Overview of CM System Changes– Rev 04/30/14

Short list of MMIS/CM program case descriptors and CM N/R renewal codes for the new programs:

Program Name / CM, MMIS & Stateside Siebel Program Codes / CM Effective Date / CO and Stateside Siebel Program Abbreviations
MAGI Adult / AMO / 1/1/14 / MAGI-IND
MAGI Child / CMO / 1/1/14 / MAGI-U19
MAGI CHIP / C21 / 1/1/14 / MAGI-CHIP
MAGI Parent and Other Caretaker Relative / PCR / Not known when it will be implemented (if ever) / MAGI-PCR
MAGI Pregnant Woman / PWO / Not known when it will be implemented (if ever) / MAGI-PW
MMIS Agency Code / Data (and eligibility) Source
FST / Fast Track
MOD / Modernization (before system changes to prevent update, sometimes when other agency data was updated from a Stateside Siebel action, the agency code was changed from HIX, FST, AFS, etc. to “MOD”)
HIX / Cover Oregon
AFS / SSP branches, 5503 & 5508
SSD / APD/AAA CM branches
CSD / Child Welfare
OYA / OYA

If the medical start date is 1/1/14 or later:

  • DONOT add new OPC, OP6, OHP-CHP, SFC or SCP clients
  • DONOT add new CEC clients. CEC has been obsoleted, the program is closed.
  • DO NOT add new CEM cases. The CEM programhas been obsoleted, but not the policy:
  • For 12-month continuous Medicaid eligibility, place the child in CMO
  • There will be new “12E” coding to replace the old CEM code, but it is not ready yet

MAGI Workaround in CM:

  • Use the MAA workaround when adding any 2013 program eligibility
  • DO NOT use the OHP-CHP workaround for MAGI CHIP
  • DO NOT use the MAA MAGI workaround for AMO or CMO
  • DO use the MAA MAGI workaround for PCR
  • DO use an OPP MAGI workaround for PWO

CMO Edit Issue:

When coding CMO and C21, please make sure the FPL ranges and age match the following:

Age / FPL / Case Descriptor / Renewal N/R
AEN / Any (no income test) / CMO / AEN
Under age 1, but not AEN / 0% thru 133% / CMO / CMO
Under age 1, but not AEN / Above 133% thru 185% / CMO / CM1
Under age 1, but not AEN / Above 185% thru 300% / C21* / C21
Age 1 thru 18 / 0% thru 133% / CMO / CMO
Age 1 thru 18 / Above 133% thru 300% / C21* / C21

*We hope to add a C22 case descriptor for MAGI CHIP children age 1 through 18. C21 would apply to MAGI CHIP children under age 1.

OHP-CHP to CMO conversion:

  • OHP-CHP children with income from 100 – 133% FPL will be converted by the CM system and updated to MMIS as CMO. A CML case descriptor will be added to identify them for MMIS tracking
  • Scheduled for mid-May 2014

