Adult Medicaid Manual MA-2221 COUNTY RESIDENCE

V. COUNTY REASSIGNMENT OF ONGOING CASES

When a recipient in an ongoing case moves from one county to another, his Medicaid eligibility must continue without a break in coverage provided he continues to meet all eligibility criteria.

A. First County Responsibility When Learning of Client’s Move or Plan to Move

1. If the client plans to move to another county, explain to the recipient his responsibility to notify the IMC in the first county when he actually moves.

2. Upon notice of the actual move to another county, inform the a/r, verbally when possible, and by transfer letter, of the agency’s responsibility to continue assistance if eligibility exists.

Also, advise the a/r of his responsibility to contact the first county immediately to report any changes in the household that may affect Medicaid eligibility such as income and/or household composition. The first county must react to all changes reported before the transfer is complete.

B. Case Status

Prior to keying a county transfer, always check the certification period. Also, check to see if there are other Medicaid cases for the household, including the Family and Children’s Medicaid Program. If a review is due, do not complete the transfer until the review is completed.

1. Authorized case

a. If a review is due, the first county must complete the review and authorize for the next certification period, then reassign the case to the second county.

(V.B.1.a.)

EXAMPLE: The transfer effective month is February. The certification period is August - January. The first county must complete the review prior to transfer.

b. If a review is due in the month the transfer is effective or later, the second county must complete the review and authorize for the next certification period.

EXAMPLE: The transfer effective month is October. The certification period is July – December. The second county must complete the review and authorize for the next certification period.

c. If the first county transfers a case to the second county with an expired certification period, the first county is still responsible for completing the review. Once the review is completed, the first county should send the second county the review to authorize the next certification period in EIS.

EXAMPLE: The transfer effective month is July. The certification period expired in June. The first county must complete the review and send the review to the second county to authorize for the next certification period in EIS.

2. Deductible case

a. If the deductible has been met by the time of the notification of the move, follow procedures in 1. above.

b. If the deductible has not been met at the time of the move, always check the certification period. Complete the review if needed and then complete the county transfer.

c. If and/or when the first county receives notification and verification from the second county that the deductible was met during the first county's responsibility, the first county authorizes assistance on a DSS-8125 for its period of responsibility only.

C. Effective Date of County Transfer

1. The effective date of the county transfer may be no earlier than the second month following completion and mailing of the transfer letter. At a minimum, the first county will continue assistance for one month following the keying of the transfer.

2. Transfer the case in EIS effective the second month following the month of input.

REVISED 11/01/11 – CHANGE NO. 17-11

(V.C.2.)

EXAMPLE: On October 18 the recipient notifies the first county of a move to the second county. The certification period is checked to determine if a review is due. The certification period ends in February. The transfer letter is mailed on October 26. The county transfer is keyed on the same day. The transfer is effective December 1.

3. You may key a county transfer through the last working day of the month.

4. Managed Care coverage is automatically terminated by EIS on the last day of the month prior to the ongoing month. See EIS 3500, Transfers for Active Cases.

D. Completing the Transfer Letter

Complete the DMA-5154, County Transfer Letter, on the same day that the county transfer is keyed.

1. Give the original to the client if he is in the agency or mail if notification was by telephone call or letter.

2. Send a copy of the transfer letter, along with a copy of the most recent case profile to the second county.

3. File a copy in the eligibility record.

E. Entering a Facility After Reporting Move to Another County

If a recipient moves to another county in a private living arrangement and then enters an institution/facility in the second county prior to the effective date of the county transfer, continue the county transfer as proposed.

F. Medicaid ID Cards

1. A change in the recipient’s address alone will not result in issuance of a new Medicaid ID card. However, if the individual is enrolled in Carolina Access/Community Care of North Carolina, his primary care provider (PCP) will likely change when he changes counties. After the new PCP information in entered into EIS, the individual will be issued a new Medicaid card with the revised PCP information as well as the recipient’s new address.

REISSUED 11/01/11 – CHANGE NO. 17-11

(V.F.)

2. The first county is responsible for mailing a returned Medicaid card, with the recipient’s old address, directly to the recipient.

3. If the client does not receive the ID card during the transfer process and it has not been returned to the first county, request a replacement if his name is on the ID card register. Refer to MA-2380, Medicaid Identification Card, for issuing a replacement card.

G. Second County Responsibility

1. If a recipient notifies you of a move from another county, but has no transfer letter, notify that county immediately. Verify the assistance status in that county. Work with the first county in determining if a review is due. Assist the county and the client in completing the review and transfer.

2. Upon receipt of the transfer letter:

a. Establish a case record including all copies of transfer letters.

b. Refer the record to the appropriate caseworker for action.

c. Contact the client immediately.

d. Enter any new information in EIS.

e. Request the client's case from the first county via form DSS-2216, Request for Record.

3. If the recipient's deductible was met during the first county's responsibility:

a. Notify the first county of the dates of eligibility,

b. Provide a listing of medical expenses considered, and

c. Authorize assistance in the second county effective the date of county reassignment.

H. Move to Third County

1. First County Responsibility:

If the recipient moves to a third county prior to the effective date of the county reassignment to the second county:

a. Notify the second county to terminate, and

b. Initiate an administrative reapplication, and

REVISED 11/01/11 – CHANGE NO. 17-11

(V.H.1.)

c. Initiate county reassignment to the third county.

2. Second County Responsibility:

a. If the recipient moves to a third county prior to the effective date of county reassignment, but the move is discovered after the effective date of county reassignment:

(1) Continue assistance, and

(2) Initiate county reassignment to the third county based on procedures in this section.

b. If the recipient moves to a third county on or after the effective date of county reassignment:

(1) Continue assistance, and

(2) Initiate county reassignment to the third county based on procedures in this section.

c. If the recipient moves, leaving no forwarding address, and all methods of contacting him are exhausted:

(1) Send timely notice of proposed action to terminate for unable to locate to the last known address. Follow requirements in MA-2420, Notice and Hearings Process.

(2) Terminate the case in EIS.

(3) Document in the record all efforts to locate the recipient.

d. If the recipient moves back to the first county prior to the effective date of transfer, but the transfer is already showing in EIS, follow procedures in V.H.1.and 2.