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DMA ADMINISTRATIVE LETTER NO. 16-01, NC Health Choice Enrollment Freeze

DATE: DECEMBER 1, 2000

Subject: NC Health Choice Enrollment Freeze

Distribution: County Director of Social Services

I. BACKGROUND

II. IMPLEMENTATION

There are two possible outcomes for the NC Health Choice applications taken 1/1/01 or later:

1. Applications taken prior to January 1, 2001 to include children in an ongoing NC Health Choice case are not affected by the enrollment freeze.

It is imperative that these applications be keyed into EIS and denied using the “C4” code. The waiting list is built using the application number of cases dispositioned with a denial code of “C4”.

Terminate these MIC-N cases using the appropriate termination code.

b. Evaluate NC Health Choice cases terminated for failure to return the DMA-5063R for reopen if the form and all information needed to determine eligibility is returned by the 10th calendar day of the month following the month of termination and the case remains NCHC eligible. Reopen the case following current procedures.
e. Follow current procedures for re-enrollments when the DMA-5063R is received timely but the information to process it is received after the 10th calendar day of the month. The DMA-5063R is not accepted as the application in these cases. The family is required to provide a new DMA-5063. This is considered a new enrollment and no new children will be enrolled during the enrollment freeze. If the DMA-5063 is returned follow instructions in II.A.2.b. above.

Inform families that, due to the enrollment freeze, they should not drop comprehensive insurance they now have for a child with special health care needs. Mark through number 4 on the DMA-5068 Letter of Explanation, which directs families to notify the insurance company of their wish to drop insurance, prior to sending it to the client. Instructions for handling reactivated cases with children identified with special health care needs and subject to a waiting period will be issued at a later date.

III. overview of waiting list and reactivation process

2. NCHC Applications Reactivated

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