All Medicaid Programs |
Obsolete Policy |
SPECIAL RULES FOR CHANGE REPORTS FROM CLIENTS WHO ARE ELIGIBLE IN DECEMBER 2013 BEFORE A REVIEW IS COMPLETED IN 2014 FOR MAGI-BASED PROGRAMS
· When a client in one of the following eligibility groups reports a change in income or household size before the end of the certification period, use MAGI methodology to determine on-going eligibility. This applies to:
o Parent/Caretaker Relatives
o Children Under Age 19
· 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).
· If a Poverty-Level Pregnant Woman reports a change in income or household size during her pregnancy, do not change her eligibility before the end of the post-partum coverage period.
· If a PCN or UPP recipient reports a change in income or household composition, do not change eligibility before the end of their certification period. If the recipient requests Medicaid coverage, use the changed information to determine eligibility for Medicaid.
Change Reporting Requirements
A. The Medicaid recipient or his/her representative is responsible to report a change in any circumstance which may affect eligibility for medical assistance programs within 10 days of the date of the change. For all programs, changes in income and household composition, and changes in assets for non-MAGI programs, are among the changes that must be reported.
1. If the 10th day is a non-business day, give the client until the first business day following the 10th day.
2. A report of a change or other information may be received from a source other than the recipient.
3. See Section 107-4 for a description of changes that must be reported.
B. The eligibility agency may accept client attestation for many change reports. Claims of citizenship and immigration status can never be verified by client statement. Other changes that require more than client statement as verification are defined in 731-3.
1. Promptly determine if the information provided by the client is reasonably compatible with available electronic data sources.
2. If the client is open for a MAGI-based coverage group, act on changes that were not already factored into the previous eligibility determination.
C. If continued eligibility cannot be determined by electronic data match, the agency must request the necessary verification from the client.
1. Workers must request any necessary verification within 10 days of the date a change is reported or information is received.
2. Workers must request only verification needed to determine current eligibility.
a. Give clients at least 10 days from the date on the written request to provide verification. If the 10th day is a non-business day, give the client until the business day following the 10th day to provide verification.
b. If the agency requests verification of citizenship or U.S. National status from the client, see section 205 for the time period the client has to provide verification.
D. If the client does not return all requested verification by the verification due date, the eligibility agency ends benefits for the first month it can give advance 10-day notice.
E. If the client provides all requested verification by the verification due date, or by the end of the report month, whichever is later, the agency continues with the eligibility determination.
1. For an adverse action, make the change for the first month that the eligibility agency can give 10-day notice.
2. If the action is in the client’s favor, or there is no change in benefits, make the change for the month immediately following the change report month.
F. The agency may begin a new 12-month certification period if it has verified all eligibility criteria after a client change report.
G. If the change causes a client to no longer be eligible for a MAGI-based coverage group (including CHIP), 4-month extended, or 12-month Transitional Medicaid, determine whether the client could receive medically needy Medicaid.
H. The electronic client information will be sent to the FFM if the client is no longer eligible for Medicaid.
I. Mail returned by the post office with no forwarding address indicates a change. See Section 811-4 to decide what steps to take.