REVISED 08/01/13 - CHANGE NOTICE 04-13
Whenever an individual/family is determined ineligible for Medicaid in any aid program category, including Work First/Benefit Diversion, he must be evaluated for ongoing Medicaid eligibility in all other aid program/categories. In most cases, the evaluation should be done as an ex parte review. To ensure this evaluation occurs when Work First terminates, EIS will not allow the case to be terminated for any reason except for those listed in II.A. All other Work First terminations must be transferred to MAF-C. The MAF-C certification period is the remainder of the Work First payment review period or 2 months, whichever is greater.
The term “ex parte review” means to review information available to the agency to make a determination of eligibility, without requiring the beneficiary to come into the agency or make a separate application. A signed redetermination document is not required. The county must explore and exhaust all possible avenues of eligibility in all Medicaid coverage groups as well as NC Health Choice. If information is not available to make a determination of eligibility, the county must provide the beneficiary reasonable opportunity to provide the necessary information.
When evaluating ongoing Medicaid eligibility for an individual/family at the end of a Medicaid certification period, including the MPW postpartum period, or at the end of a Work First payment review period, a full redetermination must be completed. At the end of a Work First payment review period, transfer the case to MAF-C for 2 months. Complete a full redetermination during these 2 months. Refer to V.B. Always send appropriate notices before termination. Do not require the individual to provide information that does not change such as birth certificates, etc.
When reviewing ongoing Medicaid eligibility, if you establish eligibility in an aid program category that requires creation of a case in EIS, a signed application is not required. Enter the DSS 8124 as an administrative new application/reapplication.
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.