5005-7       CASE REVIEWS

Medicaid and Denali KidCare cases are reviewed annually.  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 twelve months.  A review consists of a GEN 72 review application (or other documentation providing equivalent information - See 5005-2A), verification of changes, and appropriate notices.
    

2. For Denali KidCare, a full review is required every twelve months.  A review consists of a GEN 75 Denali KidCare Renewal Application Form Denali KidCare renewal application (or other documentation providing equivalent information - See 5005-2A), verification of changes, and appropriate notices.
    

3. For children in the custody of OCS Office of Children's Services a full review is required every twelve 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 Department of Health and Social Services (State) Custody;
      

   • The GEN 35A Review for Medicaid for a child in DHSS Department of Health and Social Services (State) custody; or
      

   • The GEN 75 Denali KidCare Renewal Application Form 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 Office of Children's Services 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. For children in SSI Supplemental Security Income related categories, a full review is required every twelve months.  See ADLTC Adult Disabled and Long Term Care manual section 520 A.

Note:

When a new or review application (GEN 50B or GEN 72) is received from a household, the application must be used to establish a new review / recertification period for all open programs if the household is eligible.

Example:

A household is receiving Food Stamps and Medicaid. A Food Stamp recertification is due in 3/10 but the Medicaid is authorized through 9/10. When the household submits the Food Stamp recertification, the GEN 72 must also be used to re-determine eligibility for the Medicaid case, even if the household did not mark the Medicaid program on the recertification form.

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 end of the review period, 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.