SECTION 9 CASE MAINTENANCE 

03.01.749.  CONTINUOUS HEALTH CARE ASSISTANCE ELIGIBILITY FOR CHILDREN UNDER AGE NINETEEN

03.01.750.  ANNUAL RENEWAL

03.01.751.  EXCEPTIONS TO ANNUAL RENEWAL

03.01.752.  REPORTING REQUIREMENTS

03.01.753.  TYPES OF CHANGES THAT MUST BE REPORTED

03.01.754.  PARTICIPANT FAILS TO REPORT EARNED INCOME

03.01.755. – 03.01.759  (RESERVED)

03.01.760.  NOTICE OF CHANGES IN ELIGIBILITY

03.01.761.  ADVANCE NOTICE RESPONSIBILITY

03.01.762.  ADVANCE NOTICE NOT REQUIRED

03.01.763. – 03.01.799.  (RESERVED)

03.01.749. CONTINUOUS HEALTH CARE ASSISTANCE ELIGIBILITY FOR CHILDREN UNDER AGE NINETEEN.

Children under age nineteen (19), found eligible in an initial determination or a renewal, remain eligible for a period of twelve (12) months. Eligibility stops when the child is no longer an Idaho resident, or the child dies. The twelve (12) month continuous eligibility period does not apply if, for any reason, eligibility was determined incorrectly. Children approved for emergency medical services, or pregnancy related services only, are not eligible for the twelve (12) months continuous eligibility period.  (7-1-04)T 

NOTE:  Children who were eligible for Foster Care Medicaid continue to be eligible when reunited with their family, if still an Idaho resident. The child qualifies for the remainder of the one-year period.

EXCEPTIONS TO 12 MONTH CONTINUOUS ELIGIBILITY
Children approved for Emergency Medicaid only, due to citizenship requirements, do not qualify for 12 month continuous eligibility.

Children approved under the conditional benefits provision lose eligibility when their conditional benefits end.

A child loses 12 months continuous eligibility when the child:

            -Is no longer a resident of Idaho
            -Passes the last day of the month he turns 19, or;
            -The child dies.                                                           (7-1-04)

 03.01.750. ANNUAL RENEWAL.

Participants must have an annual eligibility renewal. The annual renewal is a review of all eligibility factors.  Exceptions to annual renewal are listed in Section 751 of these rules.  (7-1-04)T 

NOTE:  If a child is determined ineligible during a renewal for PW or CHIP A, a new CHIP B or Children’s Access Card application must be obtained before the child can be enrolled in for CHIP B or Children’s Access Card. The new application is required for the following reasons:

·         CHIP B /Access has limited enrollment

·         CHIP B/ Access requires a signed Choice Agreement

·         CHIP B/ Access requires participant cost sharing                                                                                                             (8-1-05)

Handbook Table Renewal (7-1-04) 

Handbook Table Factors to Review at Renewal (7-1-04) 

Complete redeterminations before the expiration of benefits to prevent disruption in the receipt of Medicaid.

Before time-limited Medicaid coverage expires (such as pregnancy-related or Transitional Medicaid) complete a redetermination to explore potential eligibility under other coverage groups.                                        (7-1-04)

When a family does not complete a scheduled redetermination, do not end benefits before the family's 12-month eligibility period expires.

Do not automatically schedule redeterminations for Medicaid when scheduling reviews for other programs, unless the Medicaid redetermination is also due. If the participant already provided the information needed to redetermine Medicaid eligibility, for another program, the worker may process a desk redetermination.

Children who haven't completed their 12 months continuous eligibility, when the redetermination is done, remain eligible for the balance of the 12 month period.                      (7-1-04)

03.01.751. EXCEPTIONS TO ANNUAL RENEWAL.

Participants who receive Title XIX Medicaid through a time-limited coverage group do not require an annual renewal.  Coverage groups that do not require renewal are listed in Subsections 751.01 through 751.04 of these rules.  (7-1-04)T 

01. Extended Medicaid. A participant who receives Extended Medicaid is eligible as provided in Section 415 of these rules.  (7-1-04)T 

02. Transitional Medicaid. A participant who receives Transitional Medicaid is eligible as provided in Section 416 of these rules.  (7-1-04)T 

03. Low Income Pregnant Woman. A participant who receives Medicaid as a Low Income Pregnant Woman is eligible as provided in Section 502 of these rules.  (7-1-04)T 

04. Newborn Child of Medicaid Eligible Mother. A participant receiving Medicaid as the newborn child of a Medicaid eligible mother is eligible as provided in Section 601 of these rules.  (7-1-04)T

03.01.752. REPORTING REQUIREMENTS.

Changes in family circumstances must be reported to the Department. Participants have ten (10) days, from the date the change is known, to report. Report of changes may be made verbally, in writing, through personal contact, telephone, fax, electronic mail or mail.  (7-1-04)

03.01.753. TYPES OF CHANGES THAT MUST BE REPORTED.

Changes in circumstances the participant must report are listed in Subsections 753.01 through 753.12 of these rules.  (7-1-04)T 

01. Name or Address. A name change for any participant must be reported. A change of address or location must be reported.  (3-30-01) 

02. Household Composition. Changes in family composition must be reported if a parent or relative caretaker receives Medicaid.  (3-30-01) 

03. Marital Status. Marriages or divorces of any family member must be reported if a parent or relative caretaker receives Medicaid.  (3-30-01) 

04. New Social Security Number. A Social Security Number (SSN) that is newly assigned to a Medicaid Health Care Assistance program participant must be reported.  (7-1-04)T 

05. Health Insurance Coverage. Enrollment or disenrollment of a participant in a health insurance plan must be reported.  (3-30-01) 

