PMDT
What is required by eligibility worker for all prior making a PMDT referral?
Attempt to contact consumer by phone – 1 attempt required
What key function is used to returned to the current record?
F2
What are the Working Healthy criteria?
· Working Healthy Applicant is age 18-64.
· Working Healthy Applicant is claiming a disability but not SSI.
· Working Healthy Applicant is reporting a job.
What is the 6 steps for the screening process?
•Brief Overview of the Application
•Applicant Status
•Request for Coverage
•Screen for Specialized Programs and Functions
•Administrative Roles & Application Signature
•All Required Questions Answered
What are the types of Self Employment?
Sole Proprietorship:
Partnership
US Corporation or C-Corporation: A
Small Business Corporation or S Corporation
Rental Income
How long is a PMDT decision good for?
12 months. The journal/case should be reviewed to see if one has been received within the last 12 months.
What is used to determine that records pending on the screen?
Pending records are records that include zeros on the screen.
· Adult/child active with E&D or LTC with others pending MAGI.
· Adult/child active with E&D or LTC with others active with MAGI.
· Note: If child is SSI only and only HH member disabled, it is not Hybrid.
What are you looking for on brief overview?
Household Members: Who is in the Home? Who wants coverage?
Income: Who has income? Income type
Medicare: Anyone have Medicare or any other health insurance?
Resources: Who has resources? Resource type
Expenses: Expenses reported; expense type
Living Arrangement: Identify anyone living in an institution.
What is needed for rental income?
All rental income is considered to be self-employment
Schedule E – Use Schedule E for Rental Income, Partnerships and S-Corporations.
o For Rental Income – Use the “Total rental real estate and royalty income or (loss)”, Line 26.
Can the eligibility worker approve the extension for the PMDT packet?
No, the consumer must contact the PMDT Team for extension to be approved by the PMDT Team.
What is the Net Benefits Date on the TPQY-TPQ1:SSI?
This is the Actual month the consumer received the amount listed in the Fed/State Amt fields.
What is needed to route an IROD task?
Review to ensure it is a valid IROD and not just a CM task or change reported. If a valid IROD, assign task back to KDHE worker who issued the denial.
What are you looking for when reviewing for the applicant status
Active recipient – Why are they applying?
Discontinued – Was it recent?
Information Received on Denied (IROD)
Request for new coverage on an open case
What should be used when a tax return is not available?
Self-Employment Worksheet
How many referrals are needed if there is more than one applicant?
Once for each applicant and each must have a separate Contact Log.
What is the importance of start and stop dates for Buy-In?
The start & stop dates indicate the month the state started or stopped paying the premiums. If there is no stop date, the state continues to pay.
What is needed for SOBRA & Institutional NB to be routed?
Claim task.
Staff email kdhe.EDTargetedCases@ks.gov with case name and case number.
What are you reviewing for when reviewing request for coverage?
Limited Coverage Request
Age and Disability Screening
When a consumer considered self employed?
v Advertises
Decides when and where to work
Obtains own jobs and sales
Pays own expenses
There’s a risk of profit or loss
Pays on FICA and income taxes
What is needed when a case involving children must be done before sending a PMDT referral?
The child(ren) must be denied MAGI coverage.
What is Z99?
Conditional Enrollment for Part A pending QMB determination as it cannot be finalized until QMB is approved
How are HCBS request (not open/active HCBS?)
Staff reassign task to Outstationed queue and reassign Task and Program Block CaseBank to ‘LTC – HCBS’.
Aged Out Foster Care
Presumptive Eligibility
Inmate
Pre-Release
SOBRA
MediKan Reintegration
Spousal Impoverishment
What are the types of Self Employment?
Sole Proprietorship:
Partnership
US Corporation or C-Corporation: A
Small Business Corporation or S Corporation
Rental Income