Viewing Product Delivery Decisions

Decision screens are available which display the results of an eligibility decision for each insurance affordability program. These provide a detailed overview of the eligibility decision for each household member in a product delivery case. Cúram Express Rules (CER) are used to define the display rules which determine what is displayed based on whether rules or rule groups are satisfied or not. Eligibility for each program is assessed against a common set of factors, and these factors are grouped accordingly on the decision screen. The decision details provide the user with high level summary of eligibility or ineligibility for a program, as well as the ability to drill down to view members eligibility or ineligibility and reasons for that determination.

A standard set of decision screens are available for each of the insurance affordability programs - overall summary, non-financial summary and an income summary

Category	Summary Information Presented
Eligibility Summary	Displays pass/fail for Income and Non-financials
Program-specific summary for Streamlined Medicaid	Eligible members and the coverage category for which they are eligible, e.g., parent/caretaker, child, pregnant woman, adult, former foster care recipient
Program-specific summary for CHIP	Coverage cost, including the monthly premium and the maximum co-payment limit.
Program-specific summary for Insurance Assistance	Benefit unit and assistance details; including the premium tax credit and cost sharing reduction
Excluded Members	Household members that are excluded from the determination of program eligibility are displayed along with the exclusion reason. For example, members that are eligible for Medicaid coverage are displayed as excluded members in the CHIP program, with the exclusion reason: 'Eligible for Medicaid'.
Exempted Members	Members of American Indian/Alaskan Native origin are exempted from the CHIP coverage cost.

The non-financial summary includes a high level eligibility summary per member for each of the areas assessed within the non-financial rules for that program

SSN, Residency and Citizenship are displayed for Medicaid and CHIP
Residency, Citizenship and Incarceration are displayed for insurance assistance

An income summary is also presented which reflect the income requirements of each program. For Medicaid, CHIP and insurance assistance, the income summaries include the following types of information:

Financial Units (for Medicaid financial units are formed for each member of the case, for CHIP financial units are formed around each child) including whose income in the unit is counted or not counted
Tax Household (Insurance Assistance) - lists members in the tax household
Income - providing a summary of the income and the income calculations used in the eligibility determination. These vary according to the source of income used in the calculations. Income eligibility provides a summary per member including the household income, the household size, the FPL for that household size, and the income as a percentage of the FPL