Medicaid Policy
Medicaid Policy
Reportable Changes During the Certification Period
Recipients are not required to report all changes in circumstances. During the 12-month certification period, only act on the information when the enrollee requests a Medicaid determination, asks for a new income determination, or the reported change is an exception to the 12-month certification period (1008). See 815 and 1009 for information about reporting changes.
Recipients must report the following changes in household circumstances within ten (10) days during the certification period:
A change of address within the state.
A recipient household member moves out of the household.
A recipient household member moves out of the state.
A recipient becomes a resident of an institution.
A recipient household member becomes covered by or gains access to Medicare.
A recipient household member becomes covered by or gains access to the Veteran's Health Care System.
A recipient gains access to new employer-sponsored or COBRA health insurance coverage.
A recipient loses his employer-sponsored or COBRA health insurance (1003-1).
A recipient changes insurance plans.
Change in health insurance plans need to be reported within 10 days from either the day the recipient signs up or the date coverage begins, whichever is later. (See Section 1003-4, B)
There is a change in the premium amount an UPP recipient is required to pay.
A recipient enrolls in any other kind of health insurance coverage other than the employer-sponsored or COBRA coverage.
A recipient's health insurance plan no longer meets the definition of an 'UPP Qualified Health Plan' (1003-1).
Semiannual Insurance Confirmation
The Office of Recovery Services (ORS) will confirm the health insurance coverage is still active and there are no changes in covered individuals.
If ORS verifies there are no changes to the health plan or covered individuals, the UPP payments will continue.
If any of the following changes occur, ORS will notify the eligibility agency to take action on the case (1009):
The health insurance coverage has ended;
There are changes to the health plan benefits, including who is covered; or
The status of the health insurance cannot be verified.
If ORS cannot verify the health insurance status, the eligibility agency must request the necessary verification from the member.
o If the member does not provide all requested verification by the verification due date, the eligibility agency ends benefits for the first month it can give proper 10-day notice.