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Using CIS – Chapter 11

Scratchpad

CAMACA - Medical Assistance Calculation

Screen Description:

Data Elements for Input

Screen Name

Full Name

Mandatory (Y/N)

Description

Co

County

Y

Enter county code.

Record

Record

Y

Enter the client’s record number.

Cat

Category

Y

Enter the category for the appropriate eligibility determination. This field will help in determining the gross and net income tests. This field will be used in conjunction with Pers, Deemed, Preg, QMB, Disabled, HH<21, Ch, and MNO.

App Day/

Application Date,

N

This field applies only when the client files an application. Enter the day of the month in which retroactive or ongoing eligibility begins. For recipients, leave it blank.
A Note: A gross test will be performed for PC, PU, and TANF-related PD categories, only when there is an entry in this field.

Mo/Yr

Month, and Year

Y

Enter the first month of eligibility and the year.

R/O

Retrospective or Ongoing

Y

This will tell the system whether it is retroactive on ongoing coverage. Place an “R” for retroactive and an “O” for ongoing.

Pers

Number of Applicants and Recipients

Y

Enter the number of persons included in the applicant or recipient group; in addition, include anyone else who could be advantageous to the household.

Preg?

Pregnant

N

Place a “Y” in the field if calculating Healthy Beginnings (PS) for a pregnant women.

Age 65?

Age 65 or Older

N

Place a “Y” in the filed if calculating Healthy Horizons (PS, PG, TA (SLMB), NMP (PA), OR MNO (TA)) for a person age 65 or older.

QMB?

Qualified for Medicare Benefits

N

Place a “Y” in the field if the person is a Medicare recipient.
A Note: If the applicant/recipient is pregnant and receiving Medicare, only place a “Y” in one of these fields. The applicant/recipient may choose the category.

Disabled?

Disabled

N

Place a “Y” in this field if the category refers to a disabled category. If the client receives Medicare and has a disability, place a “Y” in both fields.
A Exception: If the person is age 65 or older, is employed, and either received MA benefits as a disabled person in one of the 12 consecutive months prior to reaching age 65 or should have received MA benefits as a disabled recipient in one of the 24 months prior to reaching age 65, then place a “Y” in AGE65 and Disabled fields.

HH<21?

Household Contains a Person Under Age 21

Y

When the household has a member under age 21, place a “Y” in this field. If ALL household members are 21 or older, place an “N” in this field. An “N” entry will queue the resource computation screen.
A Exception: Category TA or TJ with a “Y” in QMB and an “N” in the MNO field must have an “N” entry in the HH<21 field even if there is a household member under age 21.

#Ch <1

Number of Children less than 1

N

For Healthy Beginnings calculations, enter the number of household children under age one.

#Ch 1> <6

Number of Children Between 1 and 6 years

N

For Healthy Beginnings calculations, enter the number of household children between age one and six.

#Ch >6

Number of Children over Age 6

N

For Healthy Beginnings calculations, enter the number of household children over age six.
A Note: Only enter a child if the date of birth is after 9/30/1983.

MNO/MO 1_ 2_ 3_ 4_ 5_ 6_

 

N

Place a “Y” in this field if determining MNO. Only a “Y” in this field will allow an entry in the month fields, MO 1_ 2_ 3_ 4_ 5_ 6_. Complete the income fields on CAMACA and place an “X” in the applicable month(s). Additional CAMACA screens will generate until the collection of six months of income.
A Note: There may be a maximum of six CAMACA screens for each person that has income.

Recip #

Recipient Number

Y

Data enter the recipient ID number for the person whose income is on the screen. If more than one person has earned income, use two screens listing each person’s recipient number on their respective screens.

Deemed?

Deemed

N

Place a “Y” if there is deeming of income to the applicant/recipient group. Enter this person’s earned and unearned income in the appropriate fields. This person can receive work, personal, and basic living needs deductions.

Deemed Elg St

Deemed Eligibility Status

N

Enter the eligibility status of the non-eligible person.

NA Deps

Non-applicant Dependents

N

Enter the number of dependents in the household who are not receiving benefits.

Support

Deemed Support Amount

N

Enter the amount of support paid by this non-eligible person to members outside the household.

Earned

Earned Income Amount

N

Enter the monthly gross earned income amount or the monthly net profit from self-employment.

Incentive: TANF GA SSI

Work Incentive: TANF, GA, SSI

N

If the applicant is eligible for an earned income incentive, place a “Y” under the appropriate type of incentive. TANF refers to TANF related categories. GA refers to GA related categories. SSI refers to SSI related categories. For MNO categories, the applicant/recipient group must be eligible for and needs the incentive to qualify for benefits.
A Note: Place a “Y” in the TANF incentive field for TANF related PD/TD parents that are eligible and need the incentive to qualify for benefits.

W/P Ded: TANF, GA, SSI

Work/Personal Deductions: TANF, GA, SSI

N

Enter the amount of the work and personal deductions for each employed client. Reminder: TD parents are considered TANF related. There is a minimum of $90 for TANF related MNO. For GA related NMP there is a maximum of $25.
A Note: If the applicants/recipients of Healthy Beginnings and TANF related NMP categories are not eligible for the TANF work incentive, the applicant/recipient is eligible for a $90 standard work/personal expense deduction. If the TANF work incentive is used, the applicant/recipient is not entitled to the standard deduction.

