Adult Medicaid Manual MA-2160 QUALIFYING INDIVIDUALS 1 (QI1/MQB-E)

IV. RE-ENROLLMENT

B. Introduction

If a QI1/MQB-E recipient wants the state to continue to pay his Part B Medicare premium, his eligibility must be redetermined each calendar year. This process is called re-enrollment. Follow the same verification requirements and procedures for re-enrollment as for MQB redeterminations.

In order to make re-enrollment as easy as possible, the process has been automated to the extent possible.

B. Automated Action

1. The case management report produced on the last work day of October lists each active QI1/MQB-E case in EIS as due for redetermination.

2. EIS also creates a report listing each QI1/MQB-E recipient due for review. This report is titled MQB (QI1) RE-ENROLLMENT. The county receives two paper copies. This report is also displayed in NCXPTR under the name DHREJ MQB (QI1)RE-ENROLLMENT. This report is provided as an optional documentation tool for tracking QI1/MQB-E re-enrollment.

3. Based on case management, the state automatically mails each active QI1/MQB-E recipient a re-enrollment application (DMA-5060) on the first work day of November.

a. The DMA–5060 is pre-printed with the:

• Recipient’s name, address, district number, and case ID, and

• County name, address, and phone number, and

• Date the DMA-5060 is due at the county dss. The date is always November 25 of the current calendar year.

(IV.B.3.)

b. Included with the DMA-5060 is:

• An insert containing the recipient’s rights and responsibilities (DMA-5061), and

• A return envelope imprinted with “QI1” in large purple letters (DMA-5062).

C. Recipient Responsibilities

1. The QI1/MQB-E recipient or his representative must return the completed, signed DMA-5060 to his county department of social services by the date printed on the re-enrollment application:

a. For all automated DMA-5060s the date is November 25.

b. Manually issued DMA-5060s can have another date. Refer to III.B.2., above.

2. The QI1/MQB-E recipient or his representative must provide information necessary to establish eligibility.

D. Processing Requirements

1. Train mailroom staff to recognize returned QI1/MQB-E re-enrollment applications so they can be date-stamped and forwarded to an assigned unit for processing.

2. On receipt in the proper unit, review each returned DMA-5060 to assure it is signed and contains all information necessary to determine eligibility. If it is not signed or does not contain information necessary to determine eligibility:

a. Send a manual timely notice (DSS-8110) to terminate the case effective December 31 for failure to complete the redetermination process unless the requested information is returned.

(1) Request the necessary information on the DSS-8110, or

(2) Explain on the DSS-8110 that the DMA-5060 must be signed. Attach the DMA-5060 to the DSS-8110 with instruction to sign and return to the agency within the notice period.

b. Document the case record. You can use the MQB (QI) RE-ENROLLMENT report for documentation and tracking or other method of your choice.

(IV.D.)

3. On the first work day after November 25, compare the DMA-5060s received at the county dss to individuals who received an automated or manual DMA-5060. You may use the Case Management Report, the MQB (QI1) RE-ENROLLMENT report, or your own tracking system. For each DMA-5060 not received:

a. Send a manual timely notice (DSS-8110) to terminate the case effective December 31 for failure to return the re-enrollment application.

b. Document the case record. You can use the MQB (QI) RE-ENROLLMENT report for documentation and tracking or other method of your choice.

E. Verification Requirements

1. An interview is not required to process the DMA-5060.

2. Compare the information on the DMA-5060 to the information on the initial application or the last re-enrollment.

3. Verify Medicare entitlement, income, reserve, living arrangement, and spousal responsibility in the same manner as a MQB redetermination. Use on-line inquiries when possible.

NOTE: Always use the December Social Security benefit to determine eligibility under QI1/MQB-E. The RSDI COLA is excluded from countable income for January, February, and March of each year.

4. It is suggested you use the DMA-5007V, Verification Form for MAABD Mail Redeterminations, to complete and document necessary verifications.

F. Disposing the Re-enrollment Application

1. If the case remain eligible for MQB-E:

a. Follow EIS instructions to update eligibility on the DSS-8125 screen by December “pull” night.

b. The certification period is January through December of the next calendar year.

c. EIS generates an automated redetermination notice of eligibility.

2. If the individual is ineligible for QI1/MQB-E:

a. Follow EIS instructions to enter the correct termination code on the DSS-8125 to generate a timely notice.

b. Document the record.

(IV.F.)

c. Evaluate for QI2. If eligible for QI2, follow instructions in MA-2165 and send approval notice.

3. If the recipient does not return information necessary to determine eligibility (including the signed DMA-5060):

a. Document the record.

b. EIS terminates the case on December “pull” night and sends an adequate notice. An adequate notice is sufficient because you sent a manual timely notice previously when the DMA-5060 was not returned by the deadline. (See IV.D.3 above.)

c. If the re-enrollment application or information necessary to determine eligibility is received after the case has been terminated, process the DMA-5060 as a new application.

(1) Do not require the recipient to complete and sign a new application.

(2) Enter a reapplication in EIS. Application processing standards apply.

(3) The date of application is the date the DMA-5060 is received.

(4) Request new verification if the base period changes.

4. If the individual is eligible for MQB-Q or MQB-B, or full Medicaid:

a. Document the record, and

b. Follow EIS instructions to transfer the case to the correct aid program/category by “pull” night.