FM03b: Medicaid Eligibility - University of South Floridacenterforchildwelfare.fmhi.usf.edu/kb/RevMax/Eligibility_Medicaid... · FM03b-Medicaid Eligibility January 07, 2012 Topic

FM03b: Medicaid Eligibility

January 07, 2012

Florida Safe Families Network

FM03b-Medicaid Eligibility January 07, 2012 Topic Paper Page 2 of 63

Table of Contents 1.1. INTRODUCTION............................................................................................................................................4 1.2. PAGE – MEDICAID ELIGIBILITY SUMMARY TAB ..........................................................................................6

1.2.1. Summary Tab Overview.........................................................................................................................6 1.2.2. Page Information...................................................................................................................................7 1.2.3. Background Processing .......................................................................................................................12 1.2.4. Save Processing...................................................................................................................................14 1.2.5. CRUD Matrix ......................................................................................................................................14

1.3. POP-UP PAGE – INITIATE ACTION ..............................................................................................................16 1.3.1. Pop-up Page Overview........................................................................................................................16 1.3.2. Page Information.................................................................................................................................17 1.3.3. Background Processing .......................................................................................................................23 1.3.4. Save Processing...................................................................................................................................26 1.3.5. CRUD Matrix ......................................................................................................................................27

1.4. TAB – FLORIDA ......................................................................................................................................28 1.4.1. FLORIDA Tab Overview .....................................................................................................................28 1.4.2. Page Information.................................................................................................................................29 1.4.3. Background Processing .......................................................................................................................46 1.4.4. Save Processing...................................................................................................................................46 1.4.5. CRUD Matrix ......................................................................................................................................47

1.5. POP-UP PAGE – CITIZENSHIP DETAILS ......................................................................................................48 1.5.1. Page Information.................................................................................................................................49 1.5.2. Background Processing .......................................................................................................................49 1.5.3. Save Processing...................................................................................................................................50 1.5.4. CRUD Matrix ......................................................................................................................................50

1.6. POP-UP PAGE – FL ODS SEARCH ..............................................................................................................51 1.6.1. FL ODS Search Pop-up Page Overview .............................................................................................51 1.6.2. Page Information.................................................................................................................................52 1.6.3. Background Processing .......................................................................................................................54 1.6.4. Save Processing...................................................................................................................................55 1.6.5. CRUD Matrix ......................................................................................................................................55

1.7. POP-UP PAGE – FL CASE DETAILS.............................................................................................................56 1.7.1. FL ODS Search Details Pop-up Page Overview .................................................................................56 1.7.2. Page Information.................................................................................................................................56 1.7.3. Background Processing .......................................................................................................................58 1.7.4. Save Processing...................................................................................................................................58

1.8. INVENTORIES.............................................................................................................................................58 1.8.1. Table Descriptions...............................................................................................................................58 1.8.2. Reference Data ....................................................................................................................................60 1.8.3. Dropdowns...........................................................................................................................................61 1.8.4. List Boxes.............................................................................................................................................62 1.8.5. Automated Messages ...........................................................................................................................62

1.8.5.1. FLORIDA Status Information Return........................................................................................................ 62 1.8.6. Checklists.............................................................................................................................................63 1.8.7. Ticklers ................................................................................................................................................63 1.8.8. Notifications.........................................................................................................................................63 1.8.9. Text Templates .....................................................................................................................................63 1.8.10. Reports ............................................................................................................................................63



1.8.11. Triggers...........................................................................................................................................63 1.9. BATCH PROGRAMS ....................................................................................................................................63

1.9.1. None.....................................................................................................................................................63 1.10. REQUIREMENTS.........................................................................................................................................63

1.10.1. FME – 001 ......................................................................................................................................63 1.10.2. FME – 002 ......................................................................................................................................63 1.10.3. FME- 003........................................................................................................................................63 1.10.4. FME-004.........................................................................................................................................63



1.1. Introduction The FM03b: Medicaid Eligibility, module will support a two way interface between Florida Safe Families Network (FSFN) and the FLORIDA System for Medicaid Eligibility determinations. Data will be transmitted to the FLORIDA System in an electronic format modeled after three State approved forms. The forms are as follows: Child In Care Title IV-E and Medicaid Application (2626A), Child In Care Medicaid Application (2293), and Child In Care Eligibility Review and Change Report Form (2694). Note that Child in Care Medicaid Application (2293) is a subset of Child In Care Title IV-E and Medicaid Application (2626A). If the record transmitted to FLORIDA is Medicaid Only, then Child In Care Medicaid Application (2293) is not required. A Medicaid Eligibility page will be created for children in licensed care after ‘Refer to CIC’ is selected from the Options dropdown in the Title IV-E Foster Care Eligibility module. The page can be created in two ways. The first is upon selecting ‘Refer to CIC’ from the Options dropdown in the Title IV-E Foster Care Eligibility module. The second is an authorized user creates a Medicaid Eligibility record manually by selecting the Financial Work icon on the Banner Bar of the users desktop, then selecting ‘Medicaid Eligibility’ from the ‘Eligibility’ dropdown of the Create Financial Work page. Authorized users with an assignment to the case will be able to launch the Medicaid Eligibility page in ‘Edit Mode’ by expanding the case icon on the desktop and selecting the Medicaid Eligibility record. Users with an assignment to case who have view-only access will only be able to launch the page in ‘View-Only Mode’. Authorized users will also be able to access and edit the Medicaid Eligibility records through the Financial Work icon, on the Banner Bar. They will select ‘Medicaid Eligibility’ from the ‘Eligibility’ dropdown of the Create Financial Work page. This module contains the Summary tab, FLORIDA tab, Medicaid Certification Pop-up page, Citizenship Details Pop-up page, FL ODS Search Pop-up page, and the FL Case Details Pop-Up page. Selecting an action on the Medicaid Certification Pop-up Page will determine what information is sent to the FLORIDA System through the FLORIDA Interface.

Before a Medicaid Application can be submitted to the FLORIDA System a search for the FSFN participant’s demographics must be conducted against data in the FLORIDA Operational Data Store (FL ODS), which is nightly updated data store of the Public Assistance data from the FLORIDA System. This search will be initiated by the user to determine if the selected participant exists in the FLORIDA System. If the participant does exist in FL ODS, the user can select that returned search result to associate with the FSFN participant. The selected search result will be stored in FSFN and used by the FLORIDA Interface in communications with the FLORIDA System. If a user does not find a match in FL ODS then the user will be able to submit the FSFN participant as a new person to the FLORIDA System or initiate a Request CIC Intervention transaction. A request for Child In



Care (CIC) intervention will directly transmit the eligibility information to the CIC worker prompting the user to enter the data into the FLORIDA System manually.

After a search has been conducted, the eligibility application is submitted to the FLORIDA System by selecting the ‘Submit to FLORIDA’ from the Options dropdown on the Medicaid Eligibility page. This will designate to FSFN that this eligibility record is ready to be processed through the FLORIDA Interface to the FLORIDA System where a Medicaid determination will be made. The completion of the Void and Termination process will not be submitted to FLORIDA through the FLORIDA interface.

The FLORIDA Interface will also place entries into the ‘Work Manager’ queue of the CIC worker to notify them that a Medicaid Eligibility review and approval are needed.

Once the CIC worker has approved or denied benefits for the submitted Medicaid Eligibility record, the data will be returned to FSFN through a nightly batch process. These values include ‘Program Type’, ‘Medicaid Number’, ‘FLORIDA Case Number’, ‘Status’, and ‘Eligibility Review Date’. The worker that completed the Submission to FLORIDA will receive an automated message identifying the status of the record that was sent and the status of the record returned. The returned data will be displayed in the ‘Medicaid Eligibility History’ group box on the ‘Summary’ tab of Medicaid Eligibility page. (For topic specific details refer to the IN15 FLORIDA Interface Topic Paper.)



1.2. Page – Medicaid Eligibility Summary Tab

1.2.1. Summary Tab Overview

The Medicaid Eligibility page can be accessed by choosing the ‘Medicaid Eligibility’ value in the ‘Eligibility’ dropdown on the Create Financial Work page or expanding the case icon on the user’s desktop. For children who did not go through the Title IV-E Eligibility Determination process, authorized users can create a Medicaid Eligibility Determination request manually by selecting the Financial Work icon in the banner bar to launch the Create Financial Work page. The Create Financial Work page will launch, the user will select ‘Medicaid Eligibility’ from the ‘Eligibility’ dropdown.

On the Medicaid Eligibility page, the user will use the ‘Search’ hyperlink in the ‘Basic Header’ group box to search for the child using the Person Search page. In the Person Search page Persons Returned group box, the user will expand the ‘Person’ icon, and then expand the ‘Case’ icon to display all the cases for that participant. The user will then select the radio button for the case to which this Medicaid Eligibility record should belong and click the ‘Continue’ button to create or update the Medicaid Eligibility record.



The ‘Basic Header’ group box will pre-fill with the ‘Child Name’, ‘Case Name’, ‘SSN’, ‘FSFN Person ID’, ‘DOB’ ‘Current Medicaid Number’, and ‘FLORIDA Case Number’ once it is returned from the FLORIDA System.

The ‘Eligibility Information’ group box will pre-fill if applicable with the child’s ‘Last IV-E Determination Date’, ‘IV-E Eligibility Status’, ‘Child Receives Medicaid Assistance’ ‘Child Receives SSI’, the ‘Adoption IV-E Status’, ‘Last IV-E Adoption Determination Date’, and the ‘Adoptions Assistance State’.

The user will click the ‘Insert’ button to launch the Medicaid Certification Pop-up page. Once the Medicaid Certification page has been saved the user can select Submit to Florida from the Options dropdown, this will initiate the FLORIDA Interface. Note: The completion of the Void and Termination process will not be submitted to FLORIDA through the FLORIDA interface.

1.2.2. Page Information

Box: Basic Header

Fields: Child Name: The name of the participant selected on the Person Search page; System derived; Not user editable.

Case Name: The case name of the participant selected from the Person search page (Last name, first name, middle initial); System derived; Not user editable.

SSN: Social security number of the participant selected from the Person Search page; System derived; Not user editable.

