Ongoing Case Management
Applications require both an integrated case and a product delivery to complete the delivery of services and benefits to clients.
- Create Integrated Case
Following the authorization of programs on an application case, an Insurance Affordability integrated case is created. - Evidence Brokering
Following the creation of the Insurance Affordability integrated case, the application case evidence is automatically accepted and activated onto the integrated case. The Evidence Broker configurations that are used in Health Care Reform allows evidence to be automatically accepted and activated on the integrated case. Evidence broker configurations where the evidence is not automatically accepted and activated onto the integrated case/application case are shown in the following paragraphs. - Run Program Group Logic and Activate Product Delivery Cases
Following successful program authorization and creation (or reuse) of an integrated case, program group logic is run on the integrated case to determine the set of eligible programs and the citizens who receive these programs - Generate Communications
Cúram Health Care Reform provides for a basic set of communications, primarily to notify the applicant or current enrollee of an eligibility determination. The notification for eligibility determination varies depending on whether outstanding verifications remain that are associated with the application. - Viewing Eligibility
After the program group logic is run and the product delivery cases are active, you can view eligibility details by using the Eligibility Viewer (EV) on both the Integrated Case and Person or through the product delivery case decisions. - Viewing Product Delivery Decisions
Decision screens are available that display the results of an eligibility decision for each insurance affordability program. These screens provide a detailed overview of the eligibility decision for each household member in a product delivery case. - Check Retroactive Eligibility
Use this information to understand how to run an eligibility check for Retroactive Medicaid that uses the evidence that is active on an Insurance Affordability integrated case. - Income Support Caseworker Role
A case worker might need to manage applications and cases that combine Insurance Affordability and traditional Medicaid, Food Assistance, or Cash Assistance programs. While Cúram Health Care Reform and Income Support have distinct business processes, a caseworker can manage all applications and cases through a single workspace with the IS Case Worker role. The IS Case Worker role combines the HCR Case Worker and IS Eligibility Worker roles. By using the IS Case Worker role, a caseworker can work on applications and cases that previously needed to be done separately by the two roles.