DHHS - Medicaid Policy Manual
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All Medicaid Programs

Obsolete Policy

 

Obsolete 0114 - 227-1 Cooperation Requirements

End Date:  December 31, 2013

 

No Previous Policy

 

 

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 child support and medical support orders.

 

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 will be asked to cooperate.

 

In most cases, parents and non-parent specified relatives must cooperate or they are not eligible to receive any type of Medicaid coverage for themselves.

  1. What The Applicant/Recipient Must Do

  1. Complete an ORS/CCS application packet on any responsible parent absent of a child applying for or receiving Medicaid.

  2. Cooperate and provide the information necessary to establish the paternity of a child born out of wedlock.

  3. Cooperate and provide the information necessary to obtain medical support payments from a responsible absent parent.

  1. Who Must Be Asked To Cooperate With ORS/CSS

  1. Natural, adoptive or step parents of a child for whom they are requesting or receiving Medicaid.  This includes minor parents.  (See exceptions listed in #3 below.)  (See Family Policy, Sec. 465 for more information on minor parents.)

  2. Non-parent specified relatives of a child for whom they are requesting or receiving Medicaid. (See exceptions listed in #3 below.)

  3. Unrelated caretakers or guardians of a child for whom they are requesting or receiving Medicaid.  (See exceptions listed in #3 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.  (See exceptions listed in #3 below.)

  1. When is it Not Necessary to Complete an Application

  1. A different referral process (403-6) 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:

(1)  Children placed in foster care.

(2)  Children in the Utah State Hospital (USH).

(3)  Children in the Utah State Development Center (USDC).

(4)  Children in nursing homes.

(5)  Children in community placements.

(6)   Children in the custody of the Division of Youth Corrections.

(7)   Children who are residents of institutions or on an HCB waiver requiring 24 hour out of home care.

Note:  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.

  1. 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:

(1)  Children receiving Refugee Assistance. 

(2)  Children receiving SSI or a State Supplemental Payment.

(3)  Children living with both responsible parents.

(4)  Children living in the household who are not applying for or receiving Medicaid.

(5)  Unborn children.

  1. Pregnant Women and Medical Support Enforcement

 

For Medicaid, a pregnant woman cannot be required to cooperate with ORS/CCS for born or unborn children while she pregnant or through the end of the month in which the 60 day postpartum period ends.  Although it is not a requirement for a pregnant woman to cooperate, eligibility workers should request that she comply for any born children.

  1. Provide information to the pregnant woman regarding the benefits of establishing paternity and obtaining support from the absent parent of the unborn.

  2. Ask her to cooperate in naming and locating the absent parents by completing the ORS/CCS application packet on the absent parent(s) of any born children who will be included in the Medicaid coverage.  Do not sanction (remove/deny) a pregnant woman from the Medicaid coverage if she does not want to cooperate.

At the end of the 60 day post-partum period, if the mother wants continued coverage for herself she must comply with Medical Support Enforcement requirements for the newborn and for any other children who are receiving Medicaid.  If she refuses to cooperate and does not wish to claim good cause, apply the sanction for failure to comply with Medical Support Enforcement requirements.  (See section 227-3 and 4 for information regarding good cause and 227-6 for information regarding sanctions.)

  1. What the Eligibility Worker Must Do

  1. New Cases

Give the ORS/CSS application packet to the applicant/recipient to complete and return or refer the applicant/recipient to the ORS/CSS worker according to the local office pathway.  Eligibility workers must explain good cause for non-cooperation.  (See Section 227-3.)

  1. Reopening Cases

(1)  When reopening a Medicaid case within 60 days of the closure, use form AREN, Notification to ORS/CSS of DOH 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.

(2)  When reopening a case that has been closed for more than 60 days, require applicants to complete a new ORS/CSS application or refer them to the ORS/CSS worker according to the local office pathway.

Use Form 569 to route documentation to ORS such as good cause information, support orders, court decrees, divorce decrees, etc.