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DMA ADMINISTRATIVE LETTER NO: 06-15, UNCONVERTED MEDICAID CASES

DATE: December 17, 2015

SUBJECT: Unconverted Medicaid Cases

DISTRIBUTION: County Directors

Medicaid Supervisors

Medicaid Staff

I. Background

Effective January 1, 2014, a methodology for determining countable income and household composition based on modified adjusted gross income (MAGI) is to be applied to both Medicaid and CHIP eligibility for most enrollees, including children, pregnant women, parents and other caretaker relatives groups on applications and recertifications.

North Carolina was granted a waiver to delay using the MAGI methodology on recertification that were due in 2014 and allowed counties to continue to use the 2013 traditional budget methodology during 2014.

The state provided recommendations on how to complete the recertifications by March 31, 2015. Some counties have not met the expected deadline even with the recommendations sited in the December 2014 DCDL, therefore the state has continued (upon request) to auto extend MAGI recertifications for certain counties. Counties must manually extend other programs if recertifications are not completed timely.

II. INSTRUCTIONS

The Job Aids are: EIS Converted Case Job Aid and Advanced User EIS Converted Case Job Aid, for Conversion Process. Then follow all applicable Job Aids for authorizing if eligible when completing recertification.

To assist in this process, a report has been created that identifies these cases. It includes county, worker name, beneficiary name, program, and certification period. The report is located on FAST Help: Reports>Cases Not Fully Converted> Cases Not Fully Converted in NC FAST. The deadline for completion is January 31, 2016. NCFAST will update the report weekly to determine the progress of each county identified. OST staff has been assigned to work with the NCFAST liaison and county staff.

III. Effective date

This policy is effective upon receipt.

If you have any questions regarding this information, please contact the Operational Support Team at ost.policy.questions@dhhs.nc.gov.

Dave Richard

Deputy Secretary for Medical Assistance

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