File Clearance
This is the "pathway" to begin File Clearance
What is My Workspace > Locality Inbox?
The sources selected for "DOB Verification" and "Verification Source" for an "undocumented" alien
What is "Self Certify" and "No SSN required?"
The 4 resources used to verify income
What is the Electronic Sources, The Work Number (Equifax), SOLQ, and VEC?
External IDs that must be present on the "Demographic Info" tab for each CP consumer.
What is
- VaCMS Client ID
- MMIS Enrollee ID (if they have one)
Oscar -- entered the U.S. in 2012 -- applied for MA through the HIM , SBE-R received 5/17/2024. Oscar attested to having an I-551 document type, no alien # was present on the application. The Alien screen was updated with default information and the HUB was ran, verified "Yes." Eligibility was ran and Oscar was evaluated and approved for AC 112. CoveraVA certified/authorized the eligibility results
The eligibility results should not have been certified/authorized. Oscar is an LPR with more than 5 years in the U.S.; therefore, he qualifies for Full Benefits. SBE/FFM applications do not provide the Date of Entry, so an OBC should have been placed, and a VCL should have been sent if unable to reach the client. Also, running the HUB is incorrect when entering in the default information. Verifying the default information through the HUB will often generate false approvals.
The three programs a pending app can be associated to
What is MA, SNAP, and TANF?
Number of calendar days given to an individual who must submit their verification of immigration status to their local agency
What is 90 days?
The conversion factor for projecting income for each pay frequency: Weekly, Bi-Weekly, Semi-Monthly, Monthly, and Annually
What is
Weekly: x4.3
Bi-Weekly: x2.15
Semi-Monthly: x2
Monthly: x1
Annually: /12
What is "Notes" section?
*For both SR and Process App task
During the final eligibility run the determination resulted in client being denied for "Failed for overlapping eligibility requirement". CoverVA certified this denial and prompted the NOA to go out
"Failed for Overlapping eligibility requirement" is not the same as "Failed for overlapping eligibility requirement, client is receiving coverage on another case". Worker should have went back to the "other in-state benefits" screen and end dated/deleted the screen and re-ran eligibility to determine the true result.
Panviva document and name used to File Clear an application
What is 1159 (File Clearance for New Applications (CPU))?
Group of individuals who enter the U.S. as "emergency services" aliens for the first 5 years
What is Lawful Permanent Residents?
The income attested to (declared) by the applicant is within 20% of income information obtained from electronic sources OR that both the attested income and any electronic income verification are below the applicable income limit. Attestation considered "verified" if the income from both sources meets the 20% requirement or the income from both sources is below the limit.
What is Reasonable Compatibility
The address type selected if the client has the same physical and mailing address
What is Mailing?
Alicia called into the call center to submit an application requesting coverage for herself (32), Husband Gabriel (39), brother Theo (25) and her mother Lydia Rose (64). It was attested by Ms. Rose that Alicia was her caretaker. Case was processed by a CPU worker approving the entire household's coverage.
Case was processed incorrectly as there is an invalid signature. An OBC placed or a VCL should have been sent to have permission from Theo for Alicia to apply on his behalf.
There are 11 statuses a pending application can be in
What is "new," "started," "process," "submitted," "continue registration," "continue case assignment," "known to VaCMS," "SBE-incomplete," "SBE-different state," "duplicate request," and "wait mode?"
Eligibility chapter where you will find information regarding Alien and Citizenship requirements
What is Chapter 2: Nonfinancial Eligibility Requirements?
This is only given if the individual is not eligible for coverage due to excess income
What is 5% Disregard?
Panviva documents used for completing intake and completing SR/Process App tasks
What is
- 1561: NEW Application Intake (CPU)
- 1563: NEW Complete Process Application Task (CPU)
Client attested to zero income. When researching income was located for them. Once eligibility was ran, VACMS prompted a gap filling evaluation to be performed. Using the unattested income entered on the Gap filling evaluation screen and eligibility re-ran, the client was approved for 2 months and denied coverage for ongoing and a NOA followed
Case should not have been denied, due to CoverVA using unattested income to prompt this denial a VCL should have been sent for permission to use income located in our Electronic sources
The hierarchy of the case to be associated to if you find multiple historical cases belonging to your applicant, case-head or spouse.
What is
1. Case with the most recent active coverage (even if the case is now closed) ;
2. Case with the most HH members listed on the PDF ;
3. Denied historical case (in order of most recent w/ correct client)?
The difference between AC 112 and AC 113
What is
- AC 112: for MAGI based covered groups
- AC 113 is for children and adults in Non-MAGI F&C/Medically Needed covered groups
When to complete a Gap-Filling Evaluation
What is
1. The individual is in a "tax-filer" HH.
2. Currently monthly HH income is over the applicable monthly income limit
3. The total of income already received plus projected income for the calendar year in which eligibility is being determined, using MAGI methods applied by the HIM for the purposes of APTC eligibility, is below 100% FPL
The steps (in order) for completing Intake
What is
1. Search/retrieve the application PDF
2. Search for Duplicate SR
3. Search for the application in ConnectionPoint
4. Add consumer in ConnectionPoint (if they don't exist)
5. Create application Service Request in ConnectionPoint (if it doesn't exist)
Jill lives with her daughter, Lea, age 24 and her son, Mike, age 15. They do not file taxes. Lia is currently pregnant with 1 baby, all applied for MA. When reviewing the eligibility summary screen Jill and Lea and unborn are in the same HH and Mike is in his own HH
This is incorrect, they all follow the non-tax filer rule. Mike should be in the HH with Jill because that is his parent and he is under 19. Lea should be in a HH of 2 due to being a non-filer over 19 and expecting 1 child