Adult Medicaid Manual MA-2352 TERMINATIONS/DELETIONS/EX PARTES
III. EXCEPTIONS TO CONTINUING MEDICAID WHEN MEDICAID, INCLUDING WORK FIRST TERMINATES.
When an individual becomes ineligible for one of the following reasons, do not evaluate for on-going Medicaid.
A. Terminate Medicaid for individuals when ineligibility is for one of the following reasons:
1. Moved out of state,
2. Individual is deceased,
3. Casehead voluntarily requests termination of Medicaid and/or Work First,
a. The request must be in writing and specifically request Medicaid termination. If it is a Work First case the casehead must specifically request termination of Medicaid as well as Work First.
b. File the written request in the case record. The record must include documentation that the individual understood that he and/or the children may still be eligible for Medicaid and chose not to continue.
REVISED 07/01/13 – CHANGE NO. 05-13
c. If the request is for Work First termination and there is no written request for termination of Medicaid, authorize for MAF-C through the remainder of the Work First payment review period or 2 months, whichever is greater. Complete an ex parte review to determine ongoing Medicaid eligibility prior to the end of the certification period.
4. Individual is incarcerated in a federal prison, state juvenile justice facility, county or local jail (refer to MA-2510, Living Arrangement for instructions),
Note: The eligibility of individuals incarcerated in North Carolina Department of Public Safety, Division of Prisons (DOP) facilities, or of those age 21 thru 64 in institutions for mental disease, is placed in suspension if they remain otherwise eligible. (see MA-2510, Living Arrangement for instructions).
5. Unable to locate,
a. Document all reasonable attempts to locate the individual. This includes searching all other agency records, both paper and computer records. For example, search Food Stamps, ACTS, Service Records (Child Care, etc.), ESC, SDX, SOLQ and EPICS.
b. If the most recent address is not current, attempt to locate a telephone number to contact the individual. A current address is:
(1) Part of an active record in another program (such as Food Stamps, services or IV-D records).
(1) Part of an inactive record in another program which had active benefits, or eligibility for benefits within the past 6 months. Any activity in the case in the previous 6 months, except for mail
returned as undeliverable, is sufficient to consider the address current.
(3) From any source in the agency, if no older than 6 months. This includes Food Stamp denials. Check other available records such as ACTS, Service Records, Child Care, ESC, SDX, EPICS, etc.
(4) From any source outside the agency if no older than 6 months.
c. If the location of the payee is unknown, but you know the child(ren)'s location, authorize the child(ren) for Medicaid.
REISSUED 08/01/13 – CHANGE NO. 05-13
6. Failure to cooperate with IV-D and good cause can not be established. This applies to caretaker applying for or receiving Medicaid for herself only. Refer to MA-2375, Procedures for Child Support Enforcement, when the adult beneficiary is pregnant.
7. The only person receiving Work First Family Assistance has been approved for SSI benefits or,
8. Failure to complete or provide information for a Medicaid redetermination review. This is not a Work First review,
9. Failure to apply for benefits to which entitled.
B. Instructions to Terminate
1. Document the reason for the termination in the case record. It must be one of the exceptions listed in III. above.
2. Refer to the EIS User’s Manual for the correct termination/deletion code to generate an automated notice. Never use "OTHER".
C. After Medicaid Case is Terminated
1. Once Medicaid is terminated, follow MA-2304, Processing The Application, for reopening this case within 30 days of termination.
2. Refer to MA-2304, IV.D, Processing The Application, for procedures for determining if the case may be administratively reopened.