MEDICAL CARE SERVICES (MCS) MEDICAL (G01)
DSHS Home Page
 
Search     for:
DSHS Home    Acronyms    Alerts    Screens    WAC Number Index    WCCC

MEDICAL CARE SERVICES (MCS) MEDICAL (G01)


Revised November 21, 2013



NOTE:

As a result of implementation of the Affordable Care Act (ACA), transitional modifications have been made to ACES to support the continued issuance of Medical Care Services (MCS) classic medical assistance and Housing and Essential Needs (HEN) referral. This temporary system workaround will be in place until the GA cash and medical eligibility separation occurs in July 2014. Active MCS clients, who are eligible for a Modified Adjusted Gross Income (MAGI) medical assistance unit or a classic medical assistance unit, will display with a financial responsibility code of RC – Recipient of Cash only. For more details, see What financial responsibility codes are used for active MCS. 


Who is eligible to receive Medical Care Services (MCS) medical (G01)?

 

How long is the Medical Care Services certification period?

 

How do I screen Medical Care Services medical?

 

How do I process Medical Care Services medical?

 

What Financial Responsibility codes are used for active Medical Care Services Clients?

 

How do I process a change from MCS Medical only (G01) to ABD Cash (G02)?

 



Who is eligible to receive Medical Care Services (MCS) medical (G01)?

 

·         Adults who are who unable to work for at least 90 days due to a physical and/or mental incapacity and who meet the criteria in the following EAZ Manual WACS may be eligible for Medical Care Services (MCS) medical:

 

o    WAC 182-508-0005 Eligibility for medical care services.

 

o    WAC 182-508-0001 Medical assistance coverage for adults not covered under family medical programs.

 

o    WAC 182-508-0010 Incapacity Requirements for Medical Care Services (MCS).

 

o    WAC 182-506-0020 Assistance units for medical care services (MCS).

 

o    For additional information see EAZ Manual Chapter Medical Care Services (MCS) Program.

 

How long is the Medical Care Services certification period?

 

·         Medical Care Services can be certified for up to 12 months with a six month reporting requirement.

 

·         See EAZ Manual – WAC 182-504-0030 Medical certification periods for recipients of medical care services (MCS).

 

How do I screen Medical Care Services medical?

 

·         MCS medical is initially screened in as a G02 application following the instructions in How do I screen in Aged, Blind, or Disabled Cash Assistance?

 

How do I process Medical Care Services medical?

 

·         While pending, the AU remains a G02 AU until the incapacity determination information is received. When the incapacity determination is received, take the following steps:

 

1.    From the AMEN, select Option O – Interview. 

 

2.    On the DEM2 screen:

 

o    Enter [the appropriate code] in the Dis/Incp/ESRD field.

 

o    Enter [the appropriate code] in the Approv Source field.

 

o    Enter [the approval date] in the Approv Date field.

 

o    Enter [the established date] in the Estab Date field.

 

o    Enter [the date the incapacity approval ends] in the End Date field.

 

    The disability/incapacity end date is established by the Social Worker. For new applications this date must be more than 90 days from the date of application.

 

3.    On the VERF screen:

 

o    Enter the [date the client met all of the eligibility requirements] in the Elig Estab Date field.

 

4.    Call DONE and commit the data.

 

5.    Complete processing following the steps in the Process Application Month chapter.

 

6.    Complete finalizing following the steps in the Finalize Application chapter.

 

·         The G02 AU will trickle to G01 MCS medical only during Finalize, if appropriate, based on the disability/incapacity coding on the DEM2 screen.

 

What Financial Responsibility codes are used for active Medical Care Services clients?

 

·         Starting with the benefit month 1/2014, when a client is approved for MCS, the financial responsibility code will be one of the following codes depending upon the client's citizenship status:

 

o    RC – Recipient of Cash only: ACES assigns this code when the client is eligible for classic medical assistance or meets the citizenship and income requirements for Modified Adjusted Gross Income (MAGI) medical assistance. MCS does not issue cash, a referral is issued for Housing and Essential Needs (HEN).

 

o    RE – Recipient: ACES assigns this code when the client doesn't meet the citizenship requirements for MAGI medical assistance. HEN and Medical assistance will be issued.

 

·         The temporary workaround to use these codes will continue until the July 2014 ACES Release. During that release is when programming changes will occur to have the MCS program only issue the Housing and Essential Needs (HEN) referral. The (G01/G02) medical coverage will then be issued on a new program type.

 

How do I process a change from MCS Medical only (G01) to ABD Cash (G02)?

 

·         To process a change from GA/G01 (MCS Medical only) to ABD/G02 (Cash and CN Medical) if client’s status changes from incapacitated to disabled, take the following steps:

 

1.    Screen in a new ABD/G02 assistance unit.

 

o    Enter [the ABD/G02 approval date] as the application date.

 

2.    From the AMEN screen, select Option O – Interview

 

3.    On the STAT screen for the ABD/G02, complete the Finl Resp fields as follows:

 

o    [PN] – Applicant for the HOH.

 

o    [SP] – Ineligible Spouse for the non-applying spouse.

 

o    [NM] – Non Member for all other household members. See Case Specific Situations for married couples both applying.

 

4.    On the STAT screen for the MCS/G01, enter [a 587 reason code] for each month the ABD/G02 is approved.

 

5.    On the DEM1 screen:

 

o    Enter the [appropriate valid value] in the Liv Arng field on the DEM1 screen. See EAZ Manual – WAC 388-513-1315 for additional information on ABD clients receiving Long Term Care services.

 

o    In the Concurrent Receipt field, enter [X] – Previous Benefit Canceled/CL received CA in another program under the CA field for the current month and each historical month where ABD/G02 is to be approved.

 

6.    On the DEM2 screen:

 

o    Enter [the appropriate code] in the Dis/Incp/ESRD field. Coding in this field determines the Program Type and Medical Coverage Group.

 

o    Enter [the appropriate code] in the Approv Source field.

 

o    Enter [the approval date] in the Approv Date field.

 

o    Enter [the established date] in the Estab Date field.

 

o    Enter [the date the incapacity approval ends] in the End Date field.

 

o    See Aged, Blind, or Disabled Program Chart for additional coding information.

 

7.    On the VERF screen:

 

o    Enter the [date the client met all of the eligibility requirements] in the Elig Estab Date field.

 

8.    Call DONE and commit the data.

 

9.    Complete processing following the steps in the Process Application Month chapter.

 

10. Complete finalizing following the steps in the Finalize Application chapter.

 

o    The program type changes to ABD/G02 and the medical coverage group changes to G02.

 

o    In this situation, CN Medical coverage is retroactive to the first of the benefit month the client became CN eligible whereas the cash grant is prorated from the date the client is found eligible.


NOTE:

Retro CN medical can be opened based on the ABD Cash (G02) disability approval date when there is a need for retro medical and all other eligibility factors are met for the retro time period. An S02 AU must be screened using the disability approval date as the date of application. Clients receiving ABD Cash (G01/with MCS medical) due to citizenship status do not qualify for federal CN medical coverage.

Modification Date: November 21, 2013