All Medicaid Programs |
Obsolete Policy |
Previous Policy
SPECIAL RULES FOR CHANGE REPORTS:
An individual must have been eligible for benefits on December 1, 2013. An individual has not completed a review in 2014.
· When a client reports a change in income or household size before the end of the certification period, use MAGI methodology to determine on-going eligibility.
o The worker will need to gather household tax-filing information. (340-1 B)
· If there is no change in eligibility using MAGI methodology, continue benefits but start a new 12 month certification period.
· If the client is no longer eligible using the MAGI calculation, use the 2013 rules to determine eligibility.
o If the client is eligible using 2013 rules, continue benefits with the original certification period.
o If the client is not eligible using 2013 rules, close the program with proper notice and consider the following options:
§ If the client is a child, check eligibility for CHIP.
§ Check eligibility for a Family Medically Needy program. This may require additional verification from the client.
Make a referral to the Federally Facilitated Marketplace (FFM).
Reported Income Change
The 10*10*10 rule says that a Medicaid household must report a change of income within 10 calendar days from the date 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 falls on 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.
The agency may learn of a change in income in other ways such as computer matches with the Job Service screens, Social Security interface screens, unexplained deposits on bank statements, etc. For Nursing Home cases, see section 833.
When to Take Action on Reported Income Changes
Workers must take action within 10 days of the date the agency receives a report or learns of a change in income that could affect eligibility, spenddown amount or Work Incentive premium.
If an income change results in an increase in the spenddown or MWI premium, or causes anyone in the household to be ineligible, the agency can take action within 10 days AND the agency can give 10-day notice, make the change effective for next month.
If 10-day notice cannot be provided, make the change effective the following month.
A worker may choose to take action in less than 10 days if workload permits and the worker can give proper 10-day notice. A worker shall take action on a change as soon as possible, but no later than 10 days after learning of the change.
If the income change results in case closure, determine if any household members would be eligible under any other medical assistance programs. A new application is not required; however, all procedures relative to a new application still apply
If an income change results in a decrease in spenddown or MWI premium, or no spenddown, the agency must make the change effective the month following the month of report. The client must return necessary verifications by the end of the report month, or by the close of business on the day that is 10 days after verifications are requested. (Refer to #2.B. below.) Ten days advance notice is not required to make a change that benefits the client.
When To Take Action If Verification is Required
If the agency needs verification of an income change from the recipient, the agency will send a notice requesting verification. The agency will allow 10 days for the recipient to provide it. The worker must request any needed verification within 10 days of the reported change or within 10 days of learning of the change through another source.
When the information provided by the recipient or other source is reliable and complete enough to determine an increase in the spenddown, MWI premium or case closure, take action effective the month following the month the change was reported IF there is time to give 10-day notice. Do not wait for the verification. Send a notice requesting verification and allow 10 days for the recipient to provide the verification.
When the verification is received, decide if it is different from what was reported. Based on the verification, if benefits need to be changed, make any adjustments for the next month as long as 10-day notice can be given for an adverse change. An increase in benefits does not require 10-day notice.
If the recipient fails to provide the requested verification within 10 days, close the case based on verifications not provided.
An income change may result in an increase in benefits, such as a decrease in the spenddown. If verification is required, send a written request to the household for the verifications. Give the household 10 days to provide verifications. The effective date of the change will be the month following the month the client reports the change, if the verification is received by the end of the report month or within 10 days of the date the verification is requested. After receiving the verifications, adjust the benefits for that benefit month, if needed.
If the verification is not received timely, the effective date of the increase in benefits will be the month following the month in which the verification is received.
Change in Allowable Deductions
If a household reports a change in allowable deductions, make the changes according to whether the change will cause an increase or decrease in benefits, as described in Section 815-5 No. 1 and No. 2.