All Medicaid Programs |
Obsolete Policy |
Reporting Requirements
A Medicaid recipient or his/her representative is responsible to report changes that may affect eligibility. The client must report within 10 days of the date of the change. Section 107-4 describes changes that must be reported.
If the 10th day is a non-business day, the due date for reporting a change is the first business day following the 10th day.
Changes may be received from a source other than the recipient.
Follow the 10*10*10 rule.
The recipient has 10 calendar days to report a change from the date the change occurs;
The agency must take action on the reported change within 10 calendar days of the report; and
The agency must provide a 10-day advance notice of a negative action.
Taking Actions on Changes
Workers must decide what action to take when a change is reported. The worker must take the appropriate action within 10 days of the report date.
Do not take action on income or household changes for individuals eligible for Poverty-Level Pregnant Woman.
If a woman eligible on a different coverage group reports a pregnancy, move her to the Poverty-Level Pregnant Woman coverage group. If she was on a medically needy coverage group, do an income determination for Poverty-Level Pregnant Woman coverage.
If she is on Blind or Disabled Medicaid (other than medically needy), the woman can choose to move to Poverty-Level Pregnant Woman or stay on Blind or Disabled Medicaid. If she stays on Blind or Disabled Medicaid, her coverage is still guaranteed through the 60-day post-partum period.
The worker must use available current electronic data sources to verify the change before requesting information from the client.
If verification is needed to determine ongoing eligibility, send a written request to the client for the needed verification. Give the client at least 10 days to provide the verification. See Section 731-3 on what is acceptable verification.
If the 10th day is a non-business day, the due date is the next business day.
If the agency requests verification of citizenship or U.S. National status from the client, see section 205 for the verification time period.
Once the agency has enough information, update eligibility and send a notice of decision.
If there is an increase in the spenddown, cost of care or MWI premium, the effective date of the change is the first day of the month after the month in which proper notice is sent.
If not eligible, the effective date of the change is the end of the month in which proper notice is sent.
If the client fails to provide all requested verification by the due date, close the case effective the end of the month in which proper notice is sent.
If a change causes a recipient to lose eligibility for a medical program, the agency will determine eligibility for other medical programs. Client information will be sent to the FFM if no longer eligible.
Mail returned by the post office with no forwarding address indicates a change. See Section 811-4 to decide what steps to take.
If there is a change in allowable deductions, the effective date of the change will depend upon whether the change will cause an increase or decrease in benefits.
If the client requests medical coverage for a household member who is not receiving medical assistance, treat the request as a new application. Verify all factors of eligibility for that individual.
When making a change, do not set a new 12-month certification period unless all factors of eligibility have been verified.