824-1           ACTING ON REPORTED CHANGES

It is the responsibility of DPADivision of Public Assistance to act promptly upon information from any source if that information might affect a household’s continued eligibility. Action on changes must be taken within 10 days of the date the change becomes known to DPADivision of Public Assistance. A report of pregnancy made for an on-going Medicaid case must be acted on by the fifth working day following the report of pregnancy. All changes that a household is required to report must be reported within 10 days of the date the parent or caretaker relative knows of the change (changes reported within 10 days from the day the change actually occurred are considered timely).

Exception:

Information on an HPEHospital Presumptive Eligibility Medicaid application is not considered a report of change.

If the change results in Medicaid ineligibility, the change is effective on the first day of the month following the end of the 10-day adverse action period. A notice with timely adverse action must be sent informing the household of the closure no later than 10 days before the last day of the last month of eligibility. This ten-day period begins the date the notice is mailed.

824-1 A.       NEW MEMBER ENTERS THE HOUSEHOLD

New household members are added to a MAGIModified Adjusted Gross Income Medicaid case effective the 1st day of the month the request to add the new member is received. All factors of eligibility must be met and verified before the new member is added to the case.

When the caseworker learns that an individual has entered the household who must be included in the household, the household must be notified and given at least 10 days to provide any necessary documentation to demonstrate that the new member meets all eligibility factors.

824-1 B.      MEMBER LEAVES THE HOUSEHOLD

When a member of the assistance unit leaves the household, the departing individual is removed from the case effective the first day of the first full month they are gone. If the departing member is a child who is still within their CEPContinuous Eligibility Period and they do not meet one of the conditions listed in section 816-1(C)(1), their Medicaid eligibility should continue through the end of their CEPContinuous Eligibility Period. If the child is included in an application received from another household, their Medicaid eligibility should end on the original Medicaid case and they should be given a new CEPContinuous Eligibility Period if the child is eligible for Medicaid with the new household.

Note:

When a PIPrimary Information Person leaves the household (inclusive of death), a new application must be submitted in order for the existing household to obtain a new PIPrimary Information Person.

824-1 C.      PARENT oR GUARDIAN CHANGES

If the home of the children remains the same but a change occurs that results in the departure of the only MAGIModified Adjusted Gross Income Medicaid parent or guardian from the children's home, continued Parent/Caretaker Relative Medicaid eligibility may not exist for the adult unless the situation meets the temporary absence requirements.  

If the parent or guardian leaves permanently and a new parent or guardian enters the home permanently, the new parent or guardian should be invited to apply. The children continue to be eligible during their CEPContinuous Eligibility Period regardless of changes in household composition. (See section 816-1 C)

824-1 D.      GROUP CHANGES

Occasionally there will be changes affecting more than one or two cases. These changes fall into two general types:

1.  Changes in MAGIModified Adjusted Gross Income Medicaid law, regulation, policy, or funding:

These changes will be ordered by DPADivision of Public Assistance Policy and Program Development by means of a change to this manual or e-mail broadcast.  The change will be distributed with specified instructions for implementation.

2.  Changes in local conditions:

Many cases in a particular area of the state may be affected by such changes as pay increases for National Guardsmen, shutdown of a major employer, natural disaster, beginning or ending of special fishing seasons, etc. While the responsibility to report changes remains with the recipient, the agency has the responsibility to act upon information it receives from any source.

824-1 E.      VERIFICATION OF CHANGES

Changes that affect a household's eligibility may need to be verified according to applicable portions of this manual. Changes that require action but do not affect eligibility (such as some address changes or addition of an unrelated member to the household) do not need to be verified.

If a change affects a household's ongoing eligibility and the recipient fails to provide necessary verification after being notified in writing to do so, any adult household members are ineligible. Children in the household will remain eligible through their current continuous eligibility period. The caseworker must end the ineligible members' participation and send a timely notice of adverse action.

Requests to close an already open Medicaid case can be made verbally or in writing.

824-1 F.      REQUIRED VERIFICATION IS NOT PROVIDED 

If an ongoing case is scheduled to close for failure to provide and the household provides the verification before the effective date of the case closure, the caseworker must accept the verification and redetermine the household's eligibility. If the verification provided ultimately leads to ineligibility, 10-day notice of adverse action was met with the previously sent closure notice. 

824-1 G.   EFFECT OF CHANGES ON OTHER PROGRAMS

Many changes reported on a MAGIModified Adjusted Gross Income Medicaid case may affect ATAPAlaska Temporary Assistance Program, SNAPSupplemental Nutrition Assistance Program, APAAdult Public Assistance, GRAGeneral Relief Assistance, or CAMAChronic and Acute Medical Assistance cases, even if they require no MAGIModified Adjusted Gross Income Medicaid case work. The caseworker must examine each reported change to determine if action is required for any related program.