| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | FAMIS MEDICAID CATEGORY HISTORY SCREEN AND MEDICAL ELIGIBILITY CODES |
DISCUSSION:
Integration of the Family Medical Assistance programs into FAMIS impacts the process of passing client eligibility to the Division of Medical Services (DMS). Previously, Family Support Division (FSD) staff entered Levels of Care (LOC) into Legacy to indicate eligibility for benefits. FSD would then pass that information to DMS which would assign a Medicaid Eligibility (ME) code to the individual based on the LOC and other factors (income, age, etc.) entered by the FSD Eligibility Specialist. ME codes are used by DMS to determine the funding source and level of services for which an individual is eligible.
Once the Family Medical Assistance case is in FAMIS, FSD staff will no longer enter a LOC into the system. Instead, FAMIS will determine the Medicaid category for which the individual is eligible, assign the appropriate ME code to the Medicaid-eligible individual, and pass the information to DMS. The information will then display on the new Medicaid Category History screen (MEDHIST or FM4L) in FAMIS the day after the eligibility is processed. The attached FAMIS System Medicaid Category Code Sheet 
lists the programs, compares levels of care in Legacy to Medicaid categories in FAMIS, and provides the corresponding ME Code information. ME code information displays in FAMIS for informational purposes only; it is not necessary to inform a recipient of his/her ME code.
MEDICAID CATEGORY HISTORY SCREEN
The Medicaid Category History screen (MEDHIST or FM4L) in FAMIS is similar to the Legacy DMS Title XIX Cross Reference Eligibility screen (commonly referred to as MXIX). The MEDHIST (FM4L) screen displays an individual’s Medicaid history beginning at the point the individual receives Family Medical Assistance through FAMIS. The screen displays the Medicaid category and ME code, begin and end dates of eligibility, and the initial determination date for the Medicaid category. If Legacy contains additional Medicaid eligibility dates for the individual, the Legacy Case Indicator field displays “Y” (Yes). When this indicator displays “Y,” press F23=MXIX to see the complete Legacy Medicaid history for the individual.
Information contained on the MEDHIST screen transfers to the Legacy MXIX screen. The MXIX screen continues to be the source to view all eligibility periods for an individual. As MEDHIST displays ME code eligibility periods instead of levels of care contained in Legacy’s MXIX, workers will note some differences.
Example:
Ms. P. applies for MPW in November 2006 and does not want prior quarter coverage. She is approved for MPW prior to the birth of the child. Her child is born in November 2006 after her application is approved. Ms. P.’s Medicaid categories (after payroll closing in January 2007), show the following eligibility segments:
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MPW133, ME Code 45 – This is the original MPW eligibility period. The start date is the first day of the month of application. The end date reflects the last day of the month of the Estimated Date of Delivery. Start date for Ms. P. is 11/01/2006 and the end date is 11/30/2006.
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MPW60P, ME Code 44 – This is the MPW 60-day postpartum period. The start date is the day after the Expected Due Date or Actual Pregnancy End Date. The end date is the last day of the month containing the 60th day after the pregnancy end date. Start date for Ms. P. is 12/01/2006 and the end date is 01/31/2007.
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EWHS, ME Code 80 – This is the 12-month Extended Women’s Health Services period. The start date is the first day of the month after the 60-day postpartum period expires. The end date is the last day of the 12-month period of eligibility. Start date for Ms. P. is 02/01/2007 and the end date is 01/31/2008.
Traditionally, MXIX would have shown the following for this case:
- LOC U – Start date 11/01/06 and an end date of 01/31/07.
- LOC O – Start date 02/01/07 and an end date of 01/31/08.
However, now that the case is in FAMIS, eligibility periods will display the breakdown based on the ME codes as it shows in FAMIS. Although the MEDHIST screen shows the different eligibility segments, only the corresponding LOC displays on MXIX. Ms. P.’s MXIX screen, displayed below, shows the break up of the LOC U period into the two segments detailed on MEDHIST.
The column labeled “SYS” indicates FM if the information comes from the FAMIS system. The TOA (Type of Assistance) column displays an “F” in the second space for Medicaid segments approved in FAMIS, as follows:
| Newborn | GF |
| MAF/MC+ for Children | CF |
| MPW/EWHS | RF |
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
LH
ATTACHMENTS:
FAMIS System Medicaid Category Code Sheet