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Obsolete 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. (See Section 1008) See Section 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. (See Section 1003-1 Definitions.)
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'. (See Section 1003-1.)
Quarterly Insurance Confirmation
The Department of Health will check insurance coverage every three months by contacting the employer to confirm that the plan is the same and there are no changes in covered individuals.
If there are no changes, UPP payments continue.
Changes:
If insurance coverage has ended, DOH will contact the eligibility agency to close the case.
If the plan has changed DOH will contact the eligibility agency to send a new Form 116M. (section 1009-1 A #s 9 and 10)
If the 116M is not returned, close the case
If the 116M is returned, take appropriate action on the change.
If DOH cannot verify the current insurance status through the employer, the eligibility agency must contact the client to provide verification. If the client does not respond timely, close the case with proper notice.