All Medicaid Programs |
Obsolete Policy |
Reporting Household Composition Changes
The 10*10*10 rule says that a recipient has 10 calendar days to report a change from the date he learns of the change, the agency has 10 calendar days to take action on the reported change, and the agency must provide a 10 day advance notice of a negative action.
A client has reported the change on time if the agency receives the report by the close of business on the 10th day after the client learns of the change. If the 10th day is a non-business day, the client has until the close of business on the first business day after the 10th day. This same requirement applies to the due date for returning verifications.
Taking Actions on a Change
A New Household Member Moves In
When a new person joins the household, the worker may ask the recipient to complete an Application for Additional Persons (Form 61-C). However, do not require the form if you have enough information to determine eligibility.
If the new person wants medical assistance, the date of report is the date of application for that person. (See section 703-2) Use this date to determine eligibility for the retro period if the new household member has past medical bills. (See section 705-2 to determine the retroactive period.) The household has 30 days from the date of report to provide the information and verification needed to add the new person to an existing program or determine eligibility for a new program. For Blind and Disabled programs, the person has 90 days. If the 30th or 90th days are non-business days, the household has until the business day following the 30th or 90th day to provide the information and verification.
When someone moves into the household, determine how the change affects the household's eligibility for existing programs. Decide if that person's income or assets must be counted or deemed.
For ABD Medicaid cases decide how the change affects countable income. For example, you may need to deduct an allocation for a parent or child from income of a parent or a spouse because of the new household member. (See Medicaid, Sections 412 and 413 for income deeming, and 585 for asset deeming.)
If the new person makes the household or a family member ineligible for an existing program, close the program and give 10 day notice. Review eligibility for other medical assistance programs. (827) Do not request a new application; however, all procedures relative to a new application still apply.
If the new person is a spouse, he may receive Medicaid coverage for that month if eligible. Add the new person's income for that month to the other spouse's income for that month.
For an ABD couple, decide if the household meets the 100% of poverty income limit or must spend down to the 100% poverty income level before the new person can receive coverage. (Coverage as an SSI recipient, under an SSI protected group, or under the Medicaid Work Incentive program are also possibilities.)
For Family Medicaid, decide if the household still passes the income limit, or if a spenddown is owed.
If adding the spouse does not cause an adverse change in eligibility, add the spouse for the month of application. Coverage for the retroactive period is possible if the spouse entered the household during the retroactive period. (If a spouse did enter the household during the retroactive period, an overpayment may occur because of an untimely report.)
Adding the spouse to the case could cause a spenddown, or an increase in the spenddown, for the other spouse.
For the application month, and possibly the next month, tell the clients of the change. Find out if they want to meet the spenddown (or additional spenddown) so that the new spouse can receive Medicaid. If the couple wants to pay the spenddown or additional spenddown to cover the new spouse, make the change and notify them of the amount owed.
If they do not want to pay the spenddown, do not change coverage for the current recipient until you can give 10-day notice. Add the new spouse for the first possible month that you can give 10 day notice.
If the couple must pay a spenddown, and does not do so, close the case. Review eligibility for other medical assistance programs, particularly the Medicare Cost-Sharing programs if one or both spouses have Medicare. You do not need a new application; however, all procedures relative to a new application still apply.
Adding a Newborn Baby
If a household is receiving Medicaid but did not report and add the unborn to the Medicaid coverage before the birth, determine eligibility for the newborn baby. Use the date the household reports the birth as the date of application.
Go back to the date of the birth as long if it is within the retroactive period. If the birth date is before the beginning of the retroactive period, add the baby back only to the date the retroactive period begins. (See section 705.)
If the baby's mother was eligible for a Utah Medicaid program in the month the child was born, the baby is eligible for the MAGI Child Under One program until the baby's first birthday. (See sections 347 and 349)
An Eligible Member Leaves The Household or a Non-Disabled Child Turns 18.
Determine how the change affects eligibility for programs that are currently open or if the change could make the household eligible for another program.
For ABD programs, when deeming income from a parent or spouse and a non-disabled child turns 18, decide if the allocation for the child must stop. If the 18-year-old child is still a student regularly attending school, college or a university and the absence is temporary, the allocation may continue until the child either turns 22 or stops regularly attending school. (See sec. 405-4 - earned income exclusion, 413 - parental deeming, and 215-2 - temporary absence.)
The following questions can help you decide how the change affects the household.
Is the household member who left the only dependent child in the household?
Are the children in the household now deprived of parental support because a parent has left the home?
Is the household member who left only temporarily absent? (215-2)
Was the household member who left an aged, blind or disabled spouse?
Was income being deemed from the person who left the household?
Did the person who left the household enter an institution? (215)
How does the change affect the household?
If the change does not affect the eligibility for the rest of the household and there is time to give 10 day notice, remove the individual from the Medicaid case effective next month. If there is not time to give proper notice, remove the individual effective the following month.
If the change makes anyone in the household ineligible for a program that is currently open, close the program giving 10 day notice. Consider eligibility for other medical assistance programs. A new application is not necessary; however, all procedures relative to a new application still apply.
If the household does not report a change in household composition within 10 days of the change, an eligibility payment error may have occurred. See section 825.