Family & Children's Medicaid Change Notices

The Centers for Medicare and Medicaid Services (CMS), formerly known as HCFA, issued guidance to ensure that eligible families continue to receive Medicaid benefits. Instructions regarding ex parte reviews were issued in an April 7, 2000, letter to the State. As a result of this letter, several changes to different policies have been issued. Now MA-3357 will change to accommodate the requirements in the April 7 letter.

When TMA was first implemented, monthly reporting was instituted because the monthly reporting automated system was in place in EIS. Federal regulations have always required a quarterly report in Transitional Medicaid. Since Work First now has quarterly reporting requirements, Transitional Medicaid will change to quarterly reporting.

ii. Major Changes to MA-3357

A. Transitional Reporting Requirements

1. Parent/specified relative is required to report his income on a quarterly basis. The due dates for the Transitional Benefit Reports (TBR) are in the 4th, 7th and 10th months of TMA. To accommodate quarterly reporting, EIS changed the Transitional Tracking Screen.

2. A new Transitional Benefit Report (DMA-5082) has been developed for quarterly reporting.

3. There is a new report entitled, “Transitional Cases Due Review”. The report is listed in XPTR as “DHREJ TRANS CASES DUE REVIEW”.

a. The report will list cases that did not return quarterly reports by the second deadline in the 4th month of Transitional Medicaid (TMA). These cases are due an ex parte review before the end of the 6th month.

b. This report will also list TMA cases for which quarterly reports were received (payment type 5 cases) in the 10th month of the Transitional period. These cases are due for a redetermination review before the end of the 12th month.

4. When a TBR is not returned by the second deadline:

a. In the 4th month of TMA, the recipient has until the sixth month to prove good cause. If good cause is not found and the case is not terminated or transferred, EIS will automatically transfer the Transitional case to MAF-C for two months.

b. If the IMC does not transfer or terminate the case in the 7th or 10th months of TMA, EIS will automatically transfer the Transitional case to MAF-C for two months. This allows time for the county to conduct an ex parte review on these cases.

B. When To Conduct an Ex Parte Review or a Redetermination

1. During the Extended period if the assistance unit is no longer eligible for Medicaid, the IMC must conduct an ex parte review to determine ongoing eligibility in other aid program/categories.

2. Beginning in the 11th month of Transitional Medicaid, conduct a redetermination to determine eligibility in any other aid program/category. If the IMC does not transfer or terminate the case by the deadline in the 12th month, EIS will automatically transfer the TMA case to MAF-C for two months.

C. Clarifications Added

1. When a spouse returns home during the Earned Income Disregard period, determine if the spouse can be added to the Earned Income case. The spouse may be added if his income /assets are less than the MAF-CN limits for the needs unit. The assistance unit is no longer eligible if his income exceeds MAF-CN income/assets level for the assistance unit. Conduct ex parte reviews for each needs unit member if the spouse’s income exceeds the income limits for the assistance unit.

2. When a child returns home during the Earned Income Disregard period, add the child to the assistance unit if his income/assets do not exceed the MAF-CN limits for the needs unit. If the child’s income exceeds the MAF-CN limit for the needs unit, evaluate the child for MIC or NC Health Choice. Do not terminate the Earned Income Disregard case.

3. If, during the Earned Income Disregard period, the parent/specified relative fails to cooperate with child support, the parent/specified relative is ineligible for Medicaid. There is no child support requirement during the Transitional period.

4. When completing the 185% Poverty Level Income Test, you will no longer average the number in the assistance unit for the quarter. You will now use the number in the assistance unit in the third month.

III. Effective DATe

The effective date is October 1, 2001.

In September, all assistance units receiving Transitional benefits will be converted from monthly to quarterly reporting. On September 4, families in TMA in months one through nine received a letter explaining that they will now report quarterly rather than monthly. A copy of the letter was issued with a letter to the Directors of County Departments of Social Services. The letter was mailed to the counties in August.

IV. Implementation

On September 25, 2001, (pull night) cases in the 3^rd, 6^th, or 9^th month of TMA will be mailed the new quarterly report. The report will ask recipients to provide information for the three previous months. Some recipients may have already reported information for one or two months. If the quarterly report received is incomplete, check the case records to see if the missing information was returned on one of the previous monthly reports. Do not require recipients to report information they have already reported.

V. Updating EIS

A. Work First Quarterly/Monthly Reporting Screen – Continue to update monthly reports sent in August on this screen until September 25.

