Eligible Decision
Once the MAGI Application is submitted…
Insurance
Affordability
Application Case
When an Administrative Denial is used…
Insurance
Affordability
Application Case
Insurance
Affordability
Integrated Case
Product Delivery
Case
Account not
transferred to
the FFM
Managing Streamlined Application Evidence
Evidence start dates default to whichever is earlier, the
or the
Managing Streamlined Application Evidence
Managing Streamlined Application Evidence
When to
evidence:
• Entered incorrectly during the IEG
• An End Date is needed for an existing piece of evidence
• The Application Details need to be modified
When to
evidence:
• Added mistakenly during the IEG
Managing Streamlined Application Evidence
Why would
need to be modified?
Managing Streamlined Application Evidence
Why would
need to be modified?
Managing Streamlined Application Evidence
Managing Streamlined Application Evidence
Managing Streamlined Application Evidence
Edit the child’s
evidence.
Managing Streamlined Application Evidence
Edit the child’s
evidence.
Managing Streamlined Application Evidence
Edit the parent’s
evidence.
Managing Streamlined Application Evidence
Edit the parent’s
evidence.
Managing Streamlined Application Evidence
Additional reasons a user might edit
• Deny an individual on the application
• Withdraw an individual from the application
• Reopen an individual’s application
Managing Streamlined Application Evidence
evidence may appear incorrect at first
glance, but once you expand the toggle and view the details, the
correct information will display.
Managing Streamlined Application Evidence
evidence may appear incorrect at first
glance, but once you expand the toggle and view the details, the
correct information will display.
Managing Streamlined Application Evidence
When to
evidence?
Issues are created by attempting to add evidence that is not needed.
Requires inverse relationship
Does NOT require inverse
relationship
Managing Streamlined Application Evidence
When to
evidence?
Issues are created by attempting to add evidence that is not needed.
Requires inverse relationship
Does NOT require inverse
relationship
Managing Streamlined Application Evidence
When to
evidence?
Accidently omitted during the IEG
or
one of the following evidences applies:
Managing Streamlined Application Evidence
In order to pull OVS for additional household members add
Managing Streamlined Application Evidence
In order to pull OVS for additional household members add
Managing Streamlined Application Evidence
When a member of the HH is pregnant and there is Income evidence
reported for any household member add
Managing Streamlined Application Evidence
When a member of the HH is pregnant and there is Income evidence
reported for any household member add
Managing Streamlined Application Evidence
Some FFM apps are missing Participant Address evidence for the
additional household members.
Add
Managing Streamlined Application Evidence
Some FFM apps are missing Participant Address evidence for the
additional household members.
Add
Managing Streamlined Application Evidence
The address listed on the MAGI application may not be the same as the
address listed on the Person page.
• If worker has contacted the client and the address on the Person page is
no longer current, update the address.
• MAGI rules use the Participant Address on the MAGI application, but NC
TRACKS uses the address on the Person page.
• Every individual’s Participant Address on the MAGI application must be
identical in order to be counted in the Household.
Managing Streamlined Application Evidence
At this time, workers do not need to accept or reject
Managing Streamlined Application Evidence
At this time, workers do not need to accept or reject
Managing Streamlined Application Evidence
Some income types that used to be counted are not counted in
the MAGI methodology
Use caution entering an Income type of “Other” because
MAGI rules will count this income type.
Managing Streamlined Application Evidence
Some income types that used to be counted are not counted in
the MAGI methodology
Use caution entering an Income type of “Other” because
MAGI rules will count this income type.
Managing Streamlined Application Evidence
Individual PDC created for each
eligible household member
One PDC includes multiple eligible
household members
Managing Streamlined Application Evidence
Individual PDC created for each
eligible household member
One PDC includes multiple eligible
household members
Managing Streamlined Application Evidence
Program Classification Information can be
found on the Person Page under Benefit
History
Individual PDC created for each
eligible household member
One PDC includes multiple eligible
household members
P7 Resources
FAST Help:
• Caseworker FFM Application Job Aid
• Comparing Evidence Dashboards: Insurance Affordability and Income
Support
• Interim P7 Forced Eligibility Solution for Insurance Affordability Application
Cases
• Streamlined Application to Case and Key Differences Checklist
• Streamlined or Traditional Application Decision Tool
• County Readiness Materials  P7 Fact Sheets
• NC FAST Postcard
NC FAST Learning Gateway:
• P7 Training
• NC FAST Updates  MAGI First Touch Recertifications