DOB: The date of birth of the child; System derived; Not user editable.

Current Medicaid Number: This field will display the ‘Primary Medicaid Number’

recorded in the Person Management record, if no ‘Primary Medicaid Number’ exists in the Person Management record this field will be blank on the first launching of the Medicaid Eligibility page. This field will be updated by the ‘FLORIDA Interface’ batch process, and will contain the



‘Medicaid Number’ once it has been determined by the ‘FLORIDA System’; System Derived; Not user editable.

FLORIDA Case Number: This field is updated by the FLORIDA Interface, and will

contain the FLORIDA Case Number for the selected participant once determined by the FLORIDA System; Not user editable.

Request CIC Intervention: This check box designates that the ‘Medicaid Eligibility

Determination’ information will be sent to the ‘CIC’worker through the ‘Work Manager’ queue, to be processed manually. This check box only becomes enabled after the Medicaid Certification Pop-up page has been saved and closed; User selected; Not required.

FSFN Person ID: The unique system identifier for the selected child; System

derived; Not user editable.

Date/Time Submitted to FLORIDA:

The Date and time field will display the date and time that the eligibility determination was submitted to the FLORIDA. This field will be populated upon save, when the user who submits the record selects Submit to FLORIDA from the Options dropdown of the Medicaid Eligibility Determination page. System derived; Not user editable.

Date/Time Received from FLORIDA:

A Date and time field will display the date and time that the eligibility determination was returned from the FLORIDA system. System derived; Not user editable.

Box: Eligibility Information

Fields: Last IV-E Determination Date: The date when ‘Refer to CIC’ was selected for the most

recent Title IV-E Foster Care Eligibility Determination; System derived from the most recent Title IV-E Foster Care Eligibility Determination record that does not have a



‘Pending’ status and is not voided, if no record exists then this field will be blank; this will pull the ‘Screening Completed’ date on the most recent Title IV-E Foster Care Eligibility record. Not user editable.

IV-E Eligibility Status: Displays the most recent Title IV-E Foster Care Eligibility

Determination status of a record that has ‘Refer to CIC’ selected and is not ‘Voided’, status values are: ‘Eligible and Reimbursable’; ‘Eligible and Non-reimbursable’; ‘Ineligible’; if no Title IV-E Eligibility Determination exists this field will be blank; Not user editable.

Child Receives Medicaid Assistance: Indicates if the child receives Medicaid assistance. This

check box is updated by the FLORIDA Interface if the status of the Medicaid Eligibility is ‘Approved’ the check box will be checked; if the status is ‘Denied’ or ‘Pending’ the box will remain unchecked; Not user editable. AFCARS Value.

Child Receives SSI: Indicates if the child receives SSI based on the most recent

Title IV-E Foster Care Eligibility Determination not in a pending status; System derived based on Question 10 of the most recent Title IV-E Foster Care Initial Eligibility Determination not in a ‘Pending’ status or Question 6 on the most recent Title IV-E Foster Care Eligibility Redetermination not in a ‘Pending’ status, if these records do not exist at time of page creation then the check box will remain unchecked; Not user editable.

Last IV-E Adoption Determination Date: The date when the most recent Title IV-E Adoption

Eligibility Review was set to Approved or Saved System derived from most recent Title IV-E Adoption Eligibility Determination record that is not in a ‘Pending’ status, if no record exists at time of page creation than the field will remain blank; Not user editable.

Adoption IV-E Eligibility Status: Displays the most recent Title IV-E Adoption Eligibility

Determination Status, Eligible; Ineligible. If a Title IV-E Adoption Eligibility Determination does not exist the field will remain blank; Not user editable.



Adoption Assistance State: State where the child receives Adoption Assistance;

dropdown; User editable; Not required; Defaults to ‘Florida’.

Box: Medicaid Eligibility History

Fields: Action: The eligibility action that was selected on the Medicaid Certification Pop-up page for a selected row; values include ‘Initial’, ‘Redetermination’, ‘Change’, ‘Card Request’, and ‘Close’; Not user editable; No default value.

Program Type: Designates the approved Medicaid Assistance Group for the child; returned from the FLORIDA Interface; Not user editable; No default value.

Medicaid Number: Displays the Medicaid Number returned by the FLORIDA Interface; Not user editable; No default value.

FLORIDA Case Number: Displays the FLORIDA Case Number returned from the

FLORIDA Interface; Not user editable; No default value.

Status: Displays the status of the Medicaid Application, ‘Pending’, ‘Initiated’, ‘Submitted’, ‘Approved’, ‘Denied’, or ‘Contact CIC Worker’. ‘Pending’ will display after the Medicaid Certification Pop-up page is ‘saved’ until the ‘Submit to FLORIDA’ option is selected from the Options dropdown, Initiated will display during the interfacing process with the FLORIDA System, once the interface has completed the status will be updated to ‘Submitted’, after the CIC worker has approved the Medicaid Eligibility record the status will be updated through a nightly batch process to ‘Approved’ or ‘Denied’, if the record fails in its submission to the ‘Work Manager’ queue the status will be updated to ‘Contact CIC worker’; Not user editable; No Default value.



Eligibility From: Designates the ‘Eligibility From’ date of the eligibility period; System derived from the ‘Eligibility From’ on the Medicaid Certification Pop-up page; Not user editable.

Eligibility Review Date: Designates the date of Annual Eligibility Review; returned

by the FLORIDA Interface; Not user editable; No default value.

Request CIC Intervention: Designates if Request CIC Intervention check box was

checked; the values are ‘Yes’ and ‘No’; Not user editable; No default value.

Close Date: The date that the Medicaid Eligibility record was closed;

returned by the FLORIDA Interface, Not user editable; No default value.

Submitted to FLORIDA by: The worker who selected ‘Submit to FLORIDA’ option

from the Options dropdown; Not user editable; No default value. The completion of the Void and Termination process will not be submitted to FLORIDA through the FLORIDA interface. (For details see IN15 Florida Interface Topic Paper)

Links: Search: Navigates the user to the Person Search Page where the

user would search for the participant for whom this Medicaid record is being created. Once a participant is selected the appropriate fields are pre-filled on the Medicaid Eligibility Page. If a record already exists in the case for this participant, the ‘Medicaid Eligibility History’ group box will pre-fill with a history of past Medicaid Eligibility transactions.

Edit: Navigates the user to the Medicaid Certification Pop–up page for the Medicaid Eligibility instance selected in the ‘Medicaid Eligibility History’ group box; displays until the ‘Submit to FLORIDA’ option has been selected from the Options dropdown.



View: Navigates the user to the Medicaid Certification Pop–up page for the instance selected in the ‘Medicaid Eligibility History’ group box in View-only mode, displays after the ‘Submit to FLORIDA’ option has been selected from the Options dropdown.

Options: Submit to Florida: This option will be available to authorized users who can access the Medicaid Eligibility page. It will only display in the Options dropdown once the Medicaid Certification Pop-up has been saved.

Buttons: Insert: Creates a Medicaid Certifications Pop-up page, this button will be disabled if there is a record that has been submitted to the FLORIDA System and no FLORIDA Case Number has been returned from the FLORIDA Interface.

Save: Standard Save processing.

Close: Standard close processing.

1.2.3. Background Processing

1. If there is a Title IV-E Foster Care Eligibility Determination available in FSFN, then the ‘Last IV-E Determination Date’ field will pre-fill with the most recent Title IV-E Foster Care Eligibility Determination that has the ‘Refer to CIC’ flag set to Y.

2. If there is a Title IV-E Eligibility Determination in FSFN, then the system pre-fills with the most recent ‘IV-E Eligibility Status’ of the record that is not pending and has the ‘Refer to CIC’ flag set to Y. If there is not a Title IV-E Eligibility Determination record at the time of page creation the ‘IV–E Eligibility Status’ will be blank.

3. If the Medicaid Eligibility page is manually created or if a Title IV-E Determination is voided the ‘IV–E Eligibility Status' will default blank.

4. If there is a Title IV-E Adoption Eligibility Determination available in FSFN, then the ‘Last IV-E Adoption Determination Date’ field will pre-fill with the date from the most recent Title IV-E Adoption Eligibility Determination that does not have a ‘Pending’ status.

5. If there is a Title IV-E Adoption Eligibility Determination that has the ‘Refer to CIC’ flag set to Y in FSFN, then the system pre-fills the appropriate eligibility status as recorded on the most recent Title IV-E Adoption Eligibility Determination that does not have a ’Pending’ status. If no ‘Adoption IV-E Eligibility Status’ field will be blank.



6. The ‘Medicaid Eligibility History’ group box displays a running history of all Medicaid Eligibility transaction that have been initiated for the selected participant. The records will display in reverse chronological order based on the date the transaction was initiated.

7. If a Title IV-E Eligibility Determination exist, check Question 10 on the most recent Title IV-E Initial Eligibility Determination or Question 6 on the most recent Title IV-E Redetermination not in a ‘Pending’ status; if ‘Yes’, then the system pre-fills the ‘Child Receives SSI’ check box; if ‘No’ then the check box will remain unchecked.

8. The ‘Insert’ button will be disabled if a Medicaid Eligibility record has been submitted to the FLORIDA System and the FLORIDA Case Number has not been returned.

a. The Status of the record must also be ‘Approved’ or ‘Denied’ before the insert button becomes enabled.

9. The ‘Program Type’, ‘Medicaid Number’, ‘FLORIDA Case Number’, ‘Status’, ‘Eligibility Review Date’, and ‘Close Date’ (if applicable) will be updated by the FLORIDA Interface batch process.

10. If ‘Submit to FLORIDA’ option is selected from the Options dropdown and ‘Request CIC Intervention’ is checked in the ’Basic Header’ group box the user will receive an edit message ‘The eligibility data will be transmitted to a CIC worker for manual entry into the FLORIDA System. Do you want to Continue Yes or No buttons?’ if ‘Yes’ the record will be submitted to the CIC ‘Work Manager’ queue and the user will be returned to the desktop, if ‘No’ the user will be returned to the Medicaid Eligibility page.

11. Once ‘Submit to FLORIDA’ has been selected from the Options dropdown the Medicaid Certification Pop-up page will be frozen and not user editable and the link in the Medicaid History page should display ‘View’ hyperlink.

