All Medicaid Programs |
Obsolete Policy |
All Medical Programs
Before closing a Medicaid case, review the case for eligibility under other medical assistance programs for each recipient. This includes Medicare Cost Sharing programs (Sec. 320), Children’s Health Insurance program, UPP or Primary Care Network, if applicable.
Complete this review unless a client says he no longer wants any medical coverage, has moved out of state, cannot be located, or is deceased. Complete the review without contacting the client unless you need more information or verifications to determine eligibility. Send a notice asking for the needed verification within 10 days of the date you take action to close the case. The client does not have to complete a new application. However, all procedures and time frames relative to a new application still apply.
See the policy for CHIP, UPP or PCN to decide if you can move someone from Medicaid to either CHIP, UPP or PCN when it is not an open enrollment time. If a household member is on CHIP, UPP or PCN, and is no longer eligible for such program, decide if he could be eligible under a different medical program.
If some household members qualify for another medical program and others do not, notify the client of who qualifies and who does not. If the client could qualify for Medicaid with a spenddown, notify the client of the amount of spenddown. The notice needs to tell the client how a spenddown can be met and the time limit to meet the spenddown. If a client who would have to pay a spenddown could qualify for CHIP, UPP or PCN, tell the client about such option so the client can decide what program he wants.
Close a case only when the household no longer wants any kind of medical assistance or when you determine that a household is no longer eligible for any medical assistance program.
If you cannot give 10-day notice for any adverse actions, continue benefits to the following month. See Section 811 for exceptions to advance notice requirements. Do not extend benefits for recipients on time-limited programs who have reached the program time limit or have aged off the program. See Section 721-4 for a list of these programs.
Continued Coverage for Pregnant Women
A woman who, while pregnant, receives coverage under any Medicaid program, will remain eligible for Medicaid for the duration of her pregnancy and through the end of the month in which the 60-day post-partum period ends. She must still be a Utah resident and not be a resident of a public institution. It may require that she change coverage groups, but do not require a new income redetermination to move her to a different coverage group.
Example: If a woman becomes pregnant while on the Child program, she should transition to the Pregnant Woman program if she turns 19 during the pregnancy.
A pregnant woman who has a change in her household income will continue to receive coverage without regard to such change of income for the duration of her pregnancy and through the completion of the month in which the 60-day post-partum period ends. If needed, move the woman to the Pregnant Woman program for the duration of the pregnancy and post-partum period without conducting a new income determination.
A pregnant woman who is determined to be eligible for the Pregnant Woman Medically Needy program, must pay a spenddown each month to remain eligible for coverage under that program.
If the woman’s income increases, the spenddown amount cannot increase above the amount that was originally calculated when the program was approved.
If income decreases below the poverty limit for pregnant women, move her to the pregnant woman program.
See Sec. 349.
Additional Considerations for SSI Recipients
There are certain steps you must follow when an SSI recipient stops receiving SSI payments. Decide why SSI payments stopped. Then review 303-6 to decide if the client can qualify for another Medicaid program. Review eligibility for Protected SSI programs first. (330 forward) If the client does not qualify for a Protected SSI program, decide if he qualifies for any other medical programs before closing the case. Notify the client and narrate what actions you took.