AFDC?

AFDC

Y

This field is presented when there is a fail condition for Healthy Beginnings or TANF related NMP when using the TANF incentive. The system only allows entry when the category symbol is a PC, PU, PS, or PD and the TANF incentive is a “Y”. A “Y” or an “N” entry is required in this field to proceed with the calculation. A “Y” entry queues the CAMACU screen. An “N” entry will give the income results and cannot be changed to a “Y”. If an “N” entry is made in error, and the income results are displayed, F8 and reenter the information.

Incap/Dep Care: # <2

Number of Dependent children under age 2

N

Enter the number of children under two and the actual cost of the dependent care in the Incap/Dep Care #<2 field.
A Note:
1. The system is programmed to allow maximum allowances for Healthy Beginnings and TANF related NMP categories (PS, PC, PU, and PD) -- 200 for children under 2 regardless of full or part-time employment

2. The GA related NMP category of PD only receives the maximum allowance of $25 for work/personal expenses including dependent care.
3. MNO TANF and GA related categories have no maximum limits.
4. There are no dependent care deductions for Healthy Horizons categories.
5. For SSI-related categories of NMP and MNO, dependent care costs are considered earned income deductions.

Incap/ Dep Care: # >2

Number of Incapacitated Adults or Dependent Children over Age 2

N

Enter the number of children age two or older and or the number of incapacitated persons and the actual cost of the care in the Incap/Dep Care #>2 field.
A Note:
1. The system is programmed to allow maximum allowances for Healthy Beginnings and TANF related NMP categories (PS, PC, PU, and PD):

    $175 for children age 2 and up or an incapacitated person for full-time employment
    $150 for children age 2 and up or an incapacitated person for part-time employment

2. The GA related NMP category of PD only receives the maximum allowance of $25 for work/personal expenses including dependent care.
3. MNO TANF and GA related categories have no maximum limits.
4. There are no dependent care deductions for Healthy Horizons categories.
5. For SSI-related categories of NMP and MNO, dependent care costs are considered earned income deductions.

Incap/Dep Care: F/P Time?

Full-time or Part-time Employment

N

For incapacitated care or dependent care expenses, enter either “F” for full time or “P” for part time employment.

Unearned

Unearned Income Amount

N

Enter the monthly gross amount of unearned income.

Unearned Ded

Unearned Income Deduction Amount

N

Enter the amount of allowable deductions.
A Note: Do not include the $20.00 unearned deduction. This is deducted by the system.

Support

Support Amount

N

Enter the actual monthly amount of voluntary or court ordered support.

Ver

Verification

Y

Use this field to record how the income and resource data was verified. Access the TVER table for a list of codes.

PD MA Exps

Paid medical expense amount

N

Enter the amount of medical expenses paid by the client. This field will be used in the calculation of the spend-down and patient-pay amounts, if necessary.
A Note: For MNO, enter the total amount on one income screen. The system will not multiply this field by the number of MNO months indicated.

UNPD Non-MA Exps

Unpaid non-covered medical expense amount

N

Enter the amount of unpaid medical expenses that will not be covered by Medicaid, remains a legal obligation of the client, will not be covered by a third party, and was not previously used as an MA expense. This field will be used in the calculation of spend-down and patient-pay amounts, if necessary.
A Note: For MNO, enter the total amount on one income screen. The system will not multiply this field by the number of MNO months indicated.

UNPD MA Exps

Unpaid medical expense amount

N

Enter the amount of unpaid MA expenses that the client is applying for medical assistance coverage. This field is used in the calculation of the patient-pay liability amount, if necessary.
A Note: For MNO, enter the total amount on one income screen. The system will not multiply this field by the number of MNO months indicated.

Data Elements Refreshed and Protected

Screen Name

Full Name

Description

Net Inc

Net Income Amount

This is calculated by the system. For the Healthy Beginnings program, the system will only display results in the first column if there is an entry in either the Preg and or Ch<1 field. The system will only display an entry in the second field if there is an entry in the Ch 1> <6 field. The third field will display the results when there is an entry in the Ch >6 field. Results for the Healthy Horizons SLMB program will show in the first field. The QI-1 results will show in the second field. The third field will display the QI-2 results.

Cat Limit

Category Income Limit

The system will enter the appropriate limit from the system reference tables. For the Healthy Beginnings program, the system will display the 185% limit in the first field when there is an entry in Preg and or Ch <1 field. The second field will display the 133% limit when there is an entry in the Ch 1> <6 field. The system will display the 100% limit in the third field when there is an entry in the Ch >6 field. Limits for the Healthy Horizons SLMB program will show in the first field. The QI-1 limits will show in the second field. The third field will show the QI-2 limits.

Net - $10

Net Income After Subtracting $10

This field gives the net income after subtracting the $10. This is part of the NMP spend-down process.

Needed MA Exp

Amount of Medical Expenses Needed To Qualify

This is a system calculation. This will give the spend-down amount if the client is over income for the category.

Patient Pay

Patient-Pay Liability Amount

The system will calculate the patient-pay liability for MNO categories with unpaid medical expenses.

Special Processing:

Revised: September 15, 2000

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