12. The ‘Submit to FLORIDA’ option in the Options dropdown will only be available to authorized users after the Medicaid Certification Pop-up page has been launched and an action has been selected and saved.

13. When the ‘Submit to FLORIDA’ option in the Options dropdown and ‘Go’ is selected the user will be presented with this message ‘I certify under penalty of perjury that the information on this form is true to the best of my knowledge, including the citizen or noncitizen status of those who are applying for benefits.’ with ‘Yes’ or ‘No’ buttons. If the ‘Yes’ button is selected then the ‘Submit to FLORIDA’ action will be initiated and the user will be returned to the Medicaid Eligibility Page with a disabled ‘Save’ button, if ‘No’ is selected the user will be returned to Medicaid Eligibility page.

14. An automated message will be generated when there is not a relationship documented for the participants included in the submission. The submission cannot be complete until the relationship is entered on the relationship tab of the case before the submission is successful.

15. When information is returned from FLORIDA for each FSFN submission, an Automated Message will be generated and sent to the worker that completed the Submission to FLORIDA. The message would identify the status of the record that was sent and the status



of the record returned. The message will read: “Eligibility XXXX [Program Code] with Eligibility Status XXXXX [FSFN Eligibility Status], which you submitted to FLORIDA on XXXXX[mm/dd/yyyy] for person ID [XXXXX] in case ID [XXXXX] was XXXXX [Submission Status] with Eligibility XXXX[Program Code] on XXXXX [mm/dd/yyyy].

16. When Medicaid number is returned from FLORIDA the number will update the child’s person management record as the primary number. If the number returned from the interface matches the umber that is already designated as the primary number no update will be made. If the number returned from the interface does not match the existing number in person management it will be updated to secondary Medicaid number and the number returned from the interface batch will be inserted into the child’s person management record as the primary number.

17. Medicaid Eligibility cannot be created in closed cases. If the user attempts to create a Medicaid Eligibility in a closed case they will receive this message “Medicaid Eligibility cannot be created for Closed Case. Please search from Open Case”.

18. The completion of the Void and Termination process will not be submitted to FLORIDA through the FLORIDA interface.

1.2.4. Save Processing

1. When the page is saved if ‘Request CIC Intervention’ is checked, then the ‘Medicaid Eligibility History’ group box displays ‘Request CIC Intervention’ as ‘Yes’, and the ‘Request CIC Intervention’ check box is unchecked on the refreshed page.

2. Save processing is initiated by clicking on the ‘Save’ button. Save processing is also initiated when selecting the ‘Close’ button, and then answering ‘Yes’ when the system asks the user if they would like to ‘Save changes before closing the page.’

3. Cases with a Title IV-E Eligibility that has the ‘Refer to CIC’ flag set to Y must have at least one custodian/specified relative identified when the ‘Submit to FLORIDA’ option is selected from the Options dropdown. If one custodian/specified relative is not identified the user will receive this message ‘The FLORIDA System requires at least one adult to be submitted with this record’.

1.2.5. CRUD Matrix

Table CRUD

MEDICAID_ELIGIBILITY CRU

FLORIDA_ELIGIBILITY CRU

MEDICAID_CERT CRU



Table CRUD

FLORIDA_PART CRU

ELIGIBILITY R

ELIG_REDET R

ADOPTION_ELIG R

PERSON R

CASE_MASTER R

CASE_PART R

PERSON_IDENTIFICATION R

ADDRESS R

ORG_WORKER_ROLE R



1.3. Pop-up Page – Initiate Action

1.3.1. Pop-up Page Overview

A new Initiate Action Pop-up page will be created by clicking the ‘Insert’ button on the ‘Summary’ tab of the Medicaid Eligibility page. This pop-up page can also be accessed in edit mode by selecting the ‘Edit’ hyperlink associated to a Medicaid record before it is submitted to the FLORIDA System or in view-only mode by selecting the ‘View’ hyperlink for previously submitted Medicaid Eligibility records.

Once on the Initiate Action Pop-up page the user can select an action of ‘Initial’, ‘Redetermination’, ‘Change’, ‘Card Request’, or ‘Close’. These actions determine what transaction will be invoked by the FLORIDA Interface, and what information will be transmitted through the FLORIDA Interface to the FLORIDA System. If the user attempts to select the options of ‘Redetermination’, ‘Change’, ‘Card Request’, or ‘Close’ and an ‘Initial’ has not been submitted to the FLORIDA system and a FLORIDA Case Number has been returned by the batch they will receive a validation message. The validation message is as follows “Please complete an Initial transaction and submit to the FLORIDA system, a



FLORIDA case number must be returned from the FLORIDA system prior to selecting <Selected Action>.”

This pop-up page will display the worker who created the record, the date created, the date this record was submitted to the FLORIDA System, the user who submitted the record to the FLORIDA System, the circuit and name of the CIC worker the record was submitted to, ‘Eligibility From’, ‘Closure Reasons’, ‘Placement Address’ and the ‘Notification Address’.

The ‘Placement Address’ will display the provider’s address of the of the child’s current placement. The ‘Notification Address’ will pre-fill with the address of the eligibility worker who created the page. These address fields will be disabled unless the ’If checked all notifications will be sent to this address’ check box is checked. The ‘Medicaid Number’, ‘Eligibility Review Date’, and ‘Closure Date’ will be updated by the FLORIDA Interface.

.


Box: Eligibility Information

Fields: Action: Determines the action to be taken by the FLORIDA Interface and what data will be transmitted through the FLORIDA Interface to the FLORIDA System; radio buttons with the options of ‘Initial’, ‘Redetermination’, ‘Change’, ‘Card Request’, and ‘Close’; User selected; Required; Defaults to ‘Initial’.

Created By: This field will display the user who selected the ‘Insert’ button to create the Initiate Action pop-up page; System derived from the user who clicked the ‘Insert’ button; Not user editable.

Date Created: Will display the date the page was launched; Not user editable; Defaults to the system date when the ‘Insert’ button is clicked.

Submitted By: This field will display the user who selected ‘Submit to

FLORIDA’ from the Options dropdown on the Medicaid Eligibility page; Not user editable; Defaults to the name of the user that clicked the ‘Insert’ button.



Date Submitted: Will display the date the ‘Submit to FLORIDA’ option was selected from the Option dropdown on the Medicaid Eligibility page; Not user editable; Default to the system date when the Submit to FLORIDA option is selected.

Medicaid Number: Displays the Medicaid Number returned by the FLORIDA Interface; Not user editable; Not required; No default value.

Eligibility From: Designates the effective begin date of eligibility period; System derived from the ‘Removal Begin Date’ field on the Removal/Placement tab of the Out of Home Placement page, if a placement does not exist the field will be blank; User editable; Required. The date entered must be equal to or after the Eligibility From date of the Initial submission.

Eligibility Review Date: Designates the date of Annual Eligibility Review will be

due; returned by the FLORIDA Interface; Not user editable; No default value.

Submit 5146: Checkbox enabled when an approved and non-voided or

terminated Adoption IV-E Eligibility exists within the case for the child. Designates if the 5146 Adoption Subsidy Title IV-E Eligibility Screening Worksheet will be sent in redetermination transactions when the Submit 5146 checkbox is checked; If the 5146 Adoption Subsidy Title IV-E Eligibility Screening Worksheet exist for an approved and non-voided and non-terminated adoption eligibility at the time the Initiate Action pop-up page is launched the checkbox will default to checked. If it does not exist at the time the Initiate Action pop-up page is launched the checkbox will default to unchecked; user editable;.

Closure Date: The date that the ‘Close’ action was initiated in FSFN;

Conditionally enabled and required if the ‘Close’ action is selected; No default value.

Closure Reason: This field will display the reason for the closure of this eligibility record; Conditionally enabled and required if the ‘Close’ action is selected; No default value.



Denial Reason: This field will display the denial reason that is returned

from the FLORIDA system through the FLORIDA Interface; Not user editable; No default.

Box: Select a CIC Worker: Fields: Circuit: Designates the circuit of the CIC worker to whom this

Medicaid Eligibility record will be submitted; User selected dropdown; No default value; Required.

CIC Worker: Designates the name of the CIC worker to whom this

Medicaid Eligibility record will be submitted; User editable; conditionally required once Circuit is selected if CIC Supervisor has not been selected; No default value.

CIC Supervisor: Designates the name of the CIC supervisor to whom this

Medicaid Eligibility record will be submitted; User selected dropdown; conditionally required once Circuit is selected if CIC worker has not been selected;; No default value.

Box: Placement Address

Fields: Street/PO Box/ Route: Displays the type of address of the child’s placement;

System derived from the address type of the provider of the most recent placement; User editable; Required.

Street: Street name and number of the provider of the child’s most

recent placement; System derived from the provider of the child’s most recent placement; User editable; Conditionally enabled and required if Street/PO Box/Route = Street. (FLORIDA System field size Street Number 7 and Street Name 20; FSFN size Street Number 13 and Street Name 25)

Unit Designator: Unit Designator of the provider of the child’s most recent placement; System derived from the provider of the child’s most recent placement; User editable; Conditionally enabled if Street/PO Box/Route = Street and Not required.



Unit Designator Number: Unit Designator Number of the provider of the child’s most

recent placement; System derived from the provider of the child’s most recent placement; User editable; Conditionally enabled if Street/PO Box/Route = Street and Not required. (FLORIDA System field size 5; FSFN field size 15)

PO Box: The PO Box number of the provider of the child’s most recent placement; System derived from the provider of the child’s most recent placement; User editable; Conditionally enabled and required if Street/PO Box/Route = PO Box.

Route: Route name and number of the provider of the child’s most recent placement; System derived from provider of the child’s most recent placement; User editable; Conditionally enabled and required if Street/PO Box/Route = Route.

City: City of the provider of the child’s most recent placement; System derived from the City of the provider’s address of the child’s most recent placement; User editable; Required. (FLORIDA System field size 15; FSFN field size 40)

State: State of the provider of the child’s most recent placement; System derived from the provider‘s address of the child’s most recent placement User editable; Required.

