Medical Support and Benefits Branch

The Medical Support and Benefits Branch works towards the common goals as stated by the Division of Family Support as well as those expressed in the Department's mission statement. 

The branch is primarily responsible for supporting DCBS field staff in the interpretation and clarification of Medicaid Policy and Procedures, as well as statewide Medicaid Case Processing for Guardianship (wards of the State) and U-Cases (Psychiatric children).

In addition, the branch is responsible for the special issuance of KYHEALTH cards which are lost, stolen or that have to be issued in “Dire” Circumstances (including MED-Yes cards and MA coverage letters to providers).

The branch consists of one manager, two section supervisors and twenty (20) employees.

Primary Function (Purpose)

To provide quality resources and technical support to the service regions in the implementation and interpretation of Medicaid Policy and Procedures.

The branch consists of the following sections:

• Branch manager's office - Three positions including the branch manager.
• Medicaid Policy Section - Six positions including the section supervisor.
• Case Processing Section - Nine positions including the section supervisor.
• Technical Support Section - Two positions, both of whom report directly to the branch manager.

Katie Brown, Branch Manager
275 E. Main St., 3E-I
Frankfort, KY 40621
(502) 564-7514

The functions managed directly by the branch manager include the following:

• General administrative and clerical support for the branch
• Includes division mailroom and primary phone coverage
• KENPAC reassignments of primary physicians for Medicaid recipients
• NEMT (Non-Emergency Medical Transportation) and U-Case (Psychiatric Child)
• Monitoring the Medicaid contracts with DCBS - including quarterly meetings on both
• Responsible for monitoring eligibility determinations and statistics statewide
• Monitoring QC/OPE reviews
• Monitoring KAMES and PA-62 Systems and attending steering committee meetings
• Monitoring and evaluating DCBS field training requirements pertaining to new and ongoing policy updates and initiatives
• Responsible for yearly eligibility “budget” projections and reports based on the above-referenced eligibility data
• Responsible for K.C.P (Kentucky Physicians Care) Program, its ongoing policy and procedure directives for field staff, acting as liaison between KPC and the field offices and promoting the program statewide
• Responsible for data entry, typing correspondence, transfer of cases and maintaining case files

Medicaid Program Support - Functions:

• Policy Interpretation
• Review Federal and State Laws/Regulations for impact on current policy
• Assist in the development of new Medicaid policy and revise existing policy based on research and reviews
• Coordinate with Service Regions on policy development and revision

 Policy Clarifications

•  Assist staff with policy and procedural questions
•  Answer recipient questions
•  Assist federal, state, public and private agencies with questions

Miscellaneous

• Create NEWS messages
• Review Eligibility Statistics and provide reports as required
• Research KAMES problems
• Coordinate policy and system changes
• Write letters, memos, etc. to staff and agencies within and outside the state of Kentucky and respond to related correspondence
• Schedule and attend Medicaid policy and contract meetings as required
• Respond to Ombudsman inquiries, as well as Ombudsman request for the re-issuance of medical cards
• Other duties and special projects as assigned

Medicaid  (Adult Related)

A,B,D/AP, BP,DP: Aged, blind or disabled persons who receive SSI.  These persons may also receive State Supplementation Payment (SSP).

F,G,H/FP,GP,HP:  Aged, blind or disabled persons who do not receive SSI but may receive SSP and are considered categorically needy. 

J,K,M:  Aged, blind or disabled persons who do not receive SSI or SSP. These persons meet the same technical eligibility factors as A,B,D persons, but:

• Have income and/or resources in excess of the SSI limitations;
• Have excess income utilized either through allocation to dependents and/or spend down; or
• Are deceased and application has been made by an interested party.

Z:   Aged, blind, or disabled persons who are eligible for limited Medicaid coverage:

• Qualified Medicare Beneficiaries (QMB) - These persons receive payment of Medicare deductible, co-insurance and Buy-In
• QDWI – These persons receive only the Buy-In of the Medicare, Part A premium
• SLMB – These persons only receive the Buy-In of Medicare, Part B premium
• QI1 – These persons receive only the Buy-In of the Medicare Part B premium if the limited annual funding is still available
• QI2 – These persons receive only reimbursement for the home health portion of the Medicare Part B premium, which is issued as a one-time payment for the entire year

Medicaid  (Family Related)

 “C” Cases – Kentucky Transitional Assistance Program (K-TAP) recipients including the specified relative and the second parent.

 “E” Cases – The specified relative, second parent and children under age 18, or age 18 and meeting school attendance requirements, who meet the AFDC program criteria in effect on 7/16/96 and are not receiving K-TAP for any reason.

 “I” Cases – Children at least age 6 and born after 9/30/83, but under age, or age 18 and meeting school attendance requirements, whose family income exceeds the MA scale but does not exceed the 100% poverty Level Scale for the appropriate family size.

 “L” Cases – The specified relative, second parent and children under age 18, or 18 and meeting school attendance requirements, who except for income or resources would be eligible for a K-TAP payment.  The child is deprived of parental support due to death, incapacity or absence of a parent.  Also pregnant women, if the deprivation factor is met and eligible for a spend down.