After this date, the screen will be renamed, “Work First/Transitional Quarterly Reporting”. You will only have to update a case once per quarter for Transitional cases. EIS will automatically transfer the code you key on the Work First/Transitional Quarterly Reporting screen to the Transitional Benefit Reporting Tracking (TBR screen). All three months of the quarter will be updated on the TBR Tracking screen with the same code.

B. Transitional Benefit Report Tracking – You will be able to update the status of reports on this screen for past months.

1. If you update the TBR screen prior to September 25, you will be able to update every historical month on the TBR tracking screen.

2. If you update the screen after September 25, you will only be able to update months 3, 6 or 9. EIS will automatically enter the same code for the two previous months.

VI. What happens in August

In September, TMA assistance units will be returning Transitional Benefit Reports for the month of August. Counties are to continue to react to the receipt or non-receipt of these forms as policy prior to October 1.

A. August is First, Second, Fourth, Fifth, Seventh or Eighth Month of Transitional Medicaid

1. The monthly report for the above months (August) will be due by September 10, the Work First Family Assistance Monthly Reporting deadline in September.

2. Update the Work First Quarterly/Monthly Reporting Screen to indicate report was received timely and complete.

3. If the DSS-8192 was not returned by September 10, EIS generates a second report. If the report is received untimely or incomplete, do not react as the deadline for return of reports is the 4th, 7th, or 10th month. The crucial reports for these months will be generated at the end of September on the first quarterly report.

B. August is Third, Sixth, or Ninth Month of Transitional Medicaid

1. The monthly report for the above months (August) will be due by September 10, the Work First Family Assistance Monthly Reporting deadline in September.

2. Update the Work First Quarterly/Monthly Reporting Screen to indicate report was received timely and complete.

3. If the DSS-8192 was not returned by September 10, EIS generates a second report. If the necessary reports are not returned by September 21, the second deadline, follow policy currently contained in MA-3357. Terminate the case if appropriate.

VII. What happens in September

The new quarterly reports will be mailed to TMA families on September 25, if September is their 3^rd, 6^th, or 9^th month of Transitional Medicaid.

A. September Is First, Second, Fourth, Fifth, Seventh or Eighth Month of Transitional Medicaid

1. No DMA-5082, Transitional Benefit Report, will be generated.

2. You may continue to receive reports from prior months. Use the Transitional Benefit Report Tracking Screen to update the status of the monthly reports.

B. September is Third Month of Transitional Medicaid

1. If September is the third month of Transitional Medicaid, a quarterly report will be generated on September 25. This report will be for the first three months of transitional Medicaid (July, August and September).

2. The deadline for returning this quarterly report will be October 9, the WF Quarterly Reporting deadline in October. If the WF/Transitional Quarterly Reporting Screen is not updated in October by this deadline, a second report and a good cause insert, DMA-5084, will be mailed to the recipient.

3. If the first and second monthly reports had been returned and were complete, the only information you need completed on the quarterly report is for September. If it is complete, update the WF/Transitional Quarterly Reporting Screen.

4. If the first and/or second monthly reports had not been returned or were returned incomplete, the information on the quarterly report needs to reflect the incomplete information for the appropriate months. If the information is not complete for all months, indicate Incomplete on the WF/Transitional Quarterly Reporting Screen.

5. If the quarterly report is not returned in October, the case remains eligible through the 6th month (December).

6. Determine if good cause exists for not returning the report or submitting an incomplete report.

a. If you receive these reports or if good cause is established prior to Work First Regular Run in the 6th month (December), you must update the prior months on the TBR screen. If these months are updated, the quarterly report for the 2nd quarter will be generated at the end of the 6th month.

b. If the months are not updated by Work First Regular Run in the 6th month (December), EIS will transfer the case to MAF-C for two months from January through February. Complete an ex parte review to determine ongoing eligibility for all individuals in the case.

C. September is Sixth Month of Transitional Medicaid

1. If September is the sixth month of Transitional Medicaid, a quarterly report will be generated on September 25. This report will be for the 4th, 5th, and 6th months of transitional Medicaid (July, August and September).

2. The deadline for returning this quarterly report will be October 9, the WF Quarterly Reporting deadline in October. If the WF/Transitional Quarterly Reporting Screen is not updated in October by this deadline, a second quarterly report and a good cause insert, DMA-5084, will be mailed to the recipient.

3. If the fourth and fifth monthly reports had been returned and were complete, the only information you need completed on the quarterly report is for September. If it is complete, update the WF/Transitional Quarterly Reporting Screen.

4. If the 4th and/or 5th monthly reports had not been returned or were returned incomplete, the information on the quarterly report needs to reflect the incomplete information for the appropriate months. If the information is not complete for all months, indicate Incomplete on the WF/Transitional Quarterly Reporting Screen.

