IM-45      05/18/07

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
P.O. BOX 2320
JEFFERSON CITY, MISSOURI

TO:	ALL COUNTY OFFICES
FROM:	JANEL R. LUCK, DIRECTOR
SUBJECT:	CONVERSION OF FAMILY MEDICAL ASSISTANCE CASES FROM LEGACY TO FAMIS

DISCUSSION:

Conversion of the Family Medical Assistance programs to FAMIS is underway. Conversion of the pilot counties has been completed and the first statewide rollout will occur May 21, 2007. During county conversion, all active Family Medical Assistance (Medical Assistance for Families, MC+ for Children, MC+ for Pregnant Women, Transitional Medical Assistance, Extended Women's Health, and Newborn) cases and pending applications for these programs will be converted to FAMIS; closed and rejected cases will not be converted. When a closed or rejected individual applies for benefits after a county converts, the individual data will convert to FAMIS at the time of application.

Family Medical Assistance case information remains available and current in Legacy up to the time of conversion. Legacy cases will close with closing reason “88” at conversion; at that point information will no longer be updated in the Legacy system. For Legacy cases and cases on the Manual Conversion List (MCL), reports will continue to be produced from Legacy; FAMIS will generate reports for cases that have converted to the FAMIS system. Once a county has converted to FAMIS, staff will not be able to register or approve applications, complete interim changes or issue benefits in the Legacy system for Family Medical Assistance programs. All changes and new applications must be processed in FAMIS. Process converted cases as soon as possible to ensure automated processes work as designed.

The conversion process for the Family Medical Assistance programs differs from conversions of previous programs into FAMIS. In the Legacy system, the potential exists for one or more heads of household to have multiple cases to ensure the best coverage for recipients (example: children placed as head of household due to Legacy system assistance group limitations). FAMIS is designed to determine and approve the best coverage without splitting the members into multiple cases. As a result, at conversion, FAMIS will convert multiple cases listed for one or more heads of household into one Eligibility Unit. Cases cannot fully convert to FAMIS because Legacy does not capture all information the system needs to make a determination of eligibility. As a result, each case will either be:

• Placed in the interrupted controlled flow; or

• Placed on the Manual Conversion List (MCL).

NOTE: Each case will be placed in the MCL or controlled flow under the Eligibility Specialist whose worker number appears on the Legacy case. Placement on either list is not based on the load number.

CASES CONVERTED TO THE CONTROLLED FLOW

Cases may be placed into the controlled flow at conversion or following resolution of a Manual Conversion List problem(s). Cases without address problems, multiple Eligibility Units at the same address, unknown Eligibility Unit members, or missing or incomplete data or dates in Legacy will convert into the controlled flow. Cases with one or more of the above problems will be placed on the Manual Conversion List for resolution of the problems prior to being placed in the controlled flow.

Process all cases through the controlled flow as soon as possible. As long as the case is in the controlled flow, new actions cannot be completed and FAMIS cannot manage cases as designed. Delaying the completion of the conversion process can lead to eligibility problems resulting from the system not having all necessary information to process case actions.

When processing cases through the converted controlled flow follow these important guidelines:

• Process the converted controlled flow all the way through and wait until the next day to do an add-a-person application. Waiting until the next day after converting a case will ensure that you do not experience unnecessary problems.

• Premium MC+ for Children cases (CHIP Premium) require a budget for the month of conversion if the income is unknown to FAMIS. This is a very important step and is critical to premium cases. If a budget is not entered for the month of conversion or income is unknown to FAMIS, the system sees that as a zero income month and generates level of care and premium changes accordingly.

The alert, “CONVERTED CASE PLACED IN CONTROLLED FLOW” displays and remains on the Alert Reminder List screen when a case is placed in the controlled flow. This alert remains on the Alert Reminder List screen until the case is processed through the flow. For information on accessing cases in the controlled flow, refer to the Entering the Interrupted Controlled Flow User Guide.

CASES CONVERTED TO THE MANUAL CONVERSION LIST

Cases that cannot be converted to the controlled flow at conversion will be placed on the Manual Conversion List (MCL). Individuals will continue to receive the level of care assigned in Legacy until the case is processed through the controlled flow. For instructions on viewing the MCL, refer to the Viewing and Updating the Manual Conversion List and Requesting Conversion for Family Medical Assistance User Guide. Cases will convert to the MCL as a result of one or more of the following problems:

• The mailing address passes Code-1 but does not have a valid residential address. To help ensure that these cases are resolved prior to conversion, enter the residential address in the first line and the post office box address in the second line of IMU5.

