Family and Children's Medicaid MA-3420 RE-ENROLLMENT
II. POLICY PRINCIPLES
A. Complete the re-enrollment process according to the aid program/category prior to pull date in the last month of the certification period.
1. Complete the re-enrollment process every 12 months for MIC, NCHC, MAF-D, and MAF-C. The MAF-C case cannot include a caretaker over age 18.
2. Complete the re-enrollment process every 6 months for MAF-N, MAF-M, HSF-N or HSF-M and MAF-C when the case includes a caretaker over 18.
3. Complete the re-enrollment process for newborns prior to the end of the one year automatic newborn period.
4. Complete the re-enrollment process for an MPW case prior to the end of the postpartum period. Follow policy in this section for an MAF-N re-enrollment.
B. Begin the re-enrollment process in time to allow a timely notice period to expire prior to the pull date in the last month of the certification period.
C. Reverify only those eligibility factors that are subject to change, such as income, household composition, resources, and the status of qualified aliens lawfully residing in the United States.
1. Verify the individual continues to reside lawfully in the United States using SAVE, Systematic Alien Verification for Entitlement Program. Follow procedures in EIS 1108, SAVE Verification Information System. The case file contains a copy of documentation provided at application and may be used.
2. DO NOT use SAVE as verification for trafficking victims. The case file contains a copy of the ORR certification letter received at application.Call the trafficking verification line at (202) 401-5510 to confirm the validity of the certification letter or eligibility letter for children if questionable.
3. If the record contains expired document and the individual is unable to present any immigration documentation evidencing his alien status, refer the applicant to the local USCIS Office to obtain documentation of his immigration status.
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D. Do not reverify factors that are not subject to change, such as date of birth or citizenship. Citizenship and identity documentation is required at application and does not need to be re-established at redetermination.
Review the case record(s) due for review for citizenship and identity documentation. Conduct an SOLQ social security number inquiry for each applicant or recipient at re-enrollment. If evidence is needed at redetermination, contact the recipient using the DMA-5097, DMA-5097s, Request for Information. Begin the redetermination process in case the documents are received.
There are a few exceptions when the case record may not contain citizenship documentation at redetermination.
1. North Carolina Health Choice Children
a. The citizenship/identity documentation requirement does not apply to North Carolina Health Choice (NCHC) recipients who applied prior to January 1, 2010. NCHC recipients who applied prior to January 1, 2010 and did not provide documentation of citizenship have a C/I code 98 in EIS. At re-enrollment, citizenship does not have to be established for these individuals who continue to be NCHC eligible. Complete the redetermination and continue to use C/I code 98.
Note: If the individual terminates, at reapplication citizenship documentation is required.
b. If a NCHC recipient who applied prior to January 1, 2010 and has a C/I code of 98 changes from NCHC to Medicaid at re-enrollment, citizenship/identity documentation must be provided. Contact the recipient using the DMA-5097, DMA-5097s, Request for Information.
(1) If the recipient has the documents to provide citizenship and/or identity evidence, obtain them. Make copies, document the record, and complete the re-enrollment. Return the original documents to the recipient.
(2) If the recipient states he does not have documentation and is making a good faith effort to obtain the needed documents, document the record. If all other eligibility requirements are met, complete the redetermination and authorize with the appropriate certification period. Retain the C/I code 98 and use Special Review Code “Z” on the DSS 8125 to follow up on the status of obtaining the documents. Use the third month of the new certification period for the date. A message will show on the Case Management Report to remind the worker citizenship and/or identity documentation is needed. (See EIS 4000, Codes Appendix.)
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(3) Contact the third party source or the recipient to determine status of obtaining the documents.
(4) Continue to use Special Review Code “Z” for another 3 months. Continue to contact the recipient every 3 months or until the end of the certification period, provided:
(a) The recipient has not yet provided documents but continues to make a good faith effort to obtain the documents, or
(b) The county has not received documentation or a response from an inquiry made to assist the client.
(c) Terminate at any time when a response is received indicating that no documentation confirming citizenship/identity is found or the recipient is not continuing a good faith effort to obtain the documents or provide the county with information needed to assist in obtaining documentation.
c. If documentation confirming citizenship/identity is not provided by or at the end of the certification period, complete the DSS 8125, update the C/I code to C/I code 97 with the date the first DMA-5097 was sent requesting the documentation. Terminate the case effective the last day of the current certification period. The individual has received reasonable opportunity to provide documentation of citizenship/identity and must provide documentation confirming citizenship/identity at reapplication.
d. If the recipient cannot obtain the necessary documents, requests help, or has special needs demonstrating a need for assistance and lacks someone who can act on his behalf, the county must assist the recipient in acquiring the documents including cost involved.
2. Do not require further citizenship/ identity documentation at redetermination for the following:
a. Title IV-E and Title IV-B children. See MA-3230, Eligibility of Individuals Under Age 21, for procedures to obtain the necessary documentation of Title IV-B or Title IV-E status at redetermination.
b. Children born in the United States whose delivery was covered by Medicaid.
c. Current or former SSI recipient. Use OLV to access the SDX to prove current or former SSI status.
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E. Authorized representative
Determine if the recipient has a power of attorney, legal guardian or other authorized representative. If there already is a power of attorney, legal guardian or other authorized representative documented in the file, determine if the same individual serves in that position and whether another representative has been added. See MA-2420/MA-3430, Notice and Hearings Procedures, for instructions on adding this person to the 8125.
F. Ex Parte
1. Use OLV to document citizenship and identity for current or former SSI and Medicare recipients. Use SDX to document citizenship and identity for former SSI recipients. Use SOLQ to document citizenship and identity for current or former SSDI and Medicare recipients. Continue to use C/I code 50.
2. If the individual is changing programs and an 8124 is required, a SSA data match is completed.
G. Terminate the case at the end of the certification period when the recipient has not provided required information. Allow for timely notice.
H. If you do not complete the Medicaid re-enrollment in time to send the appropriate notice and enter the information in EIS, authorize the case one month at a time until eligibility or ineligibility is established.
I. Deductible Cases
1. Re-enroll in deductible status
a. All Medically Needy cases for a consecutive 6 month certification period if all eligibility requirements continue to be met, and
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