5220-5        REPORTING REQUIREMENTS

EIS automatically sends the Transitional Medicaid Report (TR1) in the month prior to the month the report is due.  If that report is not registered as received, a closure notice is sent on the 10th of the month in which the report is due. This notice allows the household until the 21st day of the month to submit the report.

The household is not eligible for Transitional Medicaid during the second six-month period if the TR1 report is not received by the 21st day of the month it is due.

5220-5 A.   NOTICE REQUIREMENT

A recipient must always be given timely notice before their case is closed for non-receipt of a report.  If the case is not in the correct system month, possibly because the case did not "roll over" into the current month, the caseworker is responsible for sending the household notice M803 - Transitional Med Report Due allowing them a reasonable period of time (from 10 to 15 days) to submit the report.

5220-5 B.   LATE OR INCOMPLETE REPORTS.

Reports must be complete.  A complete report is one that is signed, all questions are answered, and, for the Seventh and Tenth Month Reports, verification of income is provided.  If a report received before the "21st" cut off date is incomplete, the caseworker must send notice M455 - Transitional Medicaid Report Incomplete to the client explaining what is needed and allowing 10 days for completion of the report.  Failure to provide verification of childcare, child support payments, or self-employment expenses does not constitute an incomplete report. However, the unverified expenses will not be allowed as a deduction from the household's gross income.  Only verified expenses will be allowed as deductions.

A household may not reapply for Transitional Medicaid once it is terminated for non-receipt of a report by the 21st of the month it is due or for failure to provide a complete report.  Reinstatement of benefits is made only:

1. By order of a fair hearing officer;
    

2. Because the recipient provides proof that good cause existed for not providing the report as required;
    

3. Because the household moved out of state and then returned to Alaska (see Section 5220-6); or
    

4. Because the recipient makes a timely request for reinstatement of benefits pending a fair hearing decision.  See Administrative Procedures Manual Section 117.

5220-5 C.   AGENCY NOTIFICATION REQUIREMENTS

At the time Family Medicaid is terminated and Transitional Medicaid approved, the agency must notify the household of the family's reporting obligations, reasons Transitional Medicaid eligibility could end, and the availability of the second six-month period of Transitional Medicaid.  This requirement is met by sending EIS Eligibility Information System notice M702 - Transitional Medicaid Begins.

In the third, sixth, and ninth months of Transitional Medicaid, the agency is required to advise the household of the requirement to provide reports in the following month.  EIS Eligibility Information System will send these notices automatically by reading the "post med start month” on the EIS Eligibility Information System MERE Medical Reference screen screen, provided the case is in the correct system month.  EIS Eligibility Information System will also send a closure notice in the twelfth and final month of coverage.