 “M” Cases – Disabled children, income ineligible for MA in any Family MA category.

 “N” Cases – Individuals as in program code “L” in which the deprivation factor is unemployment or underemployment.

“P” Cases – Children in foster care in family homes or private institutions totally or partially dependent upon and supervised by a public or private child caring agency.

“T” Cases – The specified relative, second parent and children under age 18, or age 18 and meeting school attendance requirements, who meet the AFDC Program criteria in effect on 7/16/96, and are not receiving a K-TAP grant for any reason.

“U” Cases – Children who are under age 8, or age 18 and meeting school attendance  requirements, technically ineligible for SSI, and inpatients in psychiatric facility, an institution for Mental Diseases, a  Psychiatric Residential Treatment Facility or an EPSDT Long Term Care Facility.

“W” Cases – Beneficiaries of K-TAP including the specified relative and second parents.  The family meets the technical and financial criteria for K-TAP.

“Y” Cases – Children under age 18, or age 18 and meeting school attendance  requirements.

The Kentucky Children’s Health Insurance Program (KCHIP) is Kentucky’s response to Title XXI of the Social Security Act, which was implemented on Aug. 5, 1997. Title XXI, Children’s Health Insurance Program, initiated health insurance for uninsured children who are income ineligible for Medicaid, but below the 200% poverty Level. Senate Bill 128, passed on March 31, 1998, provided Kentucky’s guidelines for KCHIP.

KCHIP will cover eligible children until their 19th birthday.

Major Systems Functions

Working in partnership with OTS on system support for program staff on the following systems:

• KAMES interface
• Revising System Notices (all programs)

Critical Events

• Act as Legislative Review and Liaison member
• Participation in Policy Collaboration Team (PCT)

The Case Processing Section of the DFS MSBB carries the Guardianship case load, handles the PA-11 and PA-527 processes for SSI applicants/approvals, and issues verification letters for recipients needing proof of MA coverage for prior months.  This section also issues replacement MAIDs at recipient's request, and works with the DMS Eligibility Maintenance Branch to resolve Buy-In problems at the request of field staff.

Guardianship Section Functions

• Responsible for the notice to all parents of children receiving MA who are required by law to participate in child support enforcement activities for the purpose of securing medical support from absent parents.
• Responsible for the one-page application for retroactive medical assistance eligibility for SSI approvals which asks questions about residency, income, and resources for the month of application and could also possibly include up to two months prior to the month of application.
• Responsible for the form completed by the Social Security Administration to inform our office of the eligibility of SSI recipients.  It includes statistical information such as name, DOB, SSN, address/payee address if any, and the Eligibility (SSI Eligibility) months beginning and final month of eligibility if terminated. Also includes Date of Death if applicable. There are five categories that require SSA to send a MAP-527.  These forms are faxed and/or mailed in to our department.  We then manually input a medical card based on those months of SSI eligibility.
• New approval with emergency medical need (not completed on newly approved disability cases).
• Transfer of SSI claimant into Kentucky.
• Authorization due to hearing decision.
• Request for Medicaid due to computer limitations.
• Authorization due to death of applicant.
• Responsible for the form used by Long Term Care (LTC) facilities, Home and Community Based Services (HCBS) agencies and AIS/MR agencies to notify DCBS staff of a client’s admission, discharge or death.  Also is used for informational purposes only for Medicaid (Title XIX) covered individuals in an NF, ICF/MR/DD or Mental Psychiatric hospital.

Case Processing Section Responsibilities

• Reviews case material and determines ongoing eligibility and coordinates exchange of information between agencies
• Coordinates the exchange of information between Fiduciary Services and the Case Processing Section for guardianship clients in the State Supplementation Program.
• Coordinates the Med-Yes Program which determines retroactive MA eligibility for SSI recipients.
• Processes the applications for Med-Yes through use of form PA-11, to determine eligibility for retroactive medical assistance in the Med-Yes Program.
• Issues SSI emergency medical cards on a statewide basis.  All medical cards are loaded to KAMES Special Circumstance Program.

Technical Support Section Responsibilities

The Technical Support Section is responsible for assisting field staff, recipients, the Department for Medicaid Services, and other agencies with technical assistance and/or questions regarding Medicaid and refers calls to the appropriate section.

• Buy-Ins. Buy-In coverage includes all individuals eligible to enroll in  Medicare who are receiving or are eligible for a category of assistance under Medicaid. The client must apply to the local Medicaid office for Buy-In benefits. The Technical Support Section Medicaid worker must submit a PA-1Q, Buy-In Accrete/Delete/Restoration Request, to the Medical Support and Benefits Branch.
• Replacement letters for Medical cards are issued for prior months card.  This verifies coverage for MA during previous months. Duplicate Medical cards are issued for current month, if card is lost, stolen or  destroyed.
• Responsible for answering the phones for the entire Branch and ensuring calls are given the correct person as well as processing KENPAC Special Assignments.
• Division mailroom, including the distribution of all outgoing mail to all Service Regions and counties statewide including listings, correspondences, manual materials, clarifications to field staff, forward returned mail to appropriate counties as identified.
• Recreates and generates auto notices damaged in the mailing process.