06. End of Pregnancy. Pregnant participants must report when pregnancy ends.  (7-1-04)T 

07. Earned Income. Changes in the amount or source of earned income must be reported if a parent or relative caretaker receives Title XIX Medicaid.  (7-1-04)T 

08. Unearned Income. Changes in the amount or source of unearned income must be reported if a parent or relative caretaker receives Title XIX Medicaid.  (7-1-04)T 

09. Support Income. Changes in the amount of support paid or a change in the ordered amount must be reported if a parent or relative caretaker receives Title XIX Medicaid.  (7-1-04)T 

10. Resources. Changes in resources must be reported when a parent, relative caretaker, or pregnant woman receives Title XIX Medicaid. This includes receipt of money or goods from any source.  (7-1-04)T 

11. Vehicles. Changes in the number or type of vehicles must be reported if a parent or relative caretaker receives Title XIX Medicaid.  (7-1-04)T 

12. Disability. A family member who becomes disabled or is no longer disabled must be reported if a parent or relative caretaker receives Title XIX Medicaid.  (7-1-04)T 

ACTING ON REPORTED CHANGES

When a participant reports a change affecting an adult parent or caretaker's Medicaid eligibility, evaluate the adult's continuing eligibility under all coverage groups. This includes Transitional Medicaid (TM). If the change makes the adult ineligible, end the adult's Medicaid. Make the closure effective after providing ten-day advance notice.       (7-1-04)

Changes that do not affect eligibility.

For both adult and child Medicaid, when a participant reports changes that do not affect eligibility, it is a good customer service practice to mail an X508 notice. This acknowledges receiving the change report and tells the family Medicaid eligibility is not affected.

Communicating reporting requirements to participants.

Forms supply, in Central Office, has a brochure for participants with information about rights and responsibilities, including reporting requirements.

The change report form, HW 0592, now includes specific reporting information listed by program type.                                          (7-1-04)

 03.01.754. PARTICIPANT FAILS TO REPORT EARNED INCOME.

When a parent or relative caretaker who receives Title XIX Medicaid fails to report a change in earned income, or the change is not reported on time, the earned income disregards are not allowed in the financial determination.  (7-1-04)T 

If a change causes ineligibility for the current coverage group, but the participant remains eligible for Medicaid, there is no need to notify the participant of the change between coverage groups.

Delete, and do not mail, the closure and approval notices that generate when participants are moved between coverage groups if the level of coverage remains the same.

Use the EPICS narrative subject line to track movement between coverage groups.

If the change causes ineligibility, close Medicaid after eligibility for all other coverage groups has been explored.

Notify the participant 10 days before the closure takes effect. Notify the participant of Medicaid closure, the reason for closure, and the rule citation for closure.                    (7-1-04)

PARTICIPANTS WHO MOVE

If a Medicaid participant reports a move to another administrative area, the office receiving the report must provide the participant with the address and telephone number of the new office.

SENDING OFFICE RESPONSIBILITIES

            -Gets report of move.
            -Make every effort to get the new address.

Family Medicaid w/adult participant:

            -If no new address at time of report, order X502 notices.
            -Close MA adults
            -Do not transfer Medicaid eligible child if address info not received.
            -Do not transfer PW pregnant women if address information is not received.

If the receiving office contacts the sending office, transfer the case electronically and physically noting the change in address.

If the receiving office does not contact the sending office, the sending office must contact the receiving office.

RECEIVING FIELD OFFICE DUTIES

When Physical File Is Received:

            -Ensure electronic transfer of all open cases.
            -Ensure address is changed.
            -Assign worker.

Family Medicaid Where Adults Participate:

            -Contact family. Determine any changes in circumstances affecting eligibility.
            -Transfer a PW pregnant woman Medicaid case like an MA child case.
            -Do not complete a redetermination when a participant moves, unless the move coincides with the end of the annual eligibility period.                                                                                                           (7-1-04)

SPECIAL HELP TO DISABLED PARTICIPANTS

The Department must provide interpreters or special help for participants with visual, mental, hearing, literacy, language impairments, or other communication difficulties.

                                                                                    (7-1-04)

 03.01.755. -- 03.01.759. (RESERVED).

03.01.760. NOTICE OF CHANGES IN ELIGIBILITY.

The participant must be notified of changes in Health Care Assistance eligibility. The notice must give the effective date, the reason for the action, the rule that supports the action, and appeal rights.  (7-1-04)T

03.01.761. ADVANCE NOTICE RESPONSIBILITY.

When a reported change results in Health Care Assistance closure, the participant must be notified at least ten (10) calendar days before the effective date of the action.  (7-1-04)T

03.01.762. ADVANCE NOTICE NOT REQUIRED.

Advance notice is not required when a condition listed in Subsections 762.01 through 762.08 of these rules exists. The participant must be notified by the date of the action.  (7-1-04)T 

01. Death of Participant. The Department has proof of the participant's death.  (3-30-01) 

02. Participant Request. The participant requests closure in writing.  (3-30-01) 

03. Participant in Institution. The participant is admitted or committed to an institution. Further payments to the participant do not qualify for federal financial participation under the state plan.  (3-30-01) 

04. Nursing Care. The participant is placed in a nursing facility, or Intermediate Care Facility for the Mentally Retarded.  (3-30-01) 

05. Participant Address Unknown. The participant's whereabouts are unknown.  (3-30-01)

 06. Aid in Another State. A participant is approved for aid in another state.  (3-30-01) 

07. Eligible One Month. The participant is eligible for aid only during the calendar month of his application for aid.  (3-30-01) 

08. Retroactive Medicaid. The participant's Title XIX Medicaid or CHIP A eligibility is for a prior period.  (7-1-04)T

03.01.763. -- 03.01.799. (RESERVED).