• The residential address is in use by another Supercase. Refer to the Resolving Address Problems on the MCL User Guide for more information.

• Multiple Eligibility Units exist at the same address.

• An Eligibility Unit member is known to FAMIS. The Eligibility Unit member may currently not be active in FAMIS. FAMIS participation is reviewed to determine if the Legacy case can be converted to an existing Supercase. For instructions on resolving these cases, refer to the Legacy Case Member in FAMIS User Guide.

• There is missing or incomplete data or dates in Legacy.

The MCL screen is modified to accommodate the Family Medical Assistance conversion process. The following enhancements have been made to this screen to assist workers in managing cases on the list:

• The “M” field is added and displays before the Case Number field. This field displays “Y” when Legacy cases with multiple heads of household have common members and the conversion process combines these into a master case. This master case concept is new with this conversion process and staff must review the members to determine whether they are to be part of one or multiple Eligibility Units and one or more Supercases. Therefore, when this indicator displays “Y,” a Supercase Number cannot be entered in the SCN field until the case information has been reviewed and a determination made as to where these individuals belong.

  To review the information, enter “S” in the “C” field to select the case and press F15=CSMGMT to go to the new Medicaid Conversion Legacy Case Management screen. A list of the Eligibility Units displays on this screen. Enter the Supercase Number to which the Eligibility Units are to convert. Then press F20=CONVERT. Upon return to the Manual Conversion List screen, the Supercase Number displays and “Y” is populated in the Convert field.

• When a case converts to the MCL, all conversion problems display and can be reviewed on the MCL screen. The message, “Multiple Reasons” displays in the “Reasons” field when more than one conversion problem exists. To view these problems, select the case and press F18=MCLRSN.

  NOTE: In most instances, cases which display multiple problems will convert after fixing the address problem. Therefore, fix the address problem and request conversion the first night. If the case appears on the MCL screen again after correcting the address, utilize the listing of problems to resolve the remaining issues.

Entries may be changed on the MCL the same day they are entered. If an error is not corrected, the system may convert the EU incorrectly. For instructions on changing an entry, refer to the Viewing and Updating the Manual Conversion List and Requesting Conversion for Family Medical Assistance User Guide.

CONVERSION PRIORITIES

Each county must develop a plan of action to completely convert cases as soon as possible. Income Maintenance Program and Policy and the FAMIS Unit developed the following prioritized list to provide guidance to counties as to which cases should be processed first. Utilize the most recent case management report to identify and process cases in the following order:

1. Transitional Medical Assistance (TMA)/Child Support Closings - to ensure that quarterly reports continue to be generated timely;

2. MC+ for Pregnant Women (MPW) - to ensure a timely closing or transition to Extended Women's Health Services (EWHS);

3. Reinvestigations - FAMIS does not currently generate the reinvestigation notice for the Family Medical Assistance programs. This form should be available in FAMIS in the near future. Upon conversion it is important that the county have an action plan in place to ensure reinvestigations remain current. Utilize the Case Management Report to mail reinvestigation forms to allow for timely completion of reinvestigations;

4. CHIP Premium cases;

5. Family Medical Assistance cases with 19 year old children;

6. Newborn cases with children turning age 1;

7. MC+ for Children cases with children turning ages 1 and 6;

8. MAF/MC+ for Children cases with children turning ages 1 and 18; and

9. EWHS cases.

CONVERSION TIPS AND INFORMATION

Double Stepparent Cases

Double Stepparent Cases Converting From Legacy - MAF/MC+ cases which contain parents with their own children (no in-common children in the assistance group, commonly referred to as “double stepparent” cases) will create an adverse action to remove the second parent and his/her children. When there are no in-common children and the parent of the child is in the home, that parent must apply for his/her child.

When cases that contain stepparents and no in-common children are taken through the controlled flow, the system will create an adverse action to remove the second parent and his/her children. Do not void this action as it is correct. If the paper case record contains an application with both parents' signatures, enter a separate application in FAMIS for the parent and children being removed from the Eligibility Unit and process the application when possible. If the parent being removed from the Eligibility Unit has not signed an application in the case record, immediately send the MC+ application to the parent. When the application is received, register and process the application appropriately.

