Family and Children's Medicaid MA-3420 RE-ENROLLMENT
VIII. DETERMINING ELIGIBILITY
A. Processing Requirements
1. Determine eligibility based on the requirements for the aid program/category you are evaluating.
2. Review the form and compare information to the last re-enrollment or application to determine if there are any changes that may need follow-up.
3. Verify eligibility factors that are subject to change, such as income, household composition or resources.
a. Request only information from the recipient when it is necessary to determine ongoing eligibility.
b. If information is current or is already available to the agency, do not request it from the recipient. Refer to MA-3300, Income, for what constitutes current and available.
4. If verification of income, countable resources or other information is questionable, contact the casehead by telephone or in writing.
a. If the request is in writing, use the DMA-5097, or DMA-5097S
b. If a telephone request is made, advise the recipient what information is needed and that he may request assistance in obtaining the necessary information. Document the record to show the date of the telephone contact, the specific information requested and that the recipient was offered assistance.
REVISED 07/01/11 – CHANGE NO. 12-11
c. Set a deadline for the recipient to return the information that is 12 calendar days from the date of the request. Explain to the recipient that he is responsible for providing necessary information by the deadline.
B. Requested Information is Not Received
1. Make every attempt to process the re-enrollment no later than “pull” in the last month of the certification period.
2. If requested verification is not received by the deadline, send a timely notice proposing termination for failure to provide necessary information. Terminate the case at the end of the certification period provided timely notice has been given and timely notice period has expired by pull date in the last month of the current certification period.
3. If notice has not expired for MAF, MPW, MIC-N and NC Health Choice cases, authorize the case for an additional month. Follow instructions in EIS-3051 RedeterminingEligibility for Medicaid Only Programs, to issue benefits
C. Evaluate for Medicaid In All Categories or NC Health Choice Prior to Termination
1. If the recipient no longer meets the eligibility criteria under the original aid/program category, evaluate eligibility in all other aid program/categories.
a. Transitional Medicaid (MAF-C). Refer to MA- 3405, Twelve Month Transitional Medicaid.
If a pregnant woman would have been eligible for MAF-C when she became employed or otherwise had an increase in earned income that results in her now being ineligible for Medicaid, evaluate for Twelve Months Transitional Medicaid.
b. Four Month Transitional (AAF payment type 4). Refer to MA-3400, Four Months Transitional Medicaid.
c. If the recipient is moving from MIC to NCHC, do not key an 8124 until the fee is paid or the insurance is terminated. Refer to MA-3255, NC Health Choice.
REISSUED 07/01/11 – CHANGE NO. 12-11
2. Other possible programs
a. MAA if the record verifies an assistance unit member is 65 years or older, or
b. MAD if the record verifies an assistance unit member receives Social Security disability or there is a DMA-4037 in the record verifying that the assistance unit member has been determined disabled. If the DMA-4037 is in the case record but there is a subsequent denial of disability, evaluate the caretaker for all other aid program categories.
c. MPW when the question, Is anyone in the home pregnant, is checked yes. If the pregnancy verification was not submitted, contact the recipient to request verification of pregnancy to evaluate for MPW. Allow 12 calendar days to provide the verification of pregnancy. If the a/r requests more time to get the verification, allow an additional 12 calendar days.
d. MAF for women who qualify for Breast and Cervical Cancer Medicaid (BCCM). Refer to MA-3250, Breast and Cervical Cancer Medicaid.
e. MAF-M when the income exceeds the categorically needy income limits. Refer to II.F. for policy on certifying a case in deductible status.