Medicaid Policy
Medicaid Policy
Reporting Requirements
The UPP recipient must report changes which may affect eligibility within 10 days of the change. Changes in household composition and health insurance availability are among the changes that must be reported. See Section 1009-1 for a description of changes that must be reported.
If the 10th day is a non-business day, give the member until the first business day following the 10th day.
A report of a change or other information may be received from a source other than the recipient.
The eligibility agency may accept client statement for all change reports except for claims of citizenship and immigration status. (See Section 731)
Taking Actions on Changes
Reported changes must be evaluated to determine if they could affect eligibility during the 12-month certification period. See section 1004 to determine countable income.
Only act on the information when the enrollee requests a Medicaid determination or the reported change is an exception to the 12 month certification period. (See Section 1008)
Workers must use available electronic data sources to verify the change before requesting information from the member. (See Section 751)
If continued eligibility cannot be determined by electronic data match, then the agency must request the necessary verification from the member.
Workers must only request required verifications needed to determine eligibility.
The agency must follow the 10*10*10 rule.
The agency must take action on the reported change within 10 calendar days of the report.
The agency must give at least 10-days from the date of the notice to provide verifications.
If the 10th day is a non-business day, give the member until the first business day following the 10th day to provide the verification.
The agency must provide a 10-day advance notice on all changes unless the change meets an exception to the 10-day notice.
Ending or decreasing the UPP payment is treated as an adverse action even if the member is moving to Medicaid or CHIP.
If the member does not return all requested verification by the verification due date, the eligibility agency ends benefits for the first month it can give proper notice.
The individual must re-apply during the next UPP open enrollment.
If the member provides all requested verification by the verification due date, or by the end of the report month, whichever is later, the agency continues with the eligibility determination.
For an adverse action, make the change for the first month that the eligibility agency can give proper 10-day notice.
If the change increases the UPP payment, or there is no change in benefits. Make the change effective the month immediately following the change report month.
If the member request a Medicaid determination and is found eligible for Medicaid program without a spenddown or MWI premium, remove the Medicaid eligible individual from UPP in the first month that the eligibility agency can give proper 10-day notice.
At times the member may have dual coverage with UPP and another Medicaid program.
If the eligibility agency receives all of the verification after the effective closure date, and before the end of the month immediately following the closure, it is a new application.
A new application form is not required.
Waive the enrolled in insurance rule.
Open enrollment is waived for the month immediately following closure.
All factors of eligibility must be met.
The agency may begin a new 12-month certification period if it has verified all eligibility criteria after a member change report.
The electronic member information will be transferred to the FFM when UPP is closed.
Mail returned by the post office with no forwarding address indicates a change. See section 811-4 to decide what steps to take.
When a household reports a change of address, provide the household with voter registration information. (See Section 109 for voter registration requirements).