Use an eligibility update

Page posted: 8/3/26

Note: Lead agencies no longer use eligibility updates for assessments completed on or after July 1, 2025. DHS is in the process of creating content about the initial assessment review (IAR). For information about the IAR, refer to CBSM – IAR for HCBS.

You can complete an eligibility update (activity type 09) within 90 days of an in-person activity type 02 or 04 to open, reopen or change a program for a person.

You can use an eligibility update to take the following actions remotely:

· Establish eligibility effective retroactive to the date of the assessment (activity type 02 or 04) or up to 60 days after the eligibility update.

· Create an eligibility span based on the activity type date of the assessment (activity type 02 or 04).

· Update all fields in the long-term care (LTC) screening document.

For more information about the use and limitations of eligibility updates, refer to MMIS LTSS Manual – LTC screening document activity types, MMIS LTSS Manual – LTC screening document activity type dates and effective dates and CBSM – Eligibility update for home and community-based services (HCBS).

This page includes instructions to record an eligibility update in MMIS to open, reopen or change a program:

· At the time of the eligibility update.

· Within 60 days after the eligibility update.

Person is eligible at the time of eligibility update

Follow these instructions if you complete an eligibility update within 90 days of the in-person assessment (activity type 02 or 04) and determine the person is eligible at the time of the eligibility update.

To open, reopen or change the person’s program:

1. Type X next to screenings on the main menu, then press the transmit key to open the key panel (ASCR) screen.

2. Use:

· Action code A (Add).

· Document type L.

· Person’s person master index (PMI) number.

3. Press the transmit key to open a copy of the last saved document.

Note: Because you are using a copy of the last screening document, nearly all fields will be populated, and you can update them using activity type 09. Fields you can change will appear green, and protected fields will appear white.

4. Enter the following information on the ALT1 screen:

· Person’s birthdate in the DOB field.

· Referral date in the REF DATE field.

· Activity type 09 in the ACTIVITY TYPE field.

· Activity type date that the assessment was done in the ACT DT field.

· Certified assessor/case manager/care coordinator provider number in the CM/HP/CA NBR field.

5. Update any other information on the ALT1 screen that may have changed since the in-person assessment.

6. Press the transmit key to move to the ALT2 screen. Review and change information on the ALT2 screen, as needed, based on the eligibility update.

7. Press the transmit key to move to the ALT3 screen. Review and change information on the ALT3 screen, as needed, based on the eligibility update.

8. Press the transmit key to move to the ALT4 screen and enter:

· The applicable assessment result on the ALT4 screen:
01: Open to an HCBS program when having no previous open HCBS program history.
10: Change to a different program than previously used.
11: Reopen a program previously used.

· An effective date that reflects the date the person meets all program eligibility criteria (e.g., Medical Assistance is in effect or nursing facility discharge date)
Note: The effective date can be between the activity type date of the prior activity type 02 or 04 and up to 60 days from the activity type date of the eligibility update.

· The appropriate program type.

9. Press the transmit key to move to the ALT5 screen and update the service plan summary.

10. Press the transmit key to move to the ALT6 screen, which will only appear if the person is on the AC or ECS program. Update the information as needed.

11. Press F9 to display exception codes.

12. Resolve exception codes.

13. Press F3 to save the document. This step is important. You must save the document even if exception codes remain. MMIS will save the completed data and allow you to return to the document for additional work.

14. Press F3 to return to the screening key panel.

15. Press F3 to return to the main menu.

Person is eligible after eligibility update

Follow these instructions if you complete an eligibility update within 90 days of the in-person assessment (activity type 02 or 04) and the person is not eligible at the time of the eligibility update. You enter the eligibility update into MMIS with an assessment result based on what is known at the time of the eligibility update. This allows for the final eligibility determination to occur within 60 days of the eligibility update.

The effective date used to open, reopen or change a program after an eligibility update can be between the activity type date of the in-person assessment (activity type 02 or 04) and up to 60 days after the activity type date of the eligibility update.

The steps you must take depend on the effective date needed to open, reopen or change a program.

Later than effective date on the eligibility update screening document

If the effective date of the open, reopen or change is later than the effective date of the eligibility update (activity type 09) document, you must follow the steps on MMIS LTSS Manual – Open, reopen or change a program with an LTC screening document.

Earlier than effective date on the eligibility update

If the effective date of the open, reopen or change is earlier than the effective date of the eligibility update (activity type 09) document, you must:

1. Manually delete the eligibility update (activity type 09) screening document from MMIS

2. Reenter the eligibility update screening document with:

· Updated assessment result 01, 10 or 11.

· Effective date no earlier than the date of the activity type 02 or 04.

· Program type.

· Service codes.

3. Complete the ALT6 screen information for AC and ECS program types.

4. Press F9 to display exception codes.

5. Resolve exception codes.

6. Press F3 to save the document. This step is important. You must save the document even if exception codes remain. MMIS will save the completed data and allow you to return to the document for additional work.

7. Press F3 to return to the screening key panel.

8. Press F3 to return to the main menu.

Exception codes

Unresolved exception codes will prevent MMIS from approving a screening document. For more information, refer to MMIS LTSS Manual – Exception codes in the LTC screening document.

Additional resources

CBSM – Eligibility update for home and community-based services (HCBS)
CBSM – IAR for HCBS
MMIS LTSS Manual – LTC screening document activity types
MMIS LTSS Manual – LTC screening document activity type dates and effective dates
MMIS LTSS Manual – Exception codes in the LTC screening document
MMIS LTSS Manual – Open, reopen or change a program with an LTC screening document