APD MAGI Manual D. MAGI Service Cases

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APD MAGI Manual

Updated 10/1/20

D. MAGI Service Cases

1. Overview

On May 11, 2015, APD introduced coding changes allowing APD/AAA staff to create and maintain a service case for MAGI medical eligible individuals. A service-only case was required in order to record and store information related to an individual’s State Plan K, State Plan Personal Care, or Nursing Facility Long Term Care services, as well as facilitate provider payments. Service-only cases are also be referred to as OSV, or Only SerVice cases. The service-only cases do NOT convey medical eligibility to MMIS.

With the ONE system upgrade, the information that the OSV cases provided (client demographic information) will now be provided by the ONE system, so there is no longer any need to create or maintain these cases. Additional information will be provided about what to do with existing OSV cases.

In ONE, a MAGI recipient who is receiving services is approved for a benefit called MSERV (MAGI Service).

REMEMBER - MAGI recipients are not eligible for special needs payments, these are strictly for OSIPM recipients; however, some of these needs can be met through K Plan services. One example is CBC room and board payments authorized in OAR 411-027-0025 (see APD-PT-14-011 for more information on room and board payments). See K-State Plan Ancillary Services section (Division 35 of the Chapter 411 OARs) for more needs that can be met through K Plan services.

IMPORTANT - if your specific scenario isn't addressed, or if you experience problems with the instructions, email APD.MedicaidPolicy@dhsoha.state.or.us.

2. Procedure - Existing MAGI Client Applies for APD/AAA for NF, K-Plan, or SPPC Services

The process may vary depending on whether individuals contact a non-converted APD/AAA branch or if the service request is made through Applicant Portal or with the ONE eligibility worker.

Prior to authorizing APD services, staff must verify that client is MAGI-eligible by checking MMIS. If you do not know how to check for MAGI eligibility in MMIS, click HERE.

For all service types other than SPPC Services:

Obtain a signed 539A or 7210 if a 7210 dated 1/1/20 or later is not already on file. These clients will be subject to estate recovery. Also, MAGI service clients need to be reviewed for transfer of assets, potential resource assessments (see APD-PT-14-030), and must fall within home equity guidelines per OAR 461-145-0220 (see APD-PT-15-004). This means AVS must be requested and an interview completed.

Review the Asset Verification System (AVS) ETOPS for instructions on how service requests are handled for a MAGI recipient

For SPPC applicants:

Process the SPPC request as you normally would in CA/PS
Email the ONE eligibility worker after approving the benefit and plan to notify them that an SELG record should be available to ONE

3. Procedure - MAGI Service Client Dies or Leaves the State

If a MAGI client who is on APD services dies or leaves the state, close the services per the normal process:

Send an email to Oregon.Benefits@dhsoha.state.or.us . In the subject line of the email type one of the following:

MAGI service client deceased or
MAGI service client out of state

Include all available information (deceased date, moving date, new address, etc.) and the ONE eligibility worker will take the action to close the medical case.

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