The case manager must run a TMA budget for the come-up month. N-FOCUS TMA budgeting rules will determine if the result is that TMA eligibility continues or if some members of the family, or the entire family, are now subject to a TMA Premium. Be certain that the child(ren) in Medicaid are in the correct Medicaid eligibility category. If the children are either subject to the TMA Premium or if they are eligible under Continued Eligibility but are also not subject to the TMA Premium, close out of Budget Authorization and re-run Configuration. Update the children's Medicaid category to CMAP and then Budgeting will budget the children according to CMAP rules while the parent(s) will be budgeted according to TMA rules.
If N-FOCUS determines on the TMA budget that a Premium is required, authorize the budget. Those family members subject to the Premium will be placed into a "PD" (Premium Due) status.
NOTE: In order for the "Monthly Medicaid Premium Statement" to be mailed, the individuals must be in "PD" status. This process will not work correctly if the individual is in Active, Closed, or FR status.
N-FOCUS will generate to these households a "Monthly Medicaid Premium Statement." This monthly statement will be mailed out the day after N-FOCUS MED Cutoff. This statement advises the household which family members are subject to the Premium (those in "PD" status), the amount of the Premium and for what Month the Premium is being assessed. The bottom portion of the statement is a tear-off section. The client sends this portion of the statement in with their Premium payment.
The TMA Premium payment is mailed by the client to the Office of Economic and Family Support, P.O. Box 94926, Lincoln, NE 68509-4926. The worker should encourage the client to mail the premium payment directly to OEFS rather than turning it in at the Local Office, as OEFS staff have the appropriate security level on N-FOCUS to change the case status from "PD" to Active.
Once the client's status is changed from "PD" to Active, the system will generate a "Notice of Finding - Medicaid Premium Paid" to the client the next working day. This Notice will serve as verification that the individual(s) listed has paid the Premium and is now in Active status. If some family members who are subject to the premium have remained in Active status, they will still be shown on the monthly Medicaid Eligibility Card.
When the premium payment is received and the individual's status is changed to Active, his/her status for the come-up month is set to "PD" by the system. This flow will continue for as long as the household continues to remain eligible for TMA with a premium required in the second six-month period.
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