Effective immediately begin accepting MC+ Eligibility Notices (CSE-67) from DCSE for uninsured PFS participants.  All CSE-67's will be sent to the MC+ phone centers.  DCSE staff will determine MC+ eligibility before sending the CSE-67.  DFS staff are responsible for registering the Non-Custodial Parent application and entering the eligibility in the IMU5 system.  Services for these individuals cannot begin prior to February 1, 1999. 

The system work to approve PFS participants is not complete.  You will be notified by E-mail memorandum when the system is ready to accept approvals.

ELIGIBILITY CRITERIA:

• Uninsured

 
• Participating in Parents' Fair Share

 
• Citizenship/Alien status

 
• Social Security Number

 
• Residence

UNINSURED:

DCSE staff will use the same uninsured requirements as those used to determine eligibility for MC+ level of care "1" and "2" children referred to in Memorandum IM-87 dated July 23, 1998.
In summary, the requirements are:

• NCP does not currently have health insurance which minimally provides coverage for physician's services and hospitalization; and
• NCP must not have dropped health insurance without good cause within the six months prior to application.

Third Party Liability (TPL) requirements also apply to the PFS participant.  They must cooperate with the Division of Family Services in identifying and providing information to assist the state in pursuing any third-party who may be responsible for their medical care.  This would include parties responsible for personal injuries such as an auto accident or insurance policies that do not meet the definition of health insurance for MC+.

PARTICIPATING IN PARENTS' FAIR SHARE:

Continued participation and cooperation in PFS are mandatory for MC+ eligibility.

The DCSE PFS Self-Sufficiency Case Manager (SSCM) identifies a PFS participant who meets all the eligibility criteria for MC+.  The SSCM completes the Medicaid Eligibility Notice (CSE-67) advising DFS that the PFS participant is eligible for MC+.

The following eligibility criteria are the same as existing policy for MC+:

SOCIAL SECURITY NUMBER

RESIDENCE

CITIZENSHIP/ALIEN STATUS

Residence and social number will be established by DCSE and included on the CSE-67.

For non-citizens, DCSE will contact the phone center with the alien status, registration number and date of entry.  The Phone Center staff will follow normal procedures to determine if the alien meets alien status criteria for MC+ coverage and notify DCSE.

COVERAGE:

PFS participants approved for MC+ will receive a more restricted coverage package than that received by MC+ children and other adults under Medicaid.  This package includes most of the services covered for adults on Medicaid.  The major differences between this package and that received by other adult Medicaid recipients are:

• Vision care is limited;

 
• Routine dental care is not covered; and

 
• EPSDT services for NCP's under age 21 are not covered.

There is no cost sharing for these participants.

APPLICATION PROCEDURES:

The CSE-67 is the notification of eligibility for MC+ for PFS participants.  DCSE will send the CSE-67 to the MC+ phone centers for processing.  These cases will be maintained in the phone centers.  If the family has another type of case in their residence county, the MC+ PFS case should still be maintained in the phone center.  The reason for this is MC+ eligibility for PFS participants has no bearing on eligibility for any other type of assistance.  The pay county (Field 10A) of the IMU5 will reflect the county where the record is maintained.  An entry is required in Field 10B, Residence County, which must reflect the county of residence. 

Upon receipt of the CSE-67 identifying a PFS participant as eligible for MC+, register the application on IAPP as "X" ( Non-Custodial Parents).  The date of application will be the date the case manager enters on the CSE-67.  DCSE will be in contact with  current participants of the PFS program to determine insurance status.  Once obtained, a CSE-67 will be submitted to DFS per normal procedures.  All 'X' applications are due within 30 days, but PFS approvals should be entered in the IMU5 system shortly after receipt.  These cases will be date specific.  A level of care of 'T' will be used for non-custodial parents participating in PFS. 

The beginning date of eligibility will be the date of application or February 1, 1999, whichever is later.

Only the following entries must be completed on the IMU5 to enter an approval:

Case Update --   Field 5    - Case Action

Field 6    - Reason Open
Field 10B  - County of Residence
Field 11   - If applicable
Field 33  - Enter all zero's
Field 34   - Enter all zero's
Field 35  - Enter all zero's
Field 36  - Enter all zero's

Field 13G  - Level of Care 'T'
Field 13K  - Citizenship/Alien  status
Field 13-O3  - Insurance Indicator

Error 430 - Incorrect income for level of care 

The following forms have been produced to handle PFS applications and approvals of MC+ for the non-custodial parents under 125% and PFS participants eligible for MC+. 

• CSE-67 - PFS Medicaid Eligibility Notice used by DCSE to notify DFS of initial eligibility for MC+ as a PFS participant and of any changes that occur that effect eligibility.

 
• IM-32 NCP - MC+ Approval letter to notify non-custodial parents under 125% of Federal Poverty Level of approval for MC+.

 
• IM-32 PFS - MC+ Approval letter to notify PFS participants of approval for MC+.

DCSE will notify phone center staff via CSE-67 of changes in eligibility.  The only issues which effect continued eligibility are insured status and non-participation in the PFS program.

If a NCP successfully exits the PFS program, DCSE will advise the NCP they are no longer eligible for MC+ as a PFS participant, but may be eligible for MC+ as a non-custodial parent.  An MC+ application, IM-1UA and IM-1UA (NCP), will be included with the notification from DCSE.  The NCP will be instructed to return it to DCSE within 15 days.  If returned within 15 working days, DCSE will notify the appropriate phone center via CSE-67 that the NCP is exiting the PFS program.  The new MC+ application and a child support payment history for the past six months will be included.  If eligible for NCP, change the level of care to "F" with an  effective date of the action.  Use the IM-32 NCP to notify the non-custodial parent of eligibility for MC+ for NCP.  If ineligible for MC+ for NCP, close the MC+ for PFS.  Use the MC+ Denial Notice, IM-33 MC, to notify the non-custodial parent of their ineligibility.

If the NCP does not return the completed application to DCSE within the 15 working days, DCSE notifies DFS via CSE-67 that the NCP is exiting the PFS Program.  Take action to close the case.  An IM-80 is not required as the NCP is notified upfront their eligibility is tied to PFS participation.  Send a closing letter, IM-33 MCC, to notify the client of the date their MC+ coverage ends. 

If the NCP misses the 15 day deadline, he may still apply for MC+ for NCP through normal procedures.  However, if eligible, coverage will be interrupted. 

If the NCP is terminated from the PFS program for non-participation, DCSE sends the participant notification of ending eligibility.  An IM-1UA and IM-1UA (NCP) will be included with this notice advising that application for MC+ for NCP may be made by returning the application to DFS.  At the same time the client is notified, DCSE will send to the appropriate phone center a CSE-67 indicating the NCP is exiting the PFS program.  Discontinue MC+ coverage as a PFS participant.  An IM-80 is not required.  Send a closing letter to notify the NCP of the date MC+ coverage ends.

NOTE:  A new closing code reason, '65' - not participating in PFS program, has been added to address these closings. 

If notified by DCSE that the PFS participant has obtained health insurance, send a closing letter stating they no longer meet the uninsured criteria.  An IM-80 is not required.

• Review this memorandum with appropriate staff.

 
• Follow the procedures outlined in this memorandum to  determine eligibility for the MC+ program for uninsured Non-Custodial Parents participating in Parents' Fair Share.

 
• File the IM-32 NCP and IM-32 PFS and instructions in the Forms manual.