Adult Medicaid Admin. Letters
DMA ADMINISTRATIVE LETTER NO: 09-04, PASSALONG
DATE: DECEMBER 12, 2003
SUBJECT: POTENTIAL COLA PASSALONG ELIGIBLIES
DISTRIBUTION: County Directors of Social Services
Since implementing Passalong policy, which corrected and clarified previous policy, the Division of Medical Assistance has been evaluating how to review cases that may not have been properly evaluated for Passalong. We took steps to see if there were people on past 503 Leads Reports who may have been eligible for passalong of the RSDI COLA.
The purpose of this letter is to provide instructions to identify former SSI recipients who are terminated from Medicaid and MQB recipients who may be passalong eligible and to review their eligibility for passalong.
II. Identifying mqb and terminated individuals potentially eligible as passalong
To identify individuals who are potentially eligible for RSDI COLA passalong but were overlooked, we took all the 503 files on XPTR from 1997 to 2002 and unduplicated the files using social security numbers. These were matched to individuals in EIS who are not currently authorized for Medicaid and dropping anyone deceased to identify individuals that could be COLA passalong eligible. This resulted in a low number identified, approximately 80 individuals.
The state has provided a report in NCXPTR that identifies individuals potentially eligible for passalong of the RSDI COLA. The report title is “MQB and Terminated Individuals Potentially Eligible for Passalong”. The NCXPTR selection name is “DHREJA PASSALONG 503 LEADS 97-02”.
Individuals were selected for this report based on the following SDX and EIS criteria:
• The individual was listed on one or more 503 Leads Reports from 1997 through 2002,
• The individual was terminated in EIS or active MQB, and
• The individual is not deceased.
The report is sorted by county, then district, then alphabetically by the recipient’s last name. All individuals for the county are listed on one page as no county has more than 10 cases to review.
III. county responsibility
Each county is responsible for evaluating all individuals listed on the report for COLA passalong eligibility. This evaluation process must be completed by January 31, 2004.
Review the case record for documentation that COLA passalong has been evaluated. If COLA passalong has been evaluated and documented, no further action is needed. If there is not documentation that COLA passalong has been evaluated, you must complete an evaluation.
A. Review all agency records and look at current data to determine the individual’s current status (e.g. whether the individual is active in another program, if they have moved, etc.)
B. If you are unable to locate the individual, send a letter to the last known address, following procedures in MA-2352, Terminations/Deletions, III.A.5.
C. If the individual now resides in a different county, complete the review with help from the new county.
D. Refer to MA-2110, Passalong, for instructions on evaluating for COLA passalong and how to disregard all RSDI COLAs when determining passalong eligibility.
E. Use MA-2110, Passalong, Attachment 2, Documentation of Passalong Eligibility or Ineligibility, to document the individual’s eligibility or ineligibility for passalong.
F. File the attachment as a permanent document in the case record.
G. For each individual determined to be passalong eligible, enter in EIS the appropriate Individual Special Use code and document eligibility in the case record.
IV. Individuals Terminated within past 12 months
If a passalong eligible individual was terminated within the past 12 months, you must reinstate the individual back to the first month of eligibility after the termination. Do not reinstate the individual earlier than February 1, 2003. To reinstate the individual you must:
A. Complete an unsigned administrative application. The date of application is the first day of the first month of eligibility.
B. Medical providers must file claims within 12 months of the date of service. Complete an override request for any eligibility authorized so late that at disposition providers have less than 60 days to file claims. Check the box for county administrative error. Complete the override request at the same time you authorize the case. Follow procedures in MA-2395, Corrective Actions and Responsibility for Errors, III.
C. Determine the individual’s current address prior to reinstatement. If you are unable to locate the individual, send a letter to the last known address following procedures in MA-2352, Terminations/Deletions, III.A.5. If the individual now resides in a different county, the county in which the Medicaid terminated is still responsible for reinstating that individual for Medicaid. Once the county authorizes the individual for Medicaid, transfer the individual to the correct county, following policy in MA-2221, County Residence.
D. Once the county transfer has processed, request adjustment of responsibility for claims in months that the individual resided in the second county. Identify any claims charged in error to their county by reviewing the “Recipient Payment Register”. Once claims are identified, notify the Claims Analysis Section of DMA in writing of the charges. Include the recipient’s name, individual identification number, and dates of service.
V. individuals terminated longer than 12 months ago
Individuals who lost Medicaid eligibility longer than 12 months ago but are COLA passalong eligible cannot be automatically reinstated. You must:
A. Determine the individual’s current address.
B. Send a notice to the individual to inform him that he is potentially eligible for Medicaid and that he must apply at the dss in the county where he now resides. When you send a notice to an individual who is now living in another county, send a copy of that notice to the dss in the individual’s new county of residence.
C. If the individual applies, determine eligibility from the date of application and up to 3 months retroactive to the date of application, following application processing policy in MA-2300 – MA-2304.
If you have any questions, please contact your Medicaid Program Representative.
(This material was researched and written by Susan Ryan, Medicaid Policy Consultant, Medicaid Eligibility Unit.)