5005-7       CASE REVIEWS

Medicaid cases are reviewed either semi-annually or annually depending on the eligibility category involved.  Denali KidCare cases are reviewed semiannually.  An interview is not required for Medicaid reviews or Denali KidCare renewals, although a caseworker may request an interview if the caseworker thinks it is necessary.

5005-7 A.   Review Requirements

1. For Family Medicaid, and Under 21 Medicaid, a full review is required every six months.  A review consists of a GEN 72 review application (or other documentation providing equivalent information), verification of changes, and appropriate notices.
    

2. For Denali KidCare, a full review is required every six months.  A review consists of a GEN 75 Denali KidCare renewal application (or other documentation providing equivalent information), verification of changes, and appropriate notices.
    

3. For children in the custody of OCS (but not Title IV-E), a full review is required every six months.  A review consists of verification of changes, and appropriate notices with:
    

   • The GEN 33A Review for Medicaid and/or Title IV-E Foster Care for a child in DHSS Custody;
      

   • The GEN 35A Review for Medicaid for a child in DHSS custody; or
      

   • The GEN 75 Denali KidCare renewal application.
      

4. For adoption assistance cases (both Title IV-E and state-only), a review is required annually.  For administrative convenience, the review date for Title IV-E may be set for July and state-only adoptions may be set for August to coincide with the OCS adoption assistance annual reviews.  The review may be considered complete without receipt of an actual application if the caseworker verifies that the adoption assistance agreement remains in effect.
    

5. Title IV-E foster care cases are reviewed every six months in conjunction with the OCS Title IV-E foster care review.

5005-7 B.   Timely Reviews

If a review is received timely and needs additional information, the caseworker will need to send the Request for Information notice giving the client time to respond.  If the information is not received by the due date, the caseworker must send an additional notice with timely adverse action of case closure.

5005-7 C.   Late Reviews

If a review is received any time on or before the last day of the last month of eligibility in that certification period (i.e. 27th), and the recipient appears to be ineligible, benefits must be extended to the following month to allow time for an adverse action notice before closing the Medicaid case.  A timely adverse action notice must be given to the client that explains exactly why the case is being closed (i.e. over income/resource, etc.).

If a review is received in the month following the month it was due, the late review may be accepted and considered as an application.  In this situation, if the recipient is ineligible, the caseworker must send the appropriate Medicaid application denial notice.