Overview of Planned CM System Coding

Acronym or name / Program Code / Key Dates / Case Descriptors / Comments
APTC/CSR / N/A / Effective 1/1/14 / N/A / Cover Oregon tax credit programs
BCCTP / P2 / No changes / BCP / BCS is used when BCCTP eligible but receiving another program
CEC / P2 / No new eligibles effective 1/1/14 / CEC
CEM / P2 / Do not add new CEM coding effective 1/1/14 / CEM / Code as CMO (“12E” n/r is planned to track the end of the 12-month Continuous Eligibility period but has not been implemented)
EXT / P2 / No new EXT based on child support effective 10/1 / EXT / Child support is not countable MAGI income.
Full-pay QHP / N/A / N/A / Cover Oregon
HKC / P2 / No new eligibles effective 8/23/13 / KCA, KCE / KCE eligibles transitioned to MAGI CHIP (C21) effective 1/1/14
MAA / P2 / Except for MAA workaround clients, no new MAA clients effective 1/1/14 / MAA / Use MAA MAGI workaround for Parents and Other Caretaker Relatives, when transitioning CW and OYA children and youth and for any 2013 medical program that has been obsoleted
MA MAF / P2 / No new eligibles added effective 10/1/13 / MAF
MAGI Adult / P2 / Implemented into CM for 1/1/14 / AMO / OHP-OPU clients were converted to AMO for 1/1/14
MAGI Child / P2 / Pending / CMO / CML c/d identifies clients converted from OHP-CHP to CMO
MAGI CHIP / P2 / Implemented for 1/1/14 / C21* / 185% – 300% if under age 1; 133% – 300% if age 1 through 18
MAGI CHIP w/TPL / P2 / Pending / T21 / Scheduled for May implementation
MAGI Parent and Other Caretaker Relative / P2 / Pending; may not be implemented into CM / PCR / Use MAA workaround with “PCR WRKARND” coding
MAGI Pregnant Woman / P2 / Pending; may not be implemented into CM / PWO / Use OPP workaround with “PWO WRKARND” coding
Acronym or name / Program Code / Key Dates / Case Descriptors / Comments
Protected Pregnant Woman / P2 / For the 2-months after the pregnancy ends; Pending / PPW with PCR or PWO / No scheduled implementation date
OHP-CHP / P2 / No new eligibles effective 10/1/13 / CHP
OHP-OPC / P2 / No new eligibles with DOR 1/1/14 or later / OPC
OHP-OP6 / P2 / No new eligibles with DOR 1/1/14 or later / OP6
OHP-OPP / P2 / No new eligibles with DOR 1/1/14 or later / OPP / Use OPP workaround with “PWO WRKARND” coding when required to add PWO eligibility to CM
OHP-OPU / P2 / Program closes 12/31/13 / OPU / OPU eligibles were converted to the MAGI Adult program effective 1/1/14
OSIPM or OSIPM related SBI / N/A / SBI / 5503 will not determine eligibility for OSIPM
OSIPM services / N/A / N/A / 5503 will not determine OSIPM related service eligibility
QMB-BAS / P2 / No changes / QMB / QMM if also eligible for OCCS medical
QMB-SMB / P2 / No changes / SMB
QMB-SMF / P2 / No changes / SMF
REFM / N/A / OCCS medical is prior resource to REFM / N/A / 5503 will not determine eligibility
Substitute Care (replaces “SAC”)
OCCS only / C5 / Effective 1/1/14 / SCP, SFC, CR1, CR2 / SCP, SFC replaced by:
CR1: Title XIX residential treatment (new c/d indicates new policy that income is excluded)
CR2: Non-Title XIX residential treatment (new c/d indicates new policy that income is excluded)
Substitute and Adoptive Care (SAC)
CW only / C5 / Effective 1/1/14 / SAC, SCH, CR3 / SAC: out of state foster care or adoption assistance residing in Oregon
SCH: Chafee medical: no new Chafee clients effective 1/1/14
CR3: Former Foster Care Youth Medical

Applies to multiple programs:

12E & associated date (pending implementation) / Eligibility based on 12-month continuous eligibility policy for children; children receiving medical based on 12-month CE policy should have CMO coding
ADM / Eligible for Administrative Exam
AEN & associated date / Deemed eligible for Medicaid based on mother’s Medicaid/CHIP status
BED / Use to keep medical open past the scheduled renewal date to redetermine or send a reduction or closure notice
BCS / Eligible for BCCTP but currently receiving other medical
CID / Medical closed/denied because the client didn't provide requested citizenship documentation
CIE / Pended for citizenship documentation; past initial 90-day reasonable opportunity pend period
CIP / Pended for citizenship documentation; in initial 90-day reasonable opportunity pend period
CM1 & associated date / Eligibility for non-AEN CMO child under age 1, with household group income in the 133% through 185% FPL range
CWM / Eligible for CAWEM benefits
CWX / Eligible for CAWEM Plus benefits
DOC / Incarcerated Medicaid-approved client
DUE with associated date / Pregnant with due date (not allowed on MAGI Adult program)
ELL / Express Lane Eligibility based on federal school lunch program
ELS / Express Lane Eligibility based on SNAP
GND; pending and may not be implemented / Beneficiary’s program is closed to new applicants but their eligibility has been allowed to continue into 2014
HNA / Individual meets Medicaid/CHIP definition of American Indian/Alaska Native
HPM / Use to add income to an AMO, CMO, C21, PCR, PWO medical case
MCB / MAGI Medicaid beneficiary for parent based on their child’s previous eligibility determination
MPR; pending / MAGI Medicaid/CHIP based on Hospital Presumptive eligibility decision
NOD / Medical closed/denied because client didn’t provide requested non-citizen documentation
NOE / Pended for citizenship documentation; past initial 90-day reasonable opportunity pend period
NOP / Pended for citizenship documentation; in initial 90-day reasonable opportunity pend period
OAP / Aid paid pending contested hearing decision
PPW & associated date; not implemented yet and may not be / Protected eligibility for post-partum pregnant women
QMM / Eligible for QMB medical and other medical program
PR1 / OCCS client who loses eligibility because they have been incarcerated in non-OYA state system
PR2 / OCCS client who loses eligibility because they have been incarcerated in non-state prison (includes county jails and OYA detention)
SSD / Individual qualifies for SSD based on their own disability
SSI / Individual qualifies for SSI
T21; pending May implementation / MAGI CHIP with TPL; tracks Medicaid children at renewal in 2014 who would have been eligible for Medicaid if not for the loss of the 2013 self-employment disregard

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