DATE: December 1, 2000
Subject: NC Health Choice Caseheads With More Than One NC Health Choice Case
Distribution: County Directors of Social Services
F&C Medicaid and NC Health Choice Supervisors
F&C Medicaid and NC Health Choice Staff
We have learned that there are multiple instances of the same individual being the casehead for more than one NC Health Choice case with classifications of J, K, or S. According to MA-3225, an individual may not be the casehead for more than one NC Health Choice case unless the classification for one case is L.
All children in the family who are eligible for NC Health Choice (under any classification, except L) must be included in one case. If the family’s combined income exceeds 150%, the case must be classified K or S.
• If classified K, an enrollment fee and co-payments must be paid for all children.
• If the children are members of a federally recognized Indian tribe, they are classified S. No enrollment fee or co-payments are charged.
Refer to MA-3225, IV.A.6.e.
Because of the “freeze” of NC Health Choice enrollments, applications for NC Health Choice with a date of application of January 1, 2001 or later cannot be approved. (Refer to the Dear County Director of Social Services letter, dated November 17, 2000). This includes applications to add individuals to an existing NC Health Choice case.
The following procedures for combining NC Health Choice cases who have the same casehead require adding individuals to existing NC Health Choice cases. To accomplish the procedures in this administrative letter, all applications to add individuals to NC Health Choice cases must be registered no later than December 31, 2000. Follow instructions in this letter and in EIS-4300, Part Four.
EIS edits have been modified to prevent new NC Health Choice cases (J, K, or S classification) from being approved when there is an active NC Health Choice case (J, K, or S classification) with the same casehead.
In XPTR is a list of cases where caseheads have multiple cases. The report name is: DHREJ NCHC MULTIPLE CASES.
Take the following actions to combine the cases listed on the report. Where a timely 10-day notice is required, mail the notice in time to assure the case termination will be effective December 31, 2000.
For example: Betty Jones has an NCHC case for Sue with a certification period 01/01/00-12/31/00 and a separate NCHC case for Anne with a certification period 02/01/00-01/31/01. Both cases have a classification of J.
Close the case for Sue effective 12/31/00 and add Sue to the other case effective 01/01/01.
If there are children in J classified cases that have the same casehead as an S classified case, they must be added to the S case.
Remember that due to the impending NC Health Choice freeze on enrollments, it is imperative that an add-on application for all children on the list be registered in EIS no later than 12/31/00.
If you have any questions please contact your Medicaid Program Representative.
Paul R. Perruzzi
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.