Family and Children's Medicaid MA-3420 RE-ENROLLMENT
VII. CONDUCTING THE MAF/MPW FACE-TO-FACE OR THE TELEPHONE INTERVIEW
A. Failure to Come to Appointment
If the recipient fails to keep the appointment, terminate the case at the end of the certification period after timely notice has been given. If notice has not expired, authorize the case for an additional month.
1. At the interview, complete forms DMA-5063 and DMA-5065.
2. Review the forms with the recipient. Compare the forms with the forms on file. If there are questions about the information provided, ask the recipient to clarify the information and/or provide documentation.
3. Signing Forms
a. Face-to face interview – While in the interview, ask the recipient to sign all forms that require his signature.
b. Telephone interviews - Mail the recipient forms he must sign to complete the re-enrollment process. This does not apply to MIC or NCHC cases. (See III.A. above)
4. Inform the recipient/representative that he will be notified of any changes to be made in his medical assistance following the re-enrollment.
5. Instruct homeless recipients with no permanent address to come to the agency to pick up their annual Medicaid ID card and necessary notices.
6. Review items C. through F. below with the recipient.
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C. Responsibility to Cooperate With The County DSS
Inform the recipient/representative that he is responsible for cooperating with the county dss in providing information necessary for determining continuing eligibility. Explain that he is responsible for the following:
1. Providing the necessary information within a reasonable period of time to determine eligibility. For example, he must inform the county of any b. u. member's employment and provide wage stubs or names of collateral sources to verify this information.
2. Providing information on bills incurred for medical expenses when he has a deductible and explain the consequences of an unmet deductible.
3. Reporting within 10 calendar days to the county dss any change in situation such as an increase or decrease in income, change in address, employment, people living in the household, inheritances, and other sums of money. Explain that failure to report a change in situation may lead to the recipient having to repay assistance received in error, or being tried for fraud by the courts and receiving whatever penalty is imposed as a result of that trial. Explain to the recipient/representative the meaning of "fraud.”
D. Inform The Recipient of His Rights
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5. He has the right, following a local appeal, to appeal within the appropriate time limit to the Division of Social Services (Refer to MA-3430, Notice and Hearings Process.) if:
a. Medicaid is terminated,
b. He disagrees with having a deductible or the patient monthly liability,
c. He believes the amount of his deductible or patient monthly liability is incorrect,
d. He believes the county dss is delaying action in investigating his request for a review of his circumstances.
6. Explain the protection against discrimination on the grounds of race, creed or national origin by Title VI of the Civil Rights Act of 1964.
E. Explain Transfer of Resources
Inform the recipient that if he transfers any real property, personal property or liquid resources out of his name without receiving compensation equal to the current market value for the transferred resource, the transfer may result in a period of ineligibility. If the a/r needs assistance, now or in the future, with nursing home cost of care under any Medicaid program, CAP, or assistance with in-home health services and supplies under the MAABD programs, a sanction may be imposed. Refer to MA-2240, Transfer of Assets, in the Aged, Blind, and Disabled Medicaid Manual.
Document the recipient responses regarding transfer of resources in the case file.
F. Inform the Recipient of Other Services
1. Family Planning Services
Explain Family Planning Services to payees of individuals of childbearing age (including minors, both male and female, who can be considered to be sexually active) who desire such services. See MA-3205, Conducting a Face-to-Face Intake Interview, for details.
2. Health Check Program
Remind each recipient of the benefits of the Health Check Program. See MA-3205, Conducting a Face-to-Face Intake Interview, for details.
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3. Explain the Food and Nutrition Services
Inform the recipient of the Food and Nutrition Services (FNS) offered by the department and the procedures for applying for food stamps.
a. If he wishes to apply, initiate the required action.
b. If he receives food stamps, the Medicaid staff must provide information requested by the Food and Nutrition Services (FNS) staff, e.g., deductible information, copy of the DMA-5036, Record of Medical Expenses Applied to the Deductible,etc.
4. Explain The Women, Infants, and Children (WIC) Program
a. Explain the availability of benefits through WIC.
This program provides a nutritional supplement to pregnant women during pregnancy and up to six months after delivery, and breastfeeding women up to one year after the baby is born, and
b. Make a referral to the WIC Program when services are desired.
(1) If services are desired, the IMC must make a referral to the WIC Program at the local WIC agency.
(2) Provide the recipient a WIC Brochure, titled "A Healthy Start."
5. Explain Lifeline/Link-Up Assistance Program
Lifeline provides a monthly discount on an eligible recipient’s local telephone bill. If the recipient does not have a telephone, Link-Up provides a 50% discount, up to $30, on the cost of connecting local telephone service.
To be eligible for Life Line/Link Up the individual must:Receive Medicaid under MAF, MPW, MAABD, MQB-Q, MQB-B or MQB-E and receive telephone service listed in his name from one of the telephone companies listed on the DMA-5058, Participating Telephone Service Providers.
The caseworker must provide applicants/recipients information on Lifeline/Link-Up and provide households with the address of their participating telephone service provider (see DMA-5058). Instruct households to complete the DSS-8168-I and mail it to their telephone service provider if they meet the eligibility requirements for Lifeline/Link-Up. Refer to MA-3205, VI. F, Conducting A Face-To-Face Interview for Life Line/Link Up.
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6. Other Available Services
a. Explain that other services are available within the department and make a referral for any services requested.
b. Explain the use of the Medicaid Idenitification (MID) card.
(1) Explain that a gray Medicaid Idenitification (MID) card is issued yearly, and that a new card is issued only when there is a change in the PCP, a legal name change, or when the card is lost, destroyed, or stolen.
(2) Make sure he understands that the MID is not proof of Medicaid eligibility. See MA-3505, Medicaid Identification Card.
(3) Remind him of his responsibility in using the ID card only for eligible members and that he must take the card with him, along with other ID for adults and any other insurance cards including Medicare, when requesting services.
(4) Tell him he must sign the card, and that if he becomes ineligible for Medicaid he should not throw away the card. He may become eligible again and need the card.
c. Provide recipients with the appropriate Medicaid handbook if a request is made. The handbooks are provided to families at the time of application and there is no requirement to provide them again at re-enrollment.
d. Explain the benefits of using a Pregnancy Medical Home (PMH) and, give a copy of the DMA-5076, PMH handout. Refer to MA-3205, VI. B., Conducting A Face-To-Face Interview for PMH.
7. Inquiries of Issuance of Certificate of Creditable Coverage
The Health Insurance Portability and Accountability Act (HIPAA) requires that group plans and health insurance issuers which offer group coverage furnish certificates of creditable coverage when an individual ceases to be covered by the plan. The certificate issuance is automated and issued by the fiscal agent when a recipient is terminated. Certificates can be provided up to 24 months after termination. If a recipient inquires about a Certificate of Creditable coverage, refer him to the fiscal agent.
REISSUED 11/01/11 – CHANGE NO. 18-11