Zip: Zip code of the provider of the child’s most recent placement; System derived from the zip code of the provider’s address of the child’s most recent placement. User editable; Required.

Phone: Phone Number of the Placement address; User entered; Required; No default value.

Box: Notification Address

Fields: Street/PO Box/



Route: Displays the type of address; User editable if ‘If checked all notifications will be sent to this address’ check box is checked; Required; Default to Street.

Street: Street name and number of the Notification Address;

System derived from the unit of the worker who created this page; User editable if ‘If checked all notifications will be sent to this address’ check box is checked; Conditionally enabled and required if Street/PO Box/Route = Street;. (FLORIDA System field size Street Number 7 and Street Name 20; FSFN size Street Number 13 and Street Name 25)

Unit Designator: Unit Designator of the Notification Address; User editable if ‘If checked all notifications will be sent to this address’ check box is checked; Conditionally enabled if Street/PO Box/Route = Street and not required; No default value.

Unit Designator Number: Unit Designator Number of the Notification Address; User

editable if ‘If checked all notifications will be sent to this address’ check box is checked; Conditionally enabled if Street/PO Box/Route = Street and not required; No default value.. (FLORIDA System field size 5; FSFN field size 15)

PO Box: The PO Box number of the Notification Address; User editable if ‘If checked all notifications will be sent to this address’ check box is checked; Conditionally enabled and required if Street/PO Box/Route = PO Box; No default value.

Route: Route name and number of the Notification Address; User editable if ‘If checked all notifications will be sent to this address’ check box is checked; Conditionally enabled and required if Street/PO Box/Route = Route; No default value.

City: City of the Notification Address; System derived from the unit address of the worker that created this page; User editable if ‘If checked all notifications will be sent to this



address’ check box is checked; Required. (FLORIDA System field size 15; FSFN field size 40)

State: State of the Notification Address; System derived from the unit address of the worker that created this page; User editable if ‘If checked all notifications will be sent to this address’ check box is checked; Required.

Zip: Zip code of the Notification Address; System derived from the unit address of the worker that created this page; User editable if ‘If checked all notifications will be sent to this address’ check box is checked; Required.

Phone: Phone Number of the worker who created this page; User editable if ‘If checked all notifications will be sent to this address’ check box is checked; Required; No default value.

Expando: Comments: Text field with a maximum of 4000 characters, User

Entered, Not Required

Options: Child In Care Medicaid and Title IV-E Application -2626A: Accesses the Child In Care Medicaid and Title IV-E

Application-2626A template. This template has no user entered fields. This template will no longer be updated once the application has been ‘Submitted to FLORIDA’. When the action selected on the Initiate Action page is ‘Initial’ ‘Redetermination’, ‘Change’, ‘Card Request’ or ‘Close’, this template will be available to send to the CIC electronically. Current functionality will remain whereas the batch only transmits documents to FLORIDA that have been launched and saved in FSFN BEFORE Submission to FLORIDA.

Child in Care

Medicaid Application Form – 2293: Accesses the Child in Care Medicaid Application. This

template has no user entered fields. Will not be updated



after application has been ‘Submitted to FLORIDA’. When the action selected on the Initiate Action page is ‘Initial’, this template will be available to send to the CIC electronically. This will only be sent to FLORIDA when the submission is Medicaid Only.

Child in Care Eligibility Review and Change Report-2694: Child in Care Eligibility Review and Change Report-2694

is a printable form that includes the demographic, report information, change/review information which is system generated and is user entered for fields that were not pre-filled. This form will pre-fill both sections 2 and 3 when the action of ‘Redetermination’ and ‘Change’ is selected on the Initiate Action page. Upon save of the template the system will not be able to pre-fill. When the action selected on the Initiate Action page is ‘Initial’, ‘Redetermination’, ‘Change’, ‘Card Request’ or ‘Close’, this template will be available to send to the CIC electronically. Current functionality will remain whereas the batch only transmits documents to FLORIDA that have been launched and saved in FSFN BEFORE Submission to FLORIDA.

Buttons: Save: Standard Save Processing.

Close: Standard Close Processing.


1. Once the page has been saved an entry into the ‘Medicaid Eligibility History’ group box will be made with an ‘Edit’ link to launch the page in edit mode.

2. The FLORIDA tab will be enabled when an Initial Title IV-E determination is submitted as a Redetermination from the Medicaid eligibility page.

3. If the user attempts to select the options of ‘Redetermination’, ‘Change’, ‘Card Request’, or ‘Close’ if a ‘Initial’ has not been submitted to the FLORIDA system and a status of Approved or Denied has not been returned and a FLORIDA Case Number has not been returned by the batch they will receive a validation message. The validation message is as follows “Please complete an Initial transaction and submit to the FLORIDA system, a



FLORIDA case number must be returned from the FLORIDA system prior to selecting <Selected Action>.”

4. If the user attempts to select the action of ‘Initial’ a second time before the case has been ‘Closed’ in FLORIDA and returned by the batch the user will receive a validation message. The validation message is as follows “The FLORIDA case must be closed before a second ‘Initial’ transaction can be submitted. Submit a ‘Close’ Transaction to initiate the FLORIDA case closure process.”

5. After a Close request has been submitted to FLORIDA and a status of ‘Accepted’ has been returned and the user inserts a second Initial action the user can enter any date into the Eligibility From field.

6. If the user attempts to select the action on ‘Redetermination’ a second time before the first has a status of ‘Approved’ or ‘Denied’ returned from FLORIDA the user will receive a validation message. The validation message is as follows “FLORIDA must return a Case Status of either 'Approved' or 'Denied' before addition 'Redetermination' actions can be created.”

7. The action that is selected will invoke the following transactions:

a. Initial: designates that the participants selected through the FL ODS search will be input into the FLORIDA System by completing the Statewide Clearance Process (Trans) code of CRCC and no Parameter (Params) value) and complete the Eligibility Application Process by using the (Trans) code of (ASCC) and parameter (Params) of the RFA Number) the interface will continue the Application Entry Process until the Shelter and Utilities Questions (AFSQ) page is reached.

b. Redetermination: designates that the selected FSFN participants case eligibility information will be input into the FLORIDA System using a pre-populated version of the Application Entry Process (Trans) code of ASRE and parameters (Params) of the FL Case Number) and continue the driver until Shelter and Utilities Questions (AFSQ) page is reached.

c. Change: designates that a change has been made in FSFN that does not affect eligibility, but needs to be communicated to the FLORIDA System. These include Name, SSN, and Date of Birth changes. This information will be passed through the FLORIDA Interface, to the specified CIC worker, through the Child in Care Work Manager Application. Selecting ‘Change’, will not initiate the ASRE driver when Submit to FLORIDA is selected. Note, however, that the ASRE drive can be initiated manually where appropriate – at the discretion of the CIC worker. The documents that are launched will be transmitted to the Work Manager queue (AMS) and the CIC worker will need to review the documents and update FLORIDA and the AMS system manually.

d. Card Request: designates that a new Medicaid card is to being requested for the FSFN participant through the FLORIDA Interface, this request will be submitted to the CIC worker through the Child in Care Work Manager Application.



e. Close: designates that the Medicaid Eligibility should be closed for the selected FSFN participant through the FLORIDA Interface, this request for closure will be submitted to the CIC worker through the Child in Care Work Manager Application.

8. Change, Card Request, and Close, radio buttons will not be enabled until the previous action has a status of Approve or Denied and a FLORIDA Case Number has been returned by the FLORIDA Interface.

9. If an action of Close is selected on the Initiate Action page and an Initial Title IV-E record has been Referred to CIC and is not completed, the user will receive an edit message stating “An Initial Title IV-E Foster Care Eligibility determination exists and must be completed before a Close request can be submitted.”

10. If an action of Close is selected on the Initiate Action page and an approved Adoption Eligibility record exists for which the final eligibility has not been determined by the FLORIDA System, the user will receive an edit message stating “An approved Adoption Eligibility determination exists and must be completed before a Close request can be submitted.”

11. The Placement Address group box pre-fills with the address of the provider of the child’s most recent placement.

12. A ‘Submit 5146’ checkbox will be added to the Initiate Action page in the Eligibility Information group box. a. The checkbox will be enabled when an approved and non-voided or terminated Adoption

IV-E Eligibility exists within the case. b. The 5146 Adoption Subsidy Title IV-E Eligibility Screening Worksheet will be sent in

redetermination transactions when the Submit 5146 checkbox is checked. The checkbox will only be enabled when there is an approved Adoption Title IV-E Eligibility. (This will enable the user to determine in which circumstances the 5146 Adoption Subsidy Title IV-E Eligibility Screening Worksheet should be transmitted to FLORIDA.)

c. If the 5146 Adoption Subsidy Title IV-E Eligibility Screening Worksheet exist for approved and non-voided and non-terminated adoption eligibility at the time the Initiate Action pop-up page is launched the checkbox will default to checked. If it does not exist at the time the Initiate Action pop-up page is launched the checkbox will default to unchecked.

d. If a user attempts to check the ‘Submit 5146’ checkbox and the 5146 Adoption Subsidy Title IV-E Eligibility Screening Worksheet does not exist they will receive this message “The 5146 Adoption Subsidy Title IV-E Eligibility Screening Worksheet has not been created please create it from the Adoption Eligibility page before selecting the Submit 5146 checkbox.”

13. The 2694 Child In Care Eligibility Review and Change Report Form will always be available in the Options dropdown of the Initiate Action page. This form will pre-fill both sections 2 and 3 when the action of ‘Redetermination’ or ‘Change’ is selected in the Initiate Action page.



