MEMORANDUM
2007 Memorandums
IM-49     

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

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 pdf logo 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:
screen shot of FM4L

Traditionally, MXIX would have shown the following for this case:

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.

screen shot of MXIX

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:

LH

ATTACHMENTS:
FAMIS System Medicaid Category Code Sheet pdf logo


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