All Medicaid Programs |
Obsolete Policy |
Previous Policy
Ineligible Persons.
If a client gets coverage and that client is not eligible for all or part of the coverage, complete an overpayment referral for that person. Stop the medical coverage for the person if he is not eligible for any current medical assistance, giving proper closure notice.
Ineligible Case.
If medical coverage has been given for an ineligible case, complete an overpayment referral. Close the case if all the members are not eligible for any current medical assistance. (See Sec. 827-1 before closing the case.)
Responsibility to Repay Medicaid.
A client is responsible to repay all payments made in his or her behalf for which he or she is not eligible. Clients do not necessarily avoid an overpayment by returning the medical card to the local office. This is particularly true of clients enrolled in Health Plans and clients covered by capitated mental health services. Ineligible clients are responsible for repaying any Medicaid expenditures made on their behalf such as payments made to the health plan for that client or the capitated services payments, even if the client did not receive any services that month. Payments made on behalf of a client include an amount to cover administrative costs to the plan, the client is also responsible to pay back those administrative fees. Do not lead the client to believe that by returning the medical card there will be no overpayment. The client may still have an overpayment.
When ineligibility for a person or case is discovered, send the information to the DWS Payment Specialist. Follow the procedures for sending referrals through the Recipient Claims Database on the DWS intranet website.