14. A field will be added to the MEDICIAD_ELIG table named POST_ADOP to identify that this Medicaid Eligibility was created by the Create New Case after Finalization process in a post-adoptive case. (Note: The details of the record that will be created are outlined in the Create New Case after Finalization process (SM04a Maintain Case) this section will describe the Medicaid Eligibility specific function of this record. The POST_ADOP field will not be accessible or viewable through the FSFN application.) This field will be set to ‘P’ initially to allow the Initial or Redetermination radio buttons to be available in the post adoptive case. a. If the Redetermination action is selected first in the post-adoptive case the FLORIDA

Tab of the Medicaid Eligibility Module will be editable. Upon Submission to FLORIDA, the FLORIDA tab will be frozen and not user editable. The ‘Initial’ radio button will remain available and the POST_ADOP field will have a status of ‘P’.

b. When the user selects the ‘Initial’ action in FSFN, the FLORIDA tab will be enabled and editable. Upon submission of the Initial to FLORIDA, the FLORIDA tab will be frozen and not user editable.

c. If the ‘Initial’ radio button is selected in a Medicaid Module that already has a FLORIDA case number, when the user submits a record to FLORIDA the FLORIDA Interface will automatically check the Request CIC Intervention checkbox and the request will be sent to the CIC worker for manual processing. The POST_ADOP field will be set to ‘I’ indicating that an Initial has been submitted in a post adoptive case. The ‘Initial’ radio button will be grayed out on the Initiate Action page after the ‘Initial' record has been submitted to FLORIDA. (Note: the Adoption Eligibility will be sent directly to the CIC worker’s inbox so that the CIC worker can make the most appropriate decision on how this record should be processed. This will also reduce the need for the CIC workers to do the work twice if an erroneous record is created).

15. The FLORIDA Interface batch will also be updated to allow the completion of Title IV-E

Eligibility and Adoption Eligibility when the Action selected is “Change”. If a program code returned from FLORIDA is MCFE or MCFN and an incomplete Title IV-E that has been Referred to CIC exists the FLORIDA Interface batch will complete the Title IV-E determination. If an approved Adoption eligibility exists and MCFE or MCFN is retuned that approved Adoption Eligibility will not be completed. If the program code MCAE or MCAN is returned from FLORIDA and an approved incomplete Adoption Eligibility exists the FLORIDA Interface batch will complete the Adoption Eligibility determination. If MCAE or MCAN is returned and an incomplete Title IV-E exists and has been Referred to CIC the FLORIDA Interface batch will complete it. If a program code is returned from FLORIDA other than MCFE, MCFN, MCAE, or MCAN the FLORIDA Interface Batch will not complete the Title IV-E or Adoption Eligibility record.


1. Save Processing is initiated by clicking on the ‘Save’ button. Save processing is also initiated when selecting the ‘Close’ button, and then answering ‘Yes’ when the system asks the user if they would like to ‘Save changes before closing the page.’



2. If any required field is null at time of save processing, the user will receive an error message stating ‘Please enter data in the fields - <field name>.’

3. The effective date entered for an Action other than Initial, must be equal to or after the ‘Effective From’ date of the Initial action submission. The Message will read “The ‘Effective From’ date must be after the ‘Effective From’ date of the Initial determination to FLORIDA.”

4. On save the Placement Address will be validated to ensure that the field lengths are within the FLORIDA System field size limits. If any field exceeds the FLORIDA System field sizes the user will receive this message ‘The Florida System accepted field size for <Field Name> is <FLORIDA field size> - Please truncate the <Field Name> in <Group Box>‘.

5. If the ‘If checked all notifications will be sent to his address’ check box is checked then the notification address fields will be validated that they are within the FLORIDA System field size limits. If any field exceeds the FLORIDA System field sizes the user will receive this message ‘The Florida System accepted field size for <Field Name> is <FLORIDA field size> - Please truncate the <Field Name> in <Group Box>‘.

1.3.5. CRUD Matrix

Table CRUD

MEDICAID_CERT CRU

ADDRESS CRU

EPISODE R

PERSON R




1.4. Tab – FLORIDA

1.4.1. FLORIDA Tab Overview

The FLORIDA tab is used to collect data that will be used by the FLORIDA Interface, including parent and child medical insurance information, ‘Absent Parent Information’, the ‘Child’s Removal Address’, and the ‘Worker’s Address’.

‘Child Information’ in the ‘FSFN’ group box will pre-fill with the ‘Last Name’, ‘First Name’, ‘Middle Name’, ‘Person ID’, ‘SSN’, ‘Gender’, ‘Race’, ‘Date of Birth’ and ‘Citizenship’ from the participant’s Person Management record.

To populate the ‘FLORIDA’ group box on this page the user will select the ‘FLORIDA Search’ hyperlink. This link will launch the FL ODS Search page each FSFN participant that will be submitted as part of a Medicaid Eligibility record will have to be searched



using the FL ODS Search page, before submission. After the participant has been searched, the user can select from the returned results, and their demographic information will be returned to the ‘FLORIDA’ group box of the searched participant on the Medicaid Eligibility page, if no suitable results are returned the user may select the ‘Create’ button. When the ‘Create’ button is selected a participant will be flagged by FSFN to be created in the FLORIDA System as part of this Medicaid Eligibility submission. The participant to be created in the FLORIDA System will based on the search criteria available when the ‘Create’ button was selected. That search criteria will also be returned to the ‘FLORIDA’ group box of the FSFN participant for whom the FL ODS search was initiated.

The ‘Absent Parent Information’ expando contains the ‘Last Name’, ‘First Name’, ‘Middle Initial’, ‘SSN’, ‘Gender’, ‘Race’, ‘DOB’, ‘Street’, ‘City’, ‘State’, and ‘Zip’ of both Mother and Father absent parents. It also allows the user to document the paternity status of the father.

The ‘Custodian/Specified Relative Information’ group box will contain participants that the child was removed from and will pre-fill with the ‘Last Name’, ‘First Name’, ‘Middle Name’, ‘Person ID’, ‘SSN’, ‘Date of Birth’, ‘Gender, and ‘Race’ from the Mother and Father listed on the Title IV-E Foster Care Eligibility record if it exists. If the Child was not removed from his or her parents, then the person(s) the child was removed from will have to be search using the ‘Search’ hyperlink in the ‘FSFN’ group box of the ‘Custodian/Specified Relative Information’ group box.


Box: Child Information FSFN:

Fields: Last Name: The Last Name of the child as recorded in FSFN Person Management record; Not user editable. First Name: The First Name of the child as recorded in FSFN Person Management record; Not user editable.

Middle Initial: The Middle Initial of the child as recorded in FSFN Person Management record; Not user editable.

Person ID: A unique number generated for each person in FSFN; Not user editable.

SSN: The SSN of the child as recorded in FSFN Person Management record; Not user editable.



DOB: The DOB of the child as recorded in FSFN Person Management record; Not user editable.

Gender: The Gender of the child as recorded in FSFN person management record; not user editable; required.

Race: The Race of the child as recorded in the FSFN Person Management record; Not user editable.

Is Child a US Citizen?: The citizenship status of the child, populated from person

management, Required; Not user editable. If incorrect, user must update the person management record.

Box: Child Information FLORIDA: Field: Last Name The Last Name of the participant returned from the FL

ODS Search Page; Not user editable; No default value.

First Name: The First Name of the participant returned from the FL ODS Search Page; Not user editable; No default value.

Middle Initial: The Middle Initial of the participant returned from the FL ODS Search Page; Not user editable; No default value.

FLORIDA PIN: A unique number generated for each person in the FLORIDA System; returned from the FL ODS Search page when a participant is selected; retrieved by the interface in a nightly batch for newly created participants; Not user editable; No default value.

SSN: The SSN of the participant returned from the FL ODS Search page; Not user editable; No default value.

DOB: The Date of Birth of the participant returned from the FL ODS Search page; Not user editable; No default value. (FLORIDA System field size 8, format DDMMYYYY)



Gender: The gender of the participant returned from the FL ODS Search page; Not user editable; No default value. (FLORIDA System field size 1 ‘M/F’)

Race: The Race of the participant returned from the FL ODS Search page; not user editable; required. See Inventories 1.10.2 for details on mapping of FSFN values to FLORIDA System Race values.

Expando: Absent Parent

Box: Mother

Field: Last Name: The Last Name of the absent parent; User editable; Not required, No default value. (FLORIDA field size 15)

First Name The First Name of the absent parent; User editable; Not required; No default value. (FLORIDA field size 15)

Middle Initial: The Middle Initial of the absent parent; User editable; Not required, No default value. (FLORIDA field size 1)

SSN: The Social Security Number of the absent parent; User editable; Not required, No default value.

Gender: The Gender of the absent parent; Default to Female.

Race: The Race of the absent parent; User selected dropdown list; Not required, No default value. See Inventories 1.10.2 for details on mapping of FSFN values to FLORIDA System Race values.

DOB: The Date of Birth of the absent parent; User editable; Not required; No default value. (FLORIDA System field size 8, format MMDDYYYY)



Street: The Street name of the absent parent’s address; User entered; Not required; No default value. (FLORIDA field size Street Name 7 and Street Number 20)

City: The city of the absent parent’s address; User entered, Not required, No default value. (FLORIDA field size 20)

State: The state of the absent parent’s address; User selected dropdown list; Not required; No default value.

Reason for Absence: The reason for absence of the absent parent; User selected dropdown list; Not required; No default value.

Does either parent have health/medical insurance? Yes or No Radio buttons that indicate if either of the

child’s parents have medical insurance; User selected radio buttons; Not required; Defaults to ‘No’.

Does the policy Include the child?: Yes or No radio buttons that designates if the parent’s

health/medical insurance policy includes the child; User selected radio buttons; Conditionally required if ‘Does either parent have health/medical insurance?’ question is Yes; default to No.

Name of Carrier: Designates the name of the insurance carrier of the parents;

User entered; No default value; Not required.

Policy Number: The parents’ insurance policy number; User entered; No default value; Not required.

Does the mother have an order to pay child support? Yes or No radio buttons that designates if the parent is

required to pay child support; User selected radio buttons. If yes, what is the amount of the child support



ordered? Fields allow the user to identify the amount of child support.

Amount User Entered, Amount field to capture amount of child

support. Date of Order User Entered, Date of the Court Order Provide the County/State the order was entered: User entered text field to document where the order was

issued; 200 Characters Box: Father

Field: Last Name: The Last Name of the absent parent; User editable; Not required, No default value. (FLORIDA field size 15)

First Name The First Name of the absent parent; User editable; Not required; No default value. (FLORIDA field size 15)

Middle Initial: The Middle Initial of the absent parent; User editable; Not required, No default value. (FLORIDA field size 1)

SSN: The Social Security Number of the absent parent; User editable; Not required, No default value.

