| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | FAMIS CONVERSION OF MC+ (CHIP) PREMIUM CASES |
DISCUSSION:
By design FAMIS determines eligibility for three budget months. When taking a MC+ CHIP premium case through the controlled flow at conversion it is critical that all income information for the assistance group members is entered for the month the rollout conversion occurs. The only exception is if the income is already known to FAMIS.
Income Maintenance memo IM-45, dated 05/18/07, contains the following information:
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.
Failure to enter the income information for a premium case for the month of conversion will incorrectly change the children to a non-premium level of care, refund premiums paid, close out premium invoicing, stop automatic withdrawals of premiums (if this has been selected as method of payment), and then create an adverse action for the next budget month taking the case back to a premium level of care sixty days in the future when income is correctly entered for the second budget month.
EXAMPLE: In the Legacy system Ms. Smith is a MC+ CHIP Premium Level of Care 2 (LOC 2) for her two children. Ms. Smith is employed and her children receive child support. County rollout conversion is June 23. On July 6, the worker takes the case through the controlled flow. Ms. Smith has no income listed in the FAMIS system as she has no other active case or rejected applications (example: food stamps, temporary assistance, child care). The assistance group’s income remains the same as in Legacy. However, the income information is not transferred from Legacy to FAMIS. The eligibility specialist must enter the income information into FAMIS for a correct eligibility determination to be reached when the case fully converts to FAMIS. To take Ms. Smith’s case through the controlled flow and arrive at the correct results a budget is required for June, July, and August.
Incorrectly entering income information and results: The eligibility specialist enters Ms. Smith’s employment income and each child’s child support income for the month of July (none for June). FAMIS processes budgets for June, July, and August. Because there is no income for June, the children become MAF eligible. This ends the premium level of care incorrectly and closes the invoicing process. When the invoicing process is disrupted, the recipient is confused by the changes made, when in fact they should have had no change due to conversion.
Incorrect eligibility determinations due to incorrect data entry require a claim to be prepared for the time period the children incorrectly receive MAF coverage.
Correctly entering income information and results: On July 6 while completing the controlled flow, the eligibility specialist enters Ms. Smith’s employment income and each child’s child support income for the month of June (county conversion to FAMIS occurred in June). The FAMIS eligibility unit (EU) remains at the same level of care as in Legacy and premium invoicing continues without interruption.
All eligibility determination outcomes should be reviewed to insure a correct case decision is reached. FAMIS makes decisions based on data entered by the eligibility specialist. If data is omitted or incorrectly entered, a correct eligibility determination cannot be reached. Knowledge of policy and expected outcomes continues to be a vital part of determining eligibility.
If an unexpected result occurs, stop where you are in the process, discuss with supervisory staff and if further assistance is needed, contact the FAMIS Unit at 1-800-MOFAMIS for systems questions or Income Maintenance Program and Policy (through appropriate supervisory channels) for policy issues.
NECESSARY ACTION:
- Immediately review this memorandum with eligibility specialists.
- Enter a budget for the month of county conversion.
- Review all eligibility determinations for correct outcome.
- 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.