Medicaid Policy
Medicaid Policy
A. Who Must Be Asked To Cooperate With ORS/CSS
Medicaid applicants and recipients must be asked to cooperate with the Office of Recovery Services/Child Support Services (ORS/CSS) to establish paternity for children born out of wedlock and to initiate and/or enforce medical support orders to collect payment for medical care from any third party. This includes parents and non-parent specified relatives who are applying for or receiving Medicaid for a child, unrelated caretakers or guardians applying on behalf of a child, and children applying on their own behalf.
In most cases, parents and non-parent caretaker relatives must cooperate or they are not eligible to receive any type of Medicaid coverage for themselves. Ask the following people to cooperate.
1. Natural, adoptive or stepparents of a child for whom they are requesting or receiving Medicaid. This includes minor parents under age 18. (See exceptions listed in B. below.)
2. Non-parent specified relatives of a child for whom they are requesting or receiving Medicaid. (See exceptions listed in B. below.)
3. Unrelated caretakers or guardians of a child for whom they are requesting or receiving Medicaid; however, do not sanction an unrelated caretaker or guardian for non-cooperation. (See exceptions listed in B. below.)
4. A child who does not live with a specified relative or adult guardian, who is applying for or receiving Medicaid on his/her own behalf; however, do not sanction an unemancipated child for non-cooperation. (See exceptions listed in B. below.)
B. When is it Not Necessary to Complete an ORS/CSS Application
1. A different referral process (415-5) has been established for children in certain living arrangements. Do not complete an ORS/CSS application on the absent parent(s) for the following children:
o Children placed in foster care;
o Children in the Utah State Hospital (USH);
o Children in the Utah State Development Center (USDC);
o Children in nursing homes;
o Children in community placements;
o Children in the custody of the Division of Youth Corrections; and
o Children who are residents of institutions or on an HCB waiver requiring 24 hour out of home care.
2. Parents of children residing in institutions are responsible for child support. Tell the parent that ORS will contact them later about payment of the child support obligation. Also, give the parent a copy of the pamphlet Utah-DHS ORS PM 604, Parents Child Support Obligation for Children in Care.
3. The requirement to complete an ORS/CSS application does not apply to all children who receive Medicaid or who reside in Medicaid households. Do not complete an application on the parents of children described below:
o Children receiving Refugee Assistance;
o Children receiving SSI or a State Supplemental Payment;
o Children living with both responsible parents, and there is no absent parent;
o Children living in the household who are not applying for or receiving Medicaid; and
o Unborn children.
4. Unemancipated children, including minor parents
a. Request a minor parent complete Duty of Support procedures against the absent parent of her child. Do not sanction an unemancipated minor parent who refuses to complete the Duty of Support procedures.
b. If a minor is not living with both parents, request that the minor complete Duty of Support procedures against the absent parent. Do not sanction an unemancipated minor parent who refuses to complete the Duty of Support procedures.
o If possible, when a minor is unemancipated, contact the absent parents or stepparents of the minor parent to determine whether or not they are providing support. You may use Form 544, Statement of Non-Support, for this purpose. Alternatively, you may contact the parents by telephone. If it is not possible to contact the parents or stepparents, document why the contact could not be made.
5. Children over age 18 who do not live with their parents
a. A child who is 18 or older and is not living with parents is not required to complete Duty of Support against the parents.
b. If a child is age 18 or older and is a parent, the child must cooperate with Duty of Support against the absent parent of her or his child.
6. An individual receiving the Medicaid Cancer Program (390).
C. Pregnant Women and Medical Support Enforcement (MSE)
Do not require a pregnant woman to cooperate with MSE until the month after her 12 month postpartum period ends.
1. Provide the pregnant woman with information regarding the benefits of establishing paternity and obtaining support from the absent parents.
2. At the end of the 12 month postpartum period, determine her eligibility for other medical programs (827).
3. If eligible for a Medicaid Program she must comply with MSE requirements.
a. Send the form 619M to her and give her 60 days to comply with MSE.
b. If she does not comply with the requirements and does not wish to claim good cause (227-3 & 227-4), apply the sanction for failure to comply (227-6).
c. If she was sanctioned prior to her most recent pregnancy for non-cooperation with MSE requirements, she does not get an additional 60 days to comply. Send the form 619 M and apply the sanction.
d. She must comply for all children who are receiving Medicaid, if they have a parent absent from the household.
D. Initial Cooperation
An applicant must indicate on the application whether she intends to cooperate with medical support enforcement. If the applicant indicates an intent to cooperate, she has met the initial requirements.
If an applicant indicates that she will not cooperate, refer to E. on steps to take.
E. What the Eligibility Worker Must Do
1. New Cases -
a. If an applicant states an intent to cooperate:
i. Send the member the form 619M, which explains the MSE requirements. It also explains the option to claim good cause (227-3).
ii. When all the factors of eligibility are met, complete an eligibility decision.
iii. Allow the individual 60 days from the date of approval to comply with MSE requirements.
b. Once the applicant is determined eligible, she is a recipient and must complete the support enforcement requirements. Follow the procedure: Medical Support Enforcement – ORS Referrals, to determine the steps that a recipient must take to be considered cooperating.
c. If an applicant states she does not intend to cooperate, mail the form 619M giving her 10 days to claim good cause. If she does not cooperate or claim good cause by the due date, she is not eligible for medical assistance. Deny her Medicaid program and give her proper notice.
2. Reopening Cases -
a. When reopening a Medicaid case within 60 days of the closure for someone who has already cooperated, use form AREN, Notification to ORS/CSS of DHHS or DWS Case Reinstatement, to notify ORS/CSS that the case will be reinstated. It is not necessary to have the applicant complete a new ORS/CSS application.
b. When reopening a case that has been closed for more than 60 days, the individual is an applicant. Refer to E.1. for applicants.