Gender: The Gender of the absent parent; Default to Female.

Race: The Race of the absent parent; User selected dropdown list; Not required, No default value. See Inventories 1.10.2 for details on mapping of FSFN values to FLORIDA System Race values.

DOB: The Date of Birth of the absent parent; User editable; Not required; No default value. (FLORIDA System field size 8, format MMDDYYYY)



Street: The Street name of the absent parent’s address; User entered, Not required, No default value. (FLORIDA field size Street Name 7 and Street Number 20)

City: The city of the absent parent’s address; User entered, Not required, No default value. (FLORIDA field size 20)

State: The state of the absent parent’s address; User selected dropdown list; Not required; No default value.

Reason for Absence: The reason for absence of the absent parent; User selected dropdown list; Not required; No default value.

Is Paternity an Issue: Designates if paternity of the child an issue for the absent parent; User selected radio buttons; Not required; Default to No. (FLORIDA System field size 1; FSFN field size 1 radio button)

Does either parent have health/medical insurance? Yes or No Radio buttons that indicate if either of the

child’s parents has medical insurance; User selected radio buttons; Not required; Defaults to ‘No’.

Does the policy Include the child?: Yes or No radio buttons that designate if the parent’s

health/medical insurance policy includes the child; User selected radio buttons; Conditionally required if ‘Does either parent have health/medical insurance?’ question is Yes; default to No.

Name of Carrier: Designates the name of the insurance carrier of the parents;

User entered; No default value; Not required.

Policy Number: The parents’ insurance policy number; User entered; No default value; Not required.

Does the father have an order to pay child



support? Yes or No radio buttons that designate if the parent is required to pay child support; User selected radio buttons..

If yes, what is the amount of the child support ordered? Fields allow the user to identify the amount of child

support Amount Amount field to capture amount of child support Date of Order User entered date of the Court Order, enabled. Provide the County/State the order was entered User entered text field to document where the order was

entered. 200 Characters

Box: Custodian /Specified Relative Information

Was the child removed from

their parents: ‘Yes’ or ‘No’ radio buttons that designates if the child was removed from their parents; System derived from the Title IV-E Eligibility page Basic tab. Not user editable; Required; Defaults to ‘Yes’ if the ‘Child removed from home of:’ is set to Mother, Father, or Both; if Other is selected then default to ‘No’; if No Title IV-E Eligibility Determination exists; User editable.

Box: FSFN

Fields: Last Name: The Last Name of the Custodian/Specified Relative the child was removed from; based on the Eligibility Basic tab If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if Other is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic



information of Mother, Father, or Both from the Initial Title IV-E Foster Care Determination.

First Name The First Name of the Custodian/Specified Relative the

child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected from the Basic tab of the Title IV-E Foster Care Determination.

Middle Name: The Middle Name of the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected from the Basic tab of the Title IV-E Foster Care Determination.

Person ID: Displays the unique number generated by FSFN for the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is



selected from the Basic tab of the Title IV-E Foster Care Determination.

Gender: The gender of the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected from the Basic tab of the Title IV-E Foster Care Determination.

SSN: The Social Security Number of Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected from the Basic tab of the Title IV-E Foster Care Determination.

DOB: The Date of Birth of the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected



from the Basic tab of the Title IV-E Foster Care Determination.

US Citizen?: The citizenship status of the specified relative, populated from person management, Required; Not user editable. If incorrect, user must update the person management record.

Box: FLORIDA

Fields: Last Name: The Last Name of the participant returned from the FL ODS Search page; Not user editable; No default. (FLORIDA System field size 15; FSFN field size 30)

First Name The First Name of the participant returned from the FL ODS Search page; Not user editable. No default value.

Middle Initial: The Middle Initial of the participant returned from the FL ODS Search page; Not user editable; No default value. (FLORIDA System field size 1; FSFN field size of 20)

FLORIDA Pin: A unique number generated for each person in the FLORIDA System; returned from the FL ODS Search page when a participant is selected; retrieved by the interface in a nightly batch for newly created participants; Not user editable; No default value.

SSN: The Social Security Number of the participant returned from the FL ODS Search page; Not user editable; No default value.

DOB: The Date of Birth of the participant returned from the FL ODS Search page; Not user editable; Not default value. (FLORIDA System field size 8, format MMDDYYYY; FSFN field size of 8)

Gender: The gender of the participant returned from the FL ODS Search page; Not user editable; No default value. (FLORIDA System field size 1 ‘M/F’; FSFN dropdown)



Race: The Race of the participant returned from the FL ODS Search Page; Not user editable; Not required. See Inventories 1.8.2 for details on mapping of FSFN values to FLORIDA System Race values.

US Citizen?: The citizenship status of the child, populated from person management, Required; Not user editable. If incorrect, user must update the person management record.

Box: FSFN

Fields: Last Name: The Last Name of the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected from the Basic tab of the Title IV-E Foster Care Determination.

First Name The First Name of the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected from the Basic tab of the Title IV-E Foster Care Determination.



Middle Name: The Middle Name of the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected from the Basic tab of the Title IV-E Foster Care Determination.

Person ID: Displays the unique number generated by FSFN for the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected from the Basic tab of the Title IV-E Foster Care Determination.

SSN: The Social Security Number of the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected from the Basic tab of the Title IV-E Foster Care Determination.



DOB: The Date of Birth of the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if ‘Other’ is selected this field will be blank and the ‘Search’ hyperlink will be available; Not user editable; Not required; Defaults to demographic information of ‘Mother’, ‘Father’, or ‘Both’ is selected from the Basic tab of the Title IV-E Foster Care Determination.

Gender: The gender of the Custodian/Specified Relative the child was removed from; based on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If Mother is selected pre-fill using (ID_PERSON_RMVL), if Father is selected pre-fill using (ID_PERSON_RMVL), if Both are selected then pre-fill using (ID_PERSON_RMVL) of the mother, and the father will be System derived; if Other is selected this field will be blank and the Search hyperlink will be available; Not user editable; Not required; Defaults to demographic information of Mother, Father, or Both from the Initial Title IV-E Foster Care Determination.

US Citizen?: The citizenship status of the specified relative, populated from person management, Required; Not user editable. If incorrect, user must update the person management record.

Box: FLORIDA

Fields: Last Name: The Last Name of the participant returned from the FL ODS Search page; Not user editable; No default. (FLORIDA System field size 15; FSFN field size 30)

First Name The First Name of the participant returned from the FL ODS Search page; Not user editable. No default value.



Middle Initial: The Middle Initial of the participant returned from the FL ODS Search page; Not user editable; No default value. (FLORIDA System field size 1; FSFN field size of 20)

FLORIDA Pin: A unique number generated for each person in the FLORIDA System; returned from the FL ODS Search page when a participant is selected; retrieved by the interface in a nightly batch for newly created participants; Not user editable; No default value.

SSN: The Social Security Number of the participant returned from the FL ODS Search page; Not user editable; No default value.

DOB: The Date of Birth of the participant returned from the FL ODS Search page; Not user editable; Not default value. (FLORIDA System field size 8, format MMDDYYYY; FSFN field size of 8)

Gender: The gender of the participant returned from the FL ODS Search page; Not user editable; No default value. (FLORIDA System field size 1 ‘M/F’; FSFN dropdown)

Race: The Race of the participant returned from the FL ODS Search Page; Not user editable; Not required. See Inventories 1.8.2 for details on mapping of FSFN values to FLORIDA System Race values.

Box: Child Removal Address

Fields: Street: Street name and number of the child’s Removal Address; System derived from Street name and number of the Basic tab of the Initial Title IV-E Foster Care Determination; if no Initial Title IV-E Foster Care Determination exists this field will be blank User editable, Required. (FLORIDA System field sizes street number 7 and street name 20; FSFN field size Street Number 13 and Street Name 25)



Unit Designator: Unit Designator of the child’s Removal Address; User editable; Not required; No default value. (FLORIDA field size 3; FSFN field size dropdown list)

Unit Designator Number: Unit Designator Number of the child’s Removal Address;

User editable; Not required; No default value. FLORIDA System field size 5; FSFN field size 15)

City: City of the child’s Removal Address; System derived from

the City of the Basic tab of the Initial Title IV-E Foster Care Determination; if no Initial Title IV-E Foster Care Determination exists this field will be blank User editable, Required. (FLORIDA System field size 15; FSFN field size 40)

State: State of the child’s Removal Address; System derived from State of the Basic tab of the Initial Title IV-E Foster Care Determination; if no Initial Title IV-E Foster Care Determination exists this field will be blank User editable, Required.

Zip: Zip code of the child’s Removal Address; System derived from Zip code of the Basic tab of the Initial Title IV-E Foster Care Determination; if no Initial Title IV-E Foster Care Determination exists this field will be blank User editable, Required.

Phone: Phone Number at the home the child was removed from; User editable; Required; No default value.

Box: Worker Address

Fields: Street: Street name and number of the worker’s unit address; System derived from the unit address of the worker that created the page; User editable; Required. (FLORIDA System field size Street Number 7 and Street name 20; FSFN Street Number field size 13 and Street Name field size 25)



City: City of the worker’s unit address; System derived from the

unit address of worker that created the page; User editable; Required. (FLORIDA System field size 15; FSFN field size 40)

State: State of the worker address; System derived from the unit address of the eligibility worker that launched the page; required; disabled. (FLORIDA System field size 2; FSFN field size a dropdown list)

Zip: Zip code of the worker’s address; User Editable; Required; Defaults to the unit address of the worker that created the page.

Phone: Phone Number at the worker’s address; User editable; Required; No default value.

Expando: Other Medicaid

Information

Box: Medicaid Only

Questions: Fields: Shelter Order Date: The date of the child’s Shelter Order; User editable;

Conditionally Required; Defaults to the completed date of either of these Judicial Legal Actions Shelter Review, Shelter Hearing - Subsequent Removal or Shelter Hearing Initial with a result of Granted from the Legal module.

