DTA Connect: Updating Medical Expenses and Health Insurance Information

Overview

Active clients of any DTA program can use the DTA Connect My Info page to update and self-declare their medical expenses.

For households with an elderly (aged 60+) and/or disabled member who has medical expenses, DTA Connect will display the medical expense section and if there are existing medical expenses on record in BEACON, including insurer, expense type, amount, frequency, etc.

Clients can edit or delete recurring medical expenses (e.g., health insurance, monthly prescriptions), but they cannot edit or delete entries for non-recurring medical expenses (e.g., a one-time surgery) after submitting them on DTA Connect. However, they can report a new non-recurring medical expense.

Clients can add new medical expenses regardless of recurrence.

Rules/Procedures for TAFDC, EAEDC, or Combo Cases

Health Insurance Information

At any time, if a TAFDC, EAEDC, or combo client uses DTA Connect to add a new health insurance or update an existing health insurance record, they will appear on the Client Info Update DTA Connect view (My Office > Views > Daily Priority Actions).

Clients who have private health insurance must provide DTA with the Insurance Provider name and policy number to meet TAFDC and EAEDC requirements. The client cannot enter the policy number in DTA Connect, so you must contact the client to obtain the policy number. Follow the steps below:

Attempt two cold calls to the client.

If one of the calls is successful, obtain the health insurance policy number, consider the information self-declared, verify the information in the verification tab and wrap up the case.
If both cold calls are unsuccessful, send a mandatory VC-1 for Health Insurance Information. The VC-1 will now include a new item called Proof of Health Insurance Information. For combo cases, the VC-1 will include the mandatory Health Insurance Information item for cash and the regular optional Medical Cost item for SNAP. If the client does not follow up with verification, the record cannot be updated. The case manager must document in the narrative that the client did not follow-up and close the case for “Failure to Submit Verifications”.

Medical Expense Information

At any time, if a TAFDC, EAEDC, or combo client uses DTA Connect to add or edit medical expense(s) to maximize their SNAP benefit amount, they will appear on the Client Info Update DTA Connect view (My Office > Views > Daily Priority Actions).

To enter medical expense information on a combo case, follow the procedures below for SNAP-Only Cases in the FAW Model.

Note: It is important to emphasize to combo clients that even if they have MassHealth, reporting out of pocket medical expenses that are over $35 monthly, including mileage and travel expenses, may result in higher SNAP benefits if they are not already receiving the maximum SNAP benefit for their household.

Rules/Procedures for SNAP-Only Cases in the FAW Model

During case maintenance, if a SNAP-only client in the FAW model uses DTA Connect to add or edit medical expenses, BEACON will autowrap the changes and recalculate the case if the reported medical expenses:

are greater than $35 and less than (or equal to) $190 per month;
are only recurring;
do not include health insurance on a family plan; and
do not include mileage for medical-related travel.

If one of these conditions is missing, BEACON will create one of the following Actions to review the client’s case:

Action	Reason	Follow-up
DTA Connect – Family Health Insurance	The client reports private health insurance or MassHealth, and indicates that the insurance is on a family plan.	Follow the procedures detailed in Health Insurance Costs.
DTA Connect – Medical Expense Mileage	The client reports medical expenses that include the cost of medical-related mileage.	Follow the procedures detailed in Transportation Related Costs.
DTA Connect – Medical Expense Non-recurring	The client updates their non-recurring medical expenses.	Follow the procedures detailed in Non-recurring Medical Expenses
DTA Connect – Medical Expenses greater than $190	The client reports medical expenses that results in the household’s total medical expenses exceeding $190 per month.	Follow the procedures detailed in Standard Medical Deduction Waiver.

After applying the appropriate procedures, you must complete or dismiss the Action.

Reporting Monthly Medical Under $35 or Above $190

If a client adds medical expenses and the monthly total is under $35 or over $190, DTA Connect will display a pop-up message. The message will either tell them to review/report any other medical or health costs not directly covered in the medical expense question flow, or that they must submit verification to be credited with medical expenses above $190 per month.

Electronic Self-Declaration of Medical Expenses on DTA Connect

If a client uses DTA Connect to update their medical expenses and the total amount goes from $0 or SMD to Actuals (i.e., above $190 per month), DTA Connect will prompt the client to electronically sign a self-declaration (i.e., medical attestation) that their medical expenses are at least $35 per month. This will permit BEACON to autowrap the case if the client’s total reported medical expenses are less than or equal to $190 per month, or for staff to credit the household with the SMD pending the return of verification that their total medical expenses are above $190 per month.

If staff send a VC-1 for medical expenses above $190 and the client subsequently adds more medical (for themselves or a household member) on DTA Connect before the due date of the VC-1, a hard-edit in DTA Connect will prevent them having to re-sign the electronic self-declaration.

Reporting Medical-Related Travel (Unrelated to Mileage) on DTA Connect

Medical travel-related costs reported by clients via DTA Connect include:

Parking/tolls
Any other transportation (public, Uber/Lyft, The Ride)

These changes are autowrapped in BEACON after an overnight processing batch (given that any other changes the client has made via DTA Connect that day also met autowrap conditions). These travel-related expenses are automatically calculated, entered as a medical expense record, and autowrapped in BEACON based on the client’s responses to the prompted DTA Connect travel questions (e.g., if travel was roundtrip, the number and frequency of trips taken).

As it takes a batch job for BEACON to perform any necessary calculation for travel expenses reported via DTA Connect, always refer to the Medical record(s) in BEACON to see the fully calculated medical expense/deduction factored in the case.

The client’s travel expense indicated on the Medical web form/datasheet and on the client’s initial Medical summary on DTA Connect will resemble how the client initially reported the expense via DTA Connect.

Example

Lisa (she/her) reported that she orders an Uber to help transport herself to and from a doctor’s appointment. Lisa indicated paying $10 for each one-way trip, taking a roundtrip, and ordering the Uber 2 trips monthly.

BEACON will perform the following calculation for the entered medical expense “Any other transportation (public, ride)” record as:

$10 (each one-way trip) x 2 (roundtrips) x 2 (trips monthly) = $40 = Prospective Amount.

Lisa’s medical expense “Any other transportation (public, Uber/Lyft, The Ride)” record would be initially included on the datasheet as $10 Monthly. However, after the batch run, the client’s Medical Expense will change and display accurately as $40 Monthly on DTA Connect and on the Medical Expense page in BEACON.

End Date When Client Uses DTA Connect to End Existing Medical Expense

If a client uses DTA Connect to end an existing medical expense, the end date in BEACON will be the date that the client ended the expense. The case will be autowrapped and a notice sent if there is a change to their SNAP benefit amount.