DHHS - Medicaid Policy Manual
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  Medicaid Policy                                                                 

 

107-4 Report Changes

Effective Date: January 1, 2024

Previous Policy

  1. Applicants and recipients must report changes within 10 calendar days of the day they learn of the change.  Failure to report changes timely may create an eligibility payment error (825).  (For information on how to treat reported changes, see section 815.)
  2. The date of report is the date the applicant or recipient tells the eligibility agency through an online reporting process, in person, by telephone, by fax or by mail about a change when that report is received by the close of business.  The agency will date change reports received after the close of business as received on the next business day.  When an applicant or recipient mails information, the business day the agency receives the mailed change report is the date of report.
  3. The change is reported timely when:
    1. The agency receives the information by the close of business on the 10th day after the member learns of the change; or
    2. If a due date for reporting a change falls on a Saturday, Sunday or state holiday, the member has until the close of business on the next business day to report the change.
    3. Change reports delivered to an outreach location at a time when the office is closed will be dated as received on the last business day that an outreach staff person was working at that location.  Based on the date the change report is dated as received at an outreach location, timeliness then follows the rules in A. and B.
    4. If the agency cannot give 10-day notice for an adverse action, it must continue benefits to the following month.  See Section 811 for exceptions to advance notice requirements.  
  4. Applicants and recipients must report the following changes within 10 days of when they learn of the change:
    1. Change of more than $25 in gross monthly income.  (Nursing home and waiver members must report all income changes.)
    2. Change in income source (new source, loss of previous source).
    3. Receipt of a lump sum from any source, such as Social Security benefits, inheritances, insurance payments, accident or injury awards (insurance or court settlements), etc.
    4. Change in assets, such as gaining or losing a vehicle, or opening a bank account.  Members on MAGI-based eligibility groups do not have to report asset changes.
    5. Change of more than $25 in total allowable deductions.
    6. Change in health insurance, such as gaining or losing health insurance, changing to a different health insurance company, premium changes, and changes in the responsibility of a third party to pay medical bills for an applicant or recipient.  (Members have 30 days to report these TPL changes.)
    7. Change in household size.
    8. When a household member experiences a change in pregnancy status.
    9. Change in marital status, deprivation, or living arrangements.
    10. Change in the type of residence, such as entering or leaving an institution, or a change of address.  This includes stays in hospitals or nursing facilities for 30 or more days.
    11. Change in non-citizen status.
  5. There are additional reporting requirements for Medicaid programs using MAGI eligibility rules. Applicants and recipients must report changes in:
    1. Tax filing status.
    2. Number of claimed dependents.
    3. Earnings of a child.
    4. Student status of a child.
  6. Recipients who provide reports, forms, or verifications by any one of the dates listed below have provided the information on time:
    1. When the local office receives the information by 5:00p.m. on the due date; or
    2. When the due date is on a Saturday, Sunday or State holiday, the local office receives the information by 5:00p.m. of the first working day after the due date; or
    3. When the enrollee faxes in the information and the fax date shows it was faxed by the due date by 5:00p.m.
    4. If the agency cannot give 10-day notice for an adverse action, it must continue benefits to the following month. (See Section 811 for exceptions to the advance notice requirements.)