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Member Eligibility – Medicaid Status QRG

Across
TIP: CBCMs should not utilize the eligibility date on the “______ screen” that you first encounter in FACETS.
Step 3: If FACETS eligibility screen confirms that Medicate status has been lost, the CBCM should check the “____Date” located on the Member Screen under Prospective UM to determine if a member recently may have had a Medicaid Review.
Step 2: CBCM checks ______eligibility screen to confirm if the member has lost Medicaid status via the eligibility inquiry screen.
Step 9: CBCM’s will assist with any appeals measures when a member’s eligibility has been termed by DHS. During an _____with DHS, the member’s eligibility continues until a final decision is made.
If the member has not received paperwork regarding their Medicaid status, CBCM contacts ___ workers to find out the reason Medicaid status has changed
Step 7:If the IM worker indicates Medicaid status has been reinstated, CBCM should monitor member in FACETS for an update in _______. Eligibility reinstated prior to the 15th of the month will retro back the first of the month when eligibility was reinstated. Eligibility reinstated on or after the 15th of the month will show as eligible the 1st of the next month.
Action plan under step 4:  Continue to _____FACETS until an update in eligibility takes place
Step 6: If the member has received paperwork regarding their Medicaid status, the CBCM works with the member to manage any _______ that has been received. The CBCM should monitor FACETS to determine the future status of eligibility.
Down
Action plan #2 under step 4: Contact the ELVS line and ________ IA to help determine a member’s eligibility and to determine if there is a reason to question if the eligibility status is accurate. Reasons to question accuracy would include, but may not be limited to: providers indicating DHS is stating the member is eligible or member is stating that they got a letter regarding their eligibility status
Step 5: If the outcome of Step 4 is that ____ is indicating that a member is ineligible, or if FACETS is showing the member’s Medicaid Status has been lost and the “hire date” is past, the CBCM should take the following steps: ~Contact the member ~Inquire of the member if they have received any paperwork regarding their Medicaid status
Step 4: If the FACETS eligibility screen is indicating a loss of ________ eligibility, but the “hire date” is not past due the CBCM should take the following steps:
Step 8:When eligibility issues arise, the CBCM will continue to monitor the progress of the case including:  Providing ________ to the providers and members that an eligibility issue may be occurring and that the provider should be monitoring the status of the member’s eligibility through DHS sponsored venues.  Completion of assessments that are due.  Providing contacts via phone to assure member risks are managed.
Step 10:If a final decision has been made by DHS not to reinstate Medicaid Eligibility or a member has gone 60 days in an ineligible status; the LTSS Plan of care, authorizations and case must be _____. The CBCM must notify the UM department of the change in the members eligibility, resulting in the appropriate letter being sent to the provider and member. If there is a resolution in Medicaid eligibility, LTSS coordination continues.
Step 7 Part2: If the IM worker indicates a need for _______ to the member, CBCM works with the member to manage any instructions that the IM worker has provided to the CBCM and will follow up with the IM worker to assure that the required steps needed were complete. The CBCM will then return to the top of step 7 and
STEP 1: Member was a ______ member and is now showing as “Ineligible” in Care Compass