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.
If the change is not reported timely, determine if an overpayment occurred and refer if appropriate (825).
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, determine eligibility for the Poverty-Level Pregnant Woman coverage group.
For 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 postpartum period.
If verification is needed, send a written request to the client and give the client at least 10 days to provide the verification (731).
Once the agency has enough information, update eligibility and determine the effective date of the change per Section C below.send a notice of decision.
If verification is not provided 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, the agency will determine eligibility for other medical programs. Client information will be sent to the FFM if no longer eligible.
Do not set a new 12-month certification period unless all factors of eligibility have been verified.
For a change in address, see 815-1.
For a change in household composition, see 815-4.
For a change in income, see 815-5.
Effective Date of a Change
If a change is adding a new individual to a Medicaid program, application policy and time frames apply (703)
If a change makes a household member eligible for a better program, decreases a spenddown, MWI premium or the cost of care, the effective date is:
The month of report, if verified timely; or
The month verified, if not verified timely.
If a change causes a household member to lose eligibility, increases a spenddown, MWI premium or cost of care, the effective date of the change is the first day of the month after proper notice is sent.