Family and Children's Medicaid Admin. Letters

DMA ADMINISTRATIVE LETTER NO: 03-11, AUTOMATED TERMINATIONS OF MIC & NORTH CAROLINA HEALTH CHOICE CASES

DATE: March 23, 2011

SUBJECT: Automated Code 80 Terminations of MIC & North Carolina Health Choice (NCHC) Cases at the End of the Certification Period

DISTRIBUTION: County Directors of Social Services,

Medicaid and NCHC Supervisors,

Medicaid and NCHC Eligibility Staff

I. Background

The North Carolina Division of Medical Assistance (DMA) will discontinue the automated closure of MIC and North Carolina Health Choice (NCHC) cases with code 80 on Medicaid cut off (old pull date) the last month of the certification period.

II. policy principles

A. Code 80 Terminations:

The automated termination of MIC and NCHC cases with code 80 will end April 26, 2011. After this date, the worker will propose termination by keying an automated timely notice code in EIS or by sending a manual timely notice. The worker will key an adequate termination code in EIS the day after the manual timely notice has expired.

1. Beginning with the MIC and NCHC re-enrollments mailed April 1, 2011, EIS will not close with the automated termination code 80. If the re-enrollment form or information is not received, the worker must propose termination no earlier than the day after the re-enrollment due date. Automated re-enrollments are due on the 25th day of the month.

2. If the re-enrollment form or information is not received, the worker must key a timely notice code in EIS to propose termination no earlier than the day after the re-enrollment due date or send a manual timely notice. The worker must key an adequate termination code in EIS the day after the manual timely notice expires.

3. The termination code keyed in EIS must take effect on or before the cut off date in the last month of the certification period. Although this should be a rare occurrence, if the termination does not take effect on or before cut off, the worker must update the certification period for one month. This applies to both MIC and NCHC cases.

B. NOTICES

1. Automated Notices:

When the recipient is no longer eligible for MIC/NCHC, key the automated timely notice to allow sufficient notice to the MIC/NCHC case head that the case will terminate at the end of the current certification period.

a. Medicaid codes:

Timely and adequate termination codes for Medicaid are located in the Eligibility Information Systems Manual EIS-4000-Codes Appendix B.

b. North Carolina Health Choice codes:

Timely and adequate termination codes for NCHC are located in the EIS manual section 4300, NC Health Choice -Notices and Codes Part 6.

c. Use the DHRHR Calendar available in NCXPTR to access the cut off and extension dates.

2. Manual Notices:

If a manual timely notice is sent, the worker must mail the notice in time for the notice to expire before cut off the last month of the current certification period.

After the timely notice expires, key an adequate case termination code by cut off. Although this should be a rare occurrence, if the notice period will not expire before cut off, authorize the case for an additional month. This applies to both MIC and NCHC cases.

Refer to F& C MA-3430, Notice and Hearings Process, III. D. for the instructions regarding the completion of the manual DSS-8110.

3. The worker must authorize the case for an additional month when the timely notice period will not expire before cut off. This includes NCHC cases.

If the MIC/NCHC case is extended for one month, and the child(ren) is determined eligible, the worker must key only the remaining 11 months of the new certification period.

4. If the MIC/NCHC re-enrollment is not completed, or the case is not terminated or extended, the case will appear on the case management report as overdue beginning the month following the last month of the current certification period.

III. EFFECTIVE DATE and implementation

The automated termination of MIC and NCHC cases with code 80 ends May 2011. The last automated terminations with code 80 will be run on April 26, 2011.

If you have questions regarding this information, please contact your Medicaid Program Representative (MPR)

Craigan L. Gray, MD, MBA, JD

Director

(This information was written and researched by Cynthia Mobley, Policy Consultant, Medicaid Eligibility Unit)