Medicaid for Pregnant Women Cases

Women approved for Medicaid for Pregnant Women (MPW) are eligible for continuous coverage regardless of information entered into FAMIS at conversion. MPW budgets for converted cases will not transfer to FAMIS from Legacy and a new determination will not be completed based on income information entered during the conversion. A message displays on the budget summary screens in FAMIS to notify the worker that the budget for the converted MPW case is maintained in Legacy. Although eligibility for MPW is not impacted at conversion, to ensure accurate data is maintained in the system, enter current income for the mother when converting the case. Take the following steps when converting MPW cases into FAMIS:

• If the father of the unborn child is in the home, but not in the Supercase, add him as a Supercase member on the Supercase Member Clearance (FM0E) screen. Adding the father to the Supercase allows the worker the ability to select the father on the Pregnancy Detail screen later in the flow. If the father is not added to the Supercase, he cannot be selected on the Pregnancy Detail (FM8E) screen. Do not complete an add-a-person application as this is not necessary.

• The Legacy system utilizes the collective income of the assistance group when making a determination of eligibility for MPW. When converting to FAMIS, do not enter all assistance group members' income under the mother; enter only the mother's income on her income screens. For MPW case conversions, update other assistance group member income in the following situations:

  • Individual is active in another FAMIS Eligibility Unit (food stamps, Temporary Assistance, or child care); and

  • Income information is more current then the information listed in FAMIS.

• If the expectant mother has given birth to the child, enter the father's name (if in the home) in the appropriate field and enter the date the pregnancy ended in the “Actual Pregnancy End Date” field. Do not enter information in the “Expected Due Date” field; doing so may cause errors in calculating the 60-day post partum period.

• At conversion, for MPW cases in which another pregnancy has been reported, enter the expected due date of the new pregnancy in the “Expected Due Date” field.

  NOTE: This is only for MPW cases in the conversion process. Once an MPW case has been fully converted, separate MPW applications must be processed for additional pregnancies.

Transitional Medical Assistance Cases

Individuals on converted cases which are receiving Transitional Medical Assistance (TMA) must have the original TMA information placed on the Extended MAF screen. Enter TMA information even if the last month of TMA eligibility is the month the case converts.

An “ISD” (Insufficient Data) may display in the Supercase Eligibility Unit Summary screen (FM30) under the “EXT MAF” column after completing an EU case flow or an Eligibility Determination Resolution (EDRES). This indicates that the information in the system supports the EU as potentially eligible for TMA, but the information is incomplete. Entries must be completed that allows FAMIS to know whether or not the assistance group met the TMA requirements.

MC+ for Children Premium cases

An “ISD” (Insufficient Data) may display in the Supercase Eligibility Unit Summary screen (FM30) under the “CHIP” column after completing an EU case flow or an Eligibility Determination Resolution (EDRES). This indicates that the information in the system supports the EU as income-eligible for CHIP, but more is necessary to complete the determination. Entries must be completed that allows FAMIS to know whether or not the assistance group met the CHIP requirements.

19 Year-Olds Aging Out

Once cases are fully converted in FAMIS, the system will generate the exparte process for children turning 19. For cases where children turn 19 the month of conversion, do not attempt to remove the child's eligibility. The system will initiate the exparte process the end of the month the case is fully converted.

Unexpected Results

• If a case being processed through the flow has an unexpected outcome, check the relationships established in the Supercase.

• If the message “HOH not found” displays, first check relationships and make corrections, if needed.

• If the relationships are correct and the results continue to be questionable, stop where you are in the process and contact the FAMIS Unit at 1-800-MOFAMIS or Income Maintenance Program and Policy through appropriate supervisory channels.

TRANSFERS

The process to transfer a case depends upon whether it is active in a FAMIS or Legacy county and whether the receiving county has been converted. Continue to transfer closed or expired EUs following current procedures. Once a Family Medical Assistance EU is converted to FAMIS it is maintained in FAMIS. Any attempt to update the EU in Legacy will result in the edit “COUNTY HAS BEEN CONVERTED TO FAMIS.” For instructions on transferring a FAMIS EU, refer to the Change of Address User Guide.

When an address change is reported that will move a Family Medical Assistance EU from a Legacy county to a FAMIS county, the Legacy worker follows current procedures to request authorization to transfer the EU. The FAMIS worker then takes appropriate action to convert the case into FAMIS. For instructions on transferring a Legacy EU to a FAMIS county or caseload, refer to the Transferring a Legacy EU to FAMIS User Guide.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Develop a plan of action to fully convert cases on the Manual Conversion List (MCL) and in the controlled flow as soon as possible.
• Work cases on the MCL and in the controlled flow according to the priorities identified in this memo.
• If an unexpected result occurs at conversion, stop where you are in the process and contact the FAMIS Unit at 1-800-MOFAMIS for systems questions or Income Maintenance Program and Policy (through appropriate supervisory channels) for policy issues.

JB/LH/TM