5185-2 ACTING ON REPORTED CHANGES
It is the responsibility of DPA 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 DPA. 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).
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.
5185-2 A. NEW MEMBER ENTERS HOUSEHOLD
New household members are added to a Family 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 parent or caretaker relative must be notified and given at least 10 days to provide any necessary documentation to demonstrate that the new member meets all eligibility factors. If the caretaker relative does not provide the necessary documentation, the household is ineligible. The case is closed with timely notice of adverse action.
If the new household member meets all non-financial eligibility factors, their resources and income must be counted in the determination of eligibility for the first month in which they are eligible for at least one day.
Note:
When adding a new household member without income, use the F6-recipient key on the
EIS
MIBW
screen. This is the only situation in which the F6 key is used when adding a new household member.
5185-2 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 12-month CEP and they do not meet one of the conditions listed in section 5007, their Medicaid eligibility should continue through the end of their CEP . 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 CEP when the other household's application is approved.
5185-2 C. CARETAKER RELATIVE CHANGES
If the home of the children remains the same but a change occurs that results in the departure of the only Family Medicaid caretaker relative from the children's home, continued Family Medicaid eligibility may not exist for the adult unless the situation meets the temporary absence requirements. If it does, the benefit mailing address can be changed so the caretaker relative continues to receive the Medicaid Recipient Identification card (coupon) until the caretaker relative returns.
If the caretaker relative leaves permanently and a new caretaker relative enters the home permanently, the new caretaker relative should be invited to apply. The children continue to be eligible during their 12-month continuous eligibility period regardless of changes in household composition. (See Section 5007)
Occasionally there will be changes affecting more than one or two cases. These changes fall into two general types:
1. Changes in Family Medicaid law, regulation, policy, or funding:
These changes will be ordered by DPA 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.
5185-2 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. See EIS Procedures 2009-2 for more detail.
Note:
Do not close a case if a household does not verify deductible expenses. In these situations, process the Medicaid benefits without allowing the unverified expenses.
5185-2 F. EFFECT OF CHANGES ON OTHER PROGRAMS
Many changes reported on a Family Medicaid case may affect Temporary Assistance, Food Stamp, APA , GRA , or CAMA cases, even if they require no Family Medicaid case work. The case worker must examine each reported change to determine if action is required for any related program.
In addition to the periodic review of eligibility, special reviews may be conducted whenever there is good reason to believe that the information on file is not sufficient to insure that the household is eligible. Information indicating a need for reexamination of eligibility may come from one of the following sources:
Case maintenance systems showing the case is scheduled for a partial or full redetermination;
A report by a recipient of a change in the family's household situation; such as a change in marital status;
A report to DPA by another agency of action they have taken on an open case, or of a change in the client's circumstances;
Report of several changes at one time, all of which involve extensive verification and call continued eligibility into question; or
Information relating to a specific case or to a group of similar cases received from community sources, complaints, etc. Verification and determination requirements also apply, as do timely and adequate notice of action, rights to hearings, confidentiality, etc.
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