Medicaid Policy
Medicaid Policy
A. Reports of Change of Address
1. When a household reports a change of address or a new address is obtained through electronic verification, update the case record with the new information.
2. If the member has moved out of state, the case can be closed without 10 day notice.
3. If correspondence or the Medicaid card was mailed to the wrong address, resend them to the new address.
4. If you received returned mail with no report of a new address, see Sec 811-4.
5. Request any information needed to determine the effect of the change, such as whether the member is paying their fair share of household expenses.
6. When a household reports a change of address, provide the household with voter registration information. (See Section 109)
B. Additional Considerations for Members Receiving Nursing Home Medicaid
1. Transfer to Another Medical Institution
When a member leaves the nursing home to enter a hospital, you must determine if the hospitalization will be short or long term and if the member is expected to return to the same nursing home, a different nursing home, or not return to a nursing home at all.
2. Short term hospitalization
For determining continued residency in a nursing home, short-term hospitalization is defined as any month during which the recipient is a resident of a nursing home and is discharged to a hospital and then returns or is expected to return to the nursing home by the end of the next month.
a. If a member is in short term hospitalization and intends to return to the same nursing home, the nursing home will continue to collect the contribution to cost of care.
b. If a member is in short term hospitalization and intends to return to a different nursing home, contact that nursing home to verify. The new nursing home will begin to collect the contribution to cost of care beginning in the following month. The former nursing home already collected it in the transfer month.
c. If a member is in short-term hospitalization and does not intend to return to a nursing home, follow the instructions about discharge from a nursing home in section 833.
3. Long-Term Hospitalization
Long-term is continuous in-patient care beyond a second month of hospitalization.
a. The nursing home will collect the contribution for cost of care for the month of discharge to the long-term hospitalization. No action is required by the eligibility worker for that month. The nursing home will determine the member's cost by taking the per diem rate and multiplying it by the total number of days the member was in the nursing home. They will send any excess money collected as contribution to cost of care to ORS.
b. Change the member's address from the nursing home to another address where you know the member will be able to receive the card.
c. While in the hospital, the member must pay the contribution to the cost of care to the DWS office. As long as the member is not enrolled in a health plan, the member can also use incurred medical bills to meet the cost of care once the worker has changed the 'Type of Institution' to Hospital. Inform the member or representative of the cost of care amount and inform them of the incurred medical bills option. If the hospitalization is not reported timely, refer an overpayment.