Voluntary Placement Agreement Date: The date the child received an order that had the

appropriate wording; User editable; Conditionally Required; Defaults to the date captured in question 5 of the Title IV-E Foster Care application, if blank will populate from the “Voluntary Licensed Care Agreement Date” captured in the Out of Home Placement.

Child’s Total Earned Income: The total income of the child; Prefilled from Assets and

Employment page. Will be based on the information at time



the initial record is submitted. If there is a second initial the page will become re enabled and the system will update the information with the current data until submitted; Not Required;.

Child’s Total Unearned Income: The total income of the child; Prefilled from Assets and

Employment page. Will be based on the information at time the initial record is submitted. If there is a second initial the page will become re enabled and the system will update the information with the current data until submitted; Not Required.

Child’s Total Assets: The total assets of the child; Prefilled from Assets and

Employment page. Will be based on the information at time the initial record is submitted. If there is a second initial the page will become re enabled and the system will update the information with the current data until submitted; Not Required.

Expando:

Comments: Text field with a maximum of 32000 characters, User Entered, Not Required

Links: Search: This hyperlink will launch the FSFN Person Search Page.

FLORIDA Search: This hyperlink will launch the FL ODS Search Page.

Each person must be searched individually from the FL ODS Search Page. This hyperlink will only be available if the FSFN group box has been populated.

Remove: This hyperlink allows the user to remove the information

that is displayed in the FLORIDA group box before the Submit to FLORIDA option is selected from the options dropdown. This hyperlink will only be available after a participant has been returned from the FL ODS Search Page to the FLORIDA Tab

Options: Submit to FLORIDA: This option will be available to authorized users who can access the Medicaid Eligibility page. It will only display in the Options dropdown once the Initiate Action Pop-up page has been saved and the status is updated to ‘Pending’ in the ‘Medicaid Eligibility History’ group box.



Buttons: Save: Standard Save Processing.



1. The ‘FSFN’ group box in the ‘Child Information’ group box will be pre-filled with the child’s information that is returned from the search using the search hyperlink in the ‘Basic Header’ group box.

2. The ‘FSFN’ group box in the ‘Custodian/Specified Relative Information’ group box will pre-fill with who the child was removed from based, on the ‘Removed from Home Information’ group box on the Basic tab of the Initial Title IV-E Foster Care Eligibility Determination. If only ‘Mother’ or ‘Father’ is documented on the Initial Title IV-E Foster Care Eligibility Determination the second ‘FSFN’ group box in the ‘Custodian/Specified Relative Information’ group box will be blank, and a ‘Search’ hyperlink will be available.

3. If a Title IV-E Eligibility Determination has the ‘Refer to CIC’ flag set to Y when the ‘Submit to FLORIDA’ option is selected from the Options dropdown and at least one adult is required in the ‘Custodian/Specified Relative Information’ group box. If one adult is not selected the user will receive this message ‘The FLORIDA System requires at least one adult to be included on this record.’

4. The ‘Removal Address’ will be derived from ‘Removal Home Address’ on the Basic tab of Eligibility page if no Title IV-E Determination exists then the address field will be blank.

5. The worker address will be derived from the unit address of the worker who created the Medicaid Eligibility page.

6. The worker phone number will pre-fill from the worker’s person record.



2. If any conditionally required field is null at time of save processing, the user will receive an error message stating ‘Please enter data in the fields - <field name>.’

3. On save the ‘Removal Address’ will be validated to ensure that they are within the FLORIDA System field size limits if it exceeds the FLORIDA System field sizes the user will receive this message ‘Florida System accepted field size for <Field Name> is <FLORIDA field size> - Please truncate the <Field Name> in <Group Box>‘.



4. On save the ‘Worker Address’ will be validated to ensure that they are within the FLORIDA System field size limits if it exceeds the FLORIDA System field sizes the user will receive this message ‘The Florida System accepted field size for <Field Name> is <FLORIDA field size> - Please truncate the <Field Name> in <Group Box>‘.

1.4.5. CRUD Matrix

Table CRUD

MEDICAID_ELIGIBILITY CRU

FLORIDA_ELIGIBILITY CRU

MEDICAID_CERT CRU

FLORIDA_PART CRU

ELIGIBILITY R

ELIG_REDET R

ADOPTION_ELIG R

PERSON R

CASE_MASTER R

CASE_PART R


ADDRESS R

ORG_WORKER_ROLE R



1.5. Pop-Up Page – Citizenship Details

Page Summary

This Citizenship Details Pop-up page allows the user to input citizenship details for non-citizens. This information must be entered for all participants in a FLORIDA Case and will assist the FLORIDA System in making accurate determination regarding Medicaid Eligibility.

Box: Person Information

Field: First Name: The First name of the of the FSFN participant; Not user editable.



Last Name: The First name of the of the FSFN participant; Not user editable.

Box: Citizenship Details

Fields: Name of Country: The name of the country of citizenship for this non-citizen; User selected list; Required; No default value.

Qualified Non-Citizen ID: The Qualified Non-Citizen ID of the participant; User

editable; Required; Default to the value from Question 2b (Qualified Non-Citizen ID text box) on the Title IV-E Foster Care Eligibility Determination.

Entry Date: The date the participant entered the county; User entered; Required; No default value.

Status: Designate the immigration status of the participant; User selected dropdown list; Required; No default value.

Status Date: The date the participant began working in the United States; user entered; Required; No default value.


Save: Standard save processing.

Close: Standard close processing.


• None





2. If any conditionally required field is null at time of save processing, the user will receive an error message stating ‘Please enter data in the fields - <field name>.’

1.5.4. CRUD Matrix

None



1.6. Pop-up Page – FL ODS Search

1.6.1. FL ODS Search Pop-up Page Overview

The FL ODS Search Page will be accessed by selecting the FL Search hyperlink on the FLORIDA tab. The user will be able to search FL ODS which is a nightly updated data store of the Public Assistance data from the FLORIDA System. The Search Criteria group box will pre-fill from the FSFN group box in the Child Information and Custodian/Specified Relative group. The participant’s information that pre-fills will be dependent on which FLORIDA Search hyperlink is selected (ex. if the FLORIDA Search hyperlink is selected from the Child Information group the child’s information will pre-fill the search criteria). The search criteria will be formatted to FLORIDA System field sizes.

Once the FSFN participant has been searched in FL ODS the user can select a search result as a match to the FSFN participant and click the Continue button. (Note: the FL ODS Search page does not accept wildcard characters as search criteria) Once the continue button is selected the search result will display in the FLORIDA group box of the participant for whom the search



was initiated. If a match to the FSFN participant cannot be found during the FL ODS search the user can also select the Create button. The Create button will allow the user to take the most recent search criteria and have that display in the FLORIDA group box of the FSFN participant for whom the search was initiated.


Box: Search Criteria

Fields: Last Name: The Last Name of the FL ODS search criteria; User editable; Required; Defaults to the last name of the participant from the FLORIDA tab for whom the search was initiated. (FLORIDA field size 15; FSFN field size 30)

First Name: The First Name of the FL ODS search criteria; User editable; Required; Defaults to the first name of the participant from the FLORIDA tab for whom the search was initiated (FLORIDA field size 15; FSFN field size 30)

Middle Initial: The Middle Initial of the FL ODS search criteria; User editable; Required; Defaults to the middle initial of the participant from the FLORIDA tab for whom the search was initiated (FLORIDA field size is 1; FSFN field size 20).

SSN: The SSN of the FL ODS search criteria; User editable; Required; Defaults to the SSN of the participant from the FLORIDA tab for whom the search was initiated

DOB: The DOB of the FL ODS search criteria; User editable; Required; Defaults to the DOB of the participant from the FLORIDA tab for whom the search was initiated (format MMDDYYYY; FSFN field size 8)

Gender: The Gender of the FL ODS search criteria; User editable; Required; Defaults to the gender of the participant from the FLORIDA tab for whom the search was initiated (FLORIDA field size is 1; FSFN field size dropdown list)



Race: The Race of the FL ODS search criteria; User editable; Required; Defaults to the last name of the participant from the FLORIDA tab for whom the search was initiated. See Inventories 1.8.2 for details on mapping of FSFN values to FLORIDA System Race values.

Box: Person Returned:

Fields: <Selection Button> User selectable; no default value.

Last Name: The Last Name of the returned person from the FL ODS search; not user editable.

First Name: The First Name of the returned person from the FL ODS search; not user editable

Middle Initial: The Middle Initial of the returned person from the FL ODS search; not user editable

SSN: The SSN of the returned person from the FL ODS search; not user editable.

DOB: The DOB of the returned person from the FL ODS search; not user editable.

Gender: The Gender of the returned person from the FL ODS search; not user editable.

Race: The Race of the returned person from the FL ODS search; not user editable.

FLORIDA Pin: The FLORIDA Pin of the returned person from the FL ODS search participant; not user editable.



FL Case No: The FLORIDA Case Number of the returned person from the FL ODS search participant; not user editable.

Links: Details: This hyperlink will launch the FL Case Details Pop-

up page. Buttons: Create: This button will allow the user to populate the FLORIDA

group box of whomever the search was initiated for with the most recent search criteria.

Continue: Returns the selected person demographics to the FLORIDA tab.



1. FL ODS search criteria will pre-fill using the demographics from the FLORIDA tab in the FSFN group boxes of the ‘Child Information’ and ‘Custodian/Specified Relative Information’ group boxes.

2. The ‘Continue’ button is disabled on the FL ODS Search Page until the Search button has been selected, and when no results are returned from the search.

3. If the ‘Continue’ button is clicked the selected search result will be returned and displayed in the ‘FLORIDA’ group box of the ‘FSFN’ person the search was initiated for.

4. When ‘Create’ is selected the information that is currently in the ‘Search Criteria’ group box will be returned to the ‘FLORIDA’ group box of the participant for which the search was initiated.

5. When a search result is selected and the ‘Continue’ button is clicked the SSN and the first 5 characters of the first name, the first 5 characters of the last name, the month and year of the Date of Birth of the returned search result will evaluated for match with the search criteria. If the first 5 characters of the first name and the first 5 characters of the last name do not match the search criteria the user will receive an edit message ‘The selected participant does not match the search criteria. Please Request CIC intervention by checking the Request CIC Intervention check box in the header before submitting to FLORIDA.’ The ‘Continue’ and ‘Create’ buttons will be disabled.

