All Medicaid Programs |
Obsolete Policy |
CONDUCTING REVIEWS FOR JANUARY, FEBRUARY AND MARCH, 2014 FOR MAGI-BASED PROGRAMS
· Pre-printed reviews will be mailed to all clients unless they have opted for paperless access and they complete all requirements through MyCase.
· There is no signature requirement.
· Apply the ‘due process’ policy to extend eligibility when appropriate.
· Use the MAGI rules first to determine eligibility. If the individual remains eligible, re-certify the program for 12 months.
· If the individual fails eligibility using MAGI rules, apply 2013 rules for each program. If the client passes eligibility, re-certify the program through March 2014. Re-determine eligibility for April 2014 using MAGI rules only.
o If the client is eligible for April 2014 under MAGI rules, recertify for 12 months.
o If the client fails eligibility under MAGI rules for April 2014, close the case.
· If the individual fails using the 2013 rules, close the case. The client will need to re-apply.
· If a program closes at review for incomplete review, including not providing requested verification, allow 3 months for the client to respond without having to complete a new application.
o During these 3 months, treat the request from the client to complete the review as a new application.
o Application processing period applies.
o Approve retroactive eligibility back to the closure date if the client remains eligible.
Review Requiring Client Participation
Clients have the option of completing the review on-line or receiving a mailed paper form. The review form must be pre-populated with the most current information from electronic records. The review form is provided to the household early enough to allow the recipient time to provide the updated information to complete the review during the review month.
The review form will explain what the client is required to do to complete the review process and the due date for responding. The client must return the paper review, complete the review process online or contact the eligibility agency by phone or in person. A signature is not required.
If the client responds by the due date, or sometime during the review month, request needed verification from the client. The agency must send a written request and give the client 10 days to provide the verification.
If the client does not return all requested verification by the due date, eligibility ends at the end of the month for which the eligibility agency can give 10-day notice.
The client has three months after the effective closure date to complete the review without having to complete a new application. Process the contact as a new application. (See 703)
If the agency cannot give 10-day notice before deciding eligibility for a new certification period, the agency must extend benefits to the following month. This is called the due process month.
Extending eligibility into the due process month does not cause an overpayment if the client was eligible in the review month. However, failure to report a change that occurred before the review month that would have caused a change in eligibility for the review month could result in an overpayment for the review month and the due process month. See Section 825-5
If the client provides all requested verification by the verification due date, the eligibility agency proceeds with the eligibility decision.
The agency continues eligibility into the following month (the due process month), if needed, while it makes a decision.
Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give 10-day notice.
If the client provides all requested verification after the due date and before the end of the review month, proceed with the eligibility decision.
The agency continues eligibility into the following month (the due process month), if needed, while it makes a decision.
Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give 10-day notice.
If eligibility is continued into the due process month, the client must provide all requested verification by the verification due date.
If the client provides all requested verification by the due date, complete the review and send notice of the eligibility decision. Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give 10-day notice.
If the client fails to provide all requested verification by the due date, close the case and send proper notice.
If the client provides all requested verification after the verification due date and before the end of the due process month, the date the verification is received is a new application date. The new benefit effective date is the first day of the month after the due process month.
If an overpayment investigation determines individuals were not eligible in the review month and a due process month was established, the referral must include the due process month.
Client fails to complete review process
If the case closes because the client fails to complete the review, eligibility ends at the end of the month in which proper notice can be sent. The client has three months from the date of case closure to complete the review without submitting a new application. (If eligibility is extended to the month after the review month, the three month period begins after the second month.)
The benefit effective date will be the first day of the month in which the client contacts the agency.
The client may request retroactive coverage following the rules in Section 705.
No interview or application form is required.
Eligibility does not continue while the agency makes a decision.
Application processing time applies.