DDSD Application Pending for Approval

Case Situation

40 year-old female who currently receives MAGI MC, claims to be disabled. The completed DDSD referral packet was received and referred. The EW completed all relevant Data Collection pages. When decision was received from DDSD granting “disabled”, EW updated the disability status in CalSAWS. The client remains MAGI MC eligible.

Refer to CalSAWS "Job Aid (JA) Medical Condition Detail - Disabled,  or SP-DDSD", for additional DDSD processing instructions.

Note: If the client is ineligible for MAGI MC, Non-MAGI MC must be evaluated.

1. On the Medical Condition List page:
   1. Select Declared from the Medical Condition Category drop down list.
   2. Click the Add button.
2. On the Medical Condition Detail page, complete the DDSD referral information:
   1. Select the appropriate Change Reason from the Change Reason drop down list.
   2. Enter the Date in Reported Date field.
   3. Select Name from the Name drop down list.
   4. Select Status from the Verified drop down list (This Verified drop down list refers to the receipt of verification of the medical condition and will populate the Verification List page if left in Pending status. For example: Customer provides an SSA Award letter or completes the CW 61).
   5. Select Type from the Medical Condition Type drop down list.
3. In the SP-DDSD Application Status section of the page:
   1. Select Status from the Status drop down list.
   2. Enter Date in the Begin Date failed. 
4. Click the Save and Return button.
5. These steps are used when the DDSD decision is received. In this case example, DDSD decision is granted as “disabled”:
   1. Edit the original Medical Condition Detail record and add a Status of Disability Approved with the appropriate Begin and End Dates.
   2. Add a new Medical Condition Detail record.
   3. On the Medical Condition List page:
      1. Select Active from the Medical Condition Category drop down list.
      2. Click the Add button.
   4. On the Medical Condition Detail page:
      1. Select the Change Reason from the Change Reason drop down list.
      2. Enter the Date in the Reported Date field.
      3. Select the Medical Condition Type according to DDSD decision and enter the Begin Date for the Type.
      4. Select the appropriate answer to all mandatory questions. 
      5. Click Save and Return.
6. Complete other Data Collection pages relevant to the case.
7. Run EBDC review and Accept and Save the expected results. In this case example, the client continues to be MAGI MC eligible. (If the client is ineligible for MAGI MC and the EW clears Non-MAGI MC eligibility, Non-MAGI MC result should display).

Transactions Generated by CalSAWS to MEDS

Modify (EW25) transaction is sent to MEDS to update case information as the Aid Code is unchanged. If Non-MAGI MC is approved, CalSAWS will send the EW 20 transaction to add eligibility to MEDS for future month.

Related Topics

HCBS-DD (SARC) Waiver Program Approval

LTC Approval for Medically Indigent Individual (Aid Code 53)

LTC with Community Spouse Approval

Medi-Cal Approval with Hunt v. Kizer SOC Adjustment

Medi-Cal Special Treatment Program (MSTP) Approval

Minor Consent Approval

Minor Consent Renewal

Non-MAGI Approval - Aged

Non-MAGI Approval - Disabled