Family and Children's Medicaid MA-3410 TERMINATIONS, DELETIONS AND EX PARTES
II. EXCEPTIONS TO CONTINUING MEDICAID WHEN MEDICAID, INCLUDING WORK FIRST, TERMINATES
A. When an individual or case becomes ineligible for one of the following reasons do not evaluate for on-going Medicaid.
1. Moved out of state, or
2. Individual (s) deceased, or
3. Casehead voluntarily requests termination of Work First and/or Medicaid,
REVISED 08/01/13 - CHANGE NOTICE 04-13
(II. A. 3.)
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.
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(s) incarcerated in federal prison, state juvenile justice facility, county or local jail (refer to MA-3360, 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, are placed in suspension if they remain otherwise eligible (see MA-3360, Living Arrangement for instructions).
5. Unable to locate,
a. Document all reasonable attempts to locate the family. This includes searching all other agency records, both paper and computer records, if no older than 6 months. For example, search Food Stamps, ACTS, Service Records (Child Care, etc.), ESC, SDX, OLV, SOLQ and EPICS.
b. If the most recent address is not current, attempt to locate a telephone number to contact the family. A current address is:
(1) Part of an active record in another program (such as Food stamps, services or IV-D records).
(2) Part of an inactive record in another program which had active benefits or eligibility for benefits occurred 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 outside the agency if no older than 6 months.
(4) If the location of the payee is unknown, but you know the child(ren)’s location, authorize the child(ren) for Medicaid. or
REVISED 10/01/11 - CHANGE NOTICE 13-11
6. Failure to cooperate with IV-D without good cause. Failure to cooperate in seeking monetary child support is not a basis for Medicaid termination. The duty to cooperate in seeking medical support also applies to caretaker only cases when the eligible child(ren) receives SSI unless the caretaker is pregnant. Refer to MA-3365, Child Support, III. when the caretaker is pregnant, or
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 For Terminating
1. Document the reason for the termination in the case record and note the reason Medicaid is also being terminated. It must be one of the exceptions listed above.
2. Refer to the EIS User’s Manual for the correct termination/deletion code to generate an automated notice. Never use “Other”. If this is a Work First case, no additional Medicaid termination notice is required.