6. If the ‘Create’ button is selected and the search criterion does not include a ‘Last Name’, ‘First Name’, the user will receive an edit message stating ‘Please enter data in the highlighted fields - <field name>‘. If ‘DOB’, ‘Gender’ or ‘Race’ fields are missing, the user



will receive this message ‘Close this page and update this participants <field Name> in Person Management’.

7. If the Search button is selected and the search criterion does not include a Last Name, First Name, the user will receive an edit message stating ‘Please data in the highlighted fields - <field name>‘. If ‘DOB’, ‘Gender’ or ‘Race’ fields are missing, the user will receive this message ‘Close this page and update this participants <field Name> in Person Management’.

8. When the ‘Search’ button is clicked the ‘Last Name’ and ‘First Name’ of the search criteria will be validated to ensure that they are within the FLORIDA System field size limits if they are not the user will receive an truncate message stating ‘The Florida System accepted field size for <Field Name> is <FLORIDA field size> - Please truncate the <Field Name> in <Group Box>‘


None

1.6.5. CRUD Matrix

None



1.7. Pop-up Page – FL Case Details

1.7.1. FL ODS Search Details Pop-up Page Overview

The FL Case Details Pop-up page will be launched by selecting the ‘Details’ hyperlink on the FL ODS Search page. This pop-up page will allow the user to view more case specific information about the selected search results including the ‘Case Participants’, ‘Participant Status’, and the ‘FLORIDA Case Benefits’ received. (Note: The benefits are on the case level and the Participant Status of A (active) is at the participant level, this will designate the participants as receiving this benefit, if the Participant Status is I (inactive) then they would not be receiving the FLORIDA Case Benefit listed for this case.)


Box: FLORIDA Person Information



Fields: FL Case No: The FLORIDA Case Number of the returned person from the FL ODS search; Not user editable.

Last Name: The Last Name of the returned person from the FL ODS search; Not user editable.

First Name: The First Name of the returned person from the FL ODS search; Not user editable

FLORIDA Pin: The FLORIDA Pin of the returned person from the FL ODS search; not user editable.

DOB: The Date of Birth of the returned person from the FL ODS search; Not user editable.

SSN: The SSN of the returned person from the FL ODS search; Not user editable.

Box: FLORIDA Case Participants

Fields: Last Name: The Last Name of the other participants in the FLORIDA System case returned person from the FL ODS search; Not user editable.

First Name: The First Name of the other participants in the FLORIDA System case returned person from the FL ODS search; Not user editable.

Middle Initial: The Middle Initial of the other participants in the FLORIDA System case returned person from the FL ODS search; Not user editable.

Participants Status: The status of the participant either ‘Active’ or ‘Inactive’ in FLORIDA. Not user editable.

Box: FLORIDA Case Benefits



Fields: Medicaid: This check box indicates that this benefit is being received in this case; Not user editable.

Food Stamps: This check box indicates that this benefit is being received in this case; Not user editable.

Cash Assistance: This check box indicates that this benefit is being received in this case; Not user editable.

Medicare: This check box indicates that this benefit is being received in this case; Not user editable.

Buttons: Continue: This will return the user to the FL ODS Search page.


None


None

1.8. Inventories

1.8.1. Table Descriptions

Table Name Description



ADDRESS This table maintains all ADDRESS information pertaining to a PERSON, except Intake Report (Report and Referral). Address detail consists of home, business and any other address that is identified as required for FSFN processing. Processes of CM01 (Manage Person) build and maintain this information.

CASE A CASE is the focus of every human services business activity. A case is created as a result of intake work and can be one of three types: individual (which includes TPR and Adoption cases), family, and DCF/SHERIFF’S OFFICE/COMMUNITY-BASED CARE PARTNERS provider or other provider. The CASE table contains case relations, address and approval information. Processes of SM04 (Maintain Case) and SM05 (Close Case) create and maintain case records.

DEPRIVATION The DEPRIVATION table allows the user to enter information regarding deprivation in a child's case. Processes within FM03 (Eligibility) maintain this information.

ELIGIBILITY The ELIGIBILITY table maintains information pertaining to a foster child's initial Title IV-E eligibility determination. Once the determination is complete, the child will be assigned an eligibility status. Processes of FM03 (Eligibility) build and maintain this information.

ELIGIBILITY CHANGE The ELIGIBILITY CHANGE table stores changed information about the fields on ELIGIBILITY that affect reimbursement. Processes of FM03 (Collect/Determine Eligibility) build and maintain this information.

ELIG EPISODE The ELIG_EPISODE table stores point-in-time placement information for the corresponding eligibility record. Processes within FM03 (Eligibility) maintain this information.

ELIG REDET The ELIG_REDET table maintains information pertaining to a foster child's Title IV-E eligibility re-determinations. Once the re-determination is complete, the child will be assigned an eligibility status. Processes of FM03 (Eligibility) build and maintain this information.

EPISODE The EPISODE table maintains information pertaining to the occurrence of the delivery of one or more out-of-home Services involving one PROVIDER and one or more CASE Participants. Placement out of home and removal from home are other types of Episodes stored in this table. Processes of



SM10a (Out of Home Placement) build and maintain this information.

MEDICAID CERT The MEDICAID_CERT table records Medicaid Certifications for specified case participants. Processes within FM03 (Eligibility) maintain this information.

MEDICAID ELIGIBILITY The MEDICAID_ELIGIBILITY table is used to document Medicaid Eligibility records for a specific child. Processes within FM03 (Eligibility) maintain this information.

PERSON This PERSON table maintains information that identifies an individual known to DCF/SHERIFF’S OFFICE/COMMUNITY-BASED CARE PARTNERS or the county child welfare division such as name, date of birth, social security number, race, sex, etc. A PERSON can be a WORKER, REPORT PART, REFERRAL PART, CASE PART or PROVIDER PART. Primary search processing is centered on this data. Processes of CM01 (Manage Person) build and maintain this information.

WORKER The WORKER table maintains information pertaining to an individual (PERSON) who is employed by a county or DCF/SHERIFF’S OFFICE/COMMUNITY-BASED CARE PARTNERS and is in a job class that provides services and/or receives FSFN-defined work assignments. The information is created in CM18 (Manage Worker).

1.8.2. Reference Data

Race Mapping

FSFN FLORIDA CODE

FLORIDA

American Indian/Alaskan Native I American Indian/ Eskimo

White W White, Not of Hispanic Origin

Asian A Asian or Pacific Islander

Black/African American B Black, Not of Hispanic Origin

Native Hawaiian/Other Pacific Islander

A Asian or Pacific Islander

Multi-Racial T Other

Unable to Determine U Unknown



Reason for Absence Mapping

FSFN FLORIDA

Court Removal Court Removal

Desertion Abandonment

Divorce Divorce

Voluntary Removal Voluntary Removal

Other Unknown

1.8.3. Dropdowns

Field Name: State Table Name: STATE_CODE_DESC Group ID: TX_STATE Field Name: Circuit Table Name: CODE_DECODE Group ID: CIRCUIT Field Name: Adoption Assistance State Table Name: STATE_CODE_DESC Group ID: TX_STATE Field Name: Street/PO Box/Route Table Name: CODE_DESC Group ID: ADSTPORT Field Name: Unit Designator Table Name: CODE_DESC Group ID: UNITDSGN Field Name: Route Table Name: CODE_DESC Group ID: ROUTTYPE Field Name: Gender Table Name: CODE_DESC Group ID: PRSNGNDR Field Name: Closure Reason



Table Name: CODE_DECODE Group ID: CLSRRSN Field Name: Race Table Name: CODE_DESC Group ID: PRSNRACE Field Name: Reason for Absence Table Name: CODE_DECODE Group ID: FLABSEN

1.8.4. List Boxes

None

1.8.5. Automated Messages

1.8.5.1. FLORIDA Status Information Return To: This message will be sent to the worker (based on the e-mail documented on the

worker record in FSFN) that completed the Submission to FLORIDA. The message will identify the status of the record that was sent and the status of the record returned. Title IV-E submissions will also be submitted to FLORIDA through the Medicaid eligibility.

Subject: Medicaid returned for person ID [XXXXX] in case ID [XXXXX].

Message: Eligibility XXXX [Program Code] with Eligibility Status XXXXX [FSFN Eligibility Status], which you submitted to FLORIDA on XXXXX [mm/dd/yyyy] for person ID [XXXXX] in case ID [XXXXX] was XXXXX [Submission Status] with Eligibility XXXX [Program Code] on XXXXX [mm/dd/yyyy].

Further Explanation:

The first program code that is displayed in the message will be the text value of the program code that is sent to FLORIDA, based on the FLORIDA Interface Batch stored procedure logic. If a Title IV-E record has not been submitted to CIC and is submitted to FLORIDA, the message will indicate that a Medicaid Only determination has been submitted. The program code that is returned from FLORIDA is displayed in the message.

For example, a code of ADSUB that is submitted from FSFN to FLORIDA and returned from FLORIDA as MCFE will produce the following message:

“Eligibility Adoption Subsidy with Eligibility Status Eligible, which you submitted to FLORIDA on XXXXX[mm/dd/yyyy] for person ID[XXXXX] in case ID[XXXXX] was denied with Eligibility MCFE on XXXXX[mm/dd/yyyy].



1.8.6. Checklists

None

1.8.7. Ticklers

None

1.8.8. Notifications

None

1.8.9. Text Templates

Child in Care Medicaid Application - 2293

1.8.10. Reports

Medicaid Activity Report

Medicaid Eligibility Annual Review Report

FLORIDA Status Report

TANF Eligible children Receiving Medicaid Report

1.8.11. Triggers

None

1.9. Batch Programs

1.9.1. None

1.10. Requirements

1.10.1. FME – 001

1.10.2. FME – 002

1.10.3. FME- 003

1.10.4. FME-004

FM03b: Medicaid Eligibility - University of South Floridacenterforchildwelfare.fmhi.usf.edu/kb/RevMax/Eligibility_Medicaid... · FM03b-Medicaid Eligibility January 07, 2012 Topic

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