XEROX 28 MEC 28D-1narr - NM Human Services



28.0 NM Verify Non-Employer Sponsored Insurance (ESI) Minimum Essential Coverage (MEC)

1. Verify Non-ESI MEC System Narrative

1. System Overview

The Verify Non-ESI MEC system supports the Federally Facilitated Marketplace (FFM). This service determines individuals who are eligible for Minimum Essential Coverage (MEC) through Medicaid or CHIP and are not eligible to receive Advanced Premium Tax Credit (APTC) and Cost Sharing Reduction amount (CSRs). Each individual in a household undergoes verification, as appropriate.

The Verify Non-ESI MEC system supports the business process to validate the MEC eligibility of a single individual applicant or multiple individuals within a household. The process limits the service requester to the NM State (Medicaid, CHIP). Once a connection is established with the Hub, an electronic request to verify the Non-ESI MEC status of an application is received through the web service. The electronic request is then sent to NM MEVS to process. The MEVS system searches for the applicant on the databases. If the applicant does not have the listed Medicaid COEs in the given requested period or the details do not match with the system details, MEVS populates the appropriate response code and messages. If there are no errors, MEVS respond with appropriate MEC response code and eligibility span dates. The formatted response is then sent back to the Hub.

The following table identifies the New Mexico MEC COEs that meet the MEC criteria:

|Client_COE_Cd |COE_Description |MEET MEC CRITERIA |

|001 |SSI Aged and Mcaid Ext-Aged |Y |

|003 |SSI Blind & Mcaid Exten- Blind |Y |

|004 |SSI Disbl & Mcaid Exten-Disabl |Y |

|017 |Subsidy Adoption Other States |Y |

|019 |Refugee (Cash & Med Assist) |Y |

|027 |Post Closure-Eligible 4 Months |Y |

|028 |Transitional Medicaid |Y |

|030 |Med Assist- Pregnant Women |Y |

|031 |Newborns |Y |

|032 |133% Of Poverty Kids |Y |

|036 |185% Of Poverty Kids |Y |

|037 |Subsidy Adoption Title IV-E |Y |

|046 |FC Child Out Of NM Title IV-E |Y |

|047 |Subs Adpt Out Of NM Title IV-E |Y |

|049 |Refugee-(Med Assist Only) |Y |

|050 |Qualified Disabled Working Ind. |Y |

|052 |Breast & Cerv Cancer FM 1 |Y |

|052 |PE for Breast & Cerv Cancer FM 3 |Y |

|062 |SCI up to & including 100% FPL |Y |

|063 |SCI up to & including 150% FPL |Y |

|064 |SCI up to & including 199% FPL |Y |

|066 |Foster Care Title IV-E |Y |

|071 |CHIP FM1 |Y |

|071 |Children's PE FM 3 |Y |

|072 |JUL Family Medicaid |Y |

|074 |Qualified Working Disabled |Y |

|081 |Institutional Care - Aged |Y |

|084 |Institutional Care - Disabled |Y |

|086 |FC Child From Another State |Y |

|090 |HCBW - AIDS |Y |

|091 |HCBW - Handicapped & Elderly |Y |

|092 |HCBW - Brain Injury |Y |

|093 |HCBW - Hndcapped & Eldy(Blind) |Y |

|094 |HCBW - Med Hndcapped - Disable |Y |

|095 |HCBW - Medically Fragile |Y |

|096 |HCBW - Developmentally Disable |Y |

|100 |ABP or State Plan |Y |

|200 |Parent/Caretaker |Y |

|400 |Children's Medciaid |Y |

|401 |Children's Medicaid |Y |

|402 |Children's Medicaid |Y |

|403 |Children's Medicaid |Y |

|420 |CHIP |Y |

|421 |CHIP |Y |

|300 |Full Medicaid for Pregnant Women |Y |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download