5. Determine if good cause exists for not returning the report or submitting an incomplete report.

a. If good cause is established by October 22, the second deadline, then update the WF/Transitional Quarterly Reporting Screen.

b. If the quarterly report is not returned and/or good cause is not established, EIS will transfer the case to MAF-C for two months with adequate notice. Conduct an ex parte review to determine eligibility for other aid program/categories.

D. September is Ninth Month of Transitional Medicaid

1. If September is the ninth month of Transitional Medicaid, a quarterly report will be generated on September 25. This report will be for the 7th, 8th, and 9th months of transitional Medicaid (July, August and September).

2. The deadline for returning this quarterly report will be October 9, the WF Quarterly Reporting deadline in October. If the WF/Transitional Quarterly Reporting Screen is not updated in October by this deadline, a second quarterly report and a good cause insert, DMA-5084, will be mailed to the recipient.

3. If the 7th and 8th monthly reports had been returned and were complete, the only information you need completed on the quarterly report is for September. If it is complete, update the WF/Transitional Quarterly Reporting Screen.

4. If the 7th and/or 8th monthly reports had not been returned or were returned incomplete, the information on the quarterly report needs to reflect the complete information for the appropriate months. If the information is not complete for all months, indicate Incomplete on the WF/Transitional Quarterly Reporting Screen.

5. Determine if good cause exists for not returning the report or submitting an incomplete report.

a. If good cause is established by October 22, the second deadline, then update the WF/Transitional Quarterly Reporting Screen.

b. If the quarterly report is not returned and/or good cause is not established, EIS will transfer the case to MAF-C for two months with adequate notice. Conduct an ex parte review to determine eligibility for other aid program/categories.

E. September is Tenth Month of Transitional Medicaid

1. No quarterly transitional benefit will be generated on September 25.

2. The case will show up on the Case Management report generated on September 28.

3. On October 24, the case will show up on the new report, Transitional Medicaid Cases Due for Review. You must complete a redetermination on this case by November 21, Work First Regular Run. If no action is taken in EIS by this date, the case will transfer to MAF-C for 2 months.

F. September is the 11th Month of Transitional Medicaid and October is 12th Month

If EIS is not updated by October 24, WF regular run in October, the case will be transferred to MAF-C for two months. If the redetermination is not completed by the end of December, continue to authorize one month at a time until the redetermination is completed.

G. September is the 12th Month of Transitional Medicaid

If EIS is not updated by September 21, the case will terminate. An automated timely notice was generated at the beginning of September.

H. October is 12th Month of Transitional Medicaid

If the TMA case is in the 12^th month in October, the case will be displayed on the “Case Management Report”.

1. Complete a redetermination by October 24, Work First Regular Run in October.

2. If the redetermination is not completed, the case will transfer to MAF-C for two months with an adequate notice.

VIII. Calendar of Changes

The following changes will occur in Transitional Medicaid.

A. September

1. EIS mailed a letter to TMA families in months one through nine as of September, explaining they will now be reporting their income quarterly rather than monthly.

2. During September, EIS will produce timely notices to TMA recipients who are in their 12th month of TMA.

3. The revised “Notice of TMA” (DMA-5083) will be inserted with the DSS-8110 when a assistance unit transfers from MAF-C to TMA.

4. September 10 is the first deadline for returning the August monthly report for cases in the 4th, 7th and 10th months of TMA. EIS will produce the 4th, 7th, and 10th month notices and notice register associated with these notices for cases that have not returned their reports. These notices will stop in October.

5. On September 21,

a. EIS will terminate pay type 5 cases that are in the 12th month.

b. EIS will terminate pay type 5 cases that have not returned all of the required reports.

6. On September 25,

a. The new quarterly report, DMA-5082, will be produced for cases in their 3rd, 6th, or 9th month of TMA as of September.

b. New title for reporting register “Work First Quarterly Reporting Register. It is listed as “DHREJ WF QTRLY REPORTING REG” in NCXPTR.

7. On September 26,

a. The “Work First Quarterly/Monthly Reporting” screen is renamed “Work First/Transitional Quarterly Reporting”.

b. The “Transitional Benefit Report” screen will change how it updates. You will only be able to update months 3, 6, or 9 and EIS will automatically enter the same code for the two previous months.

8. On September 28, the Case Management Report will run with the transitional special messages as it currently does. Effective October 31, the report will no longer include the TMA special messages.

B. October

1. On October 9, EIS will generate a 2nd quarterly report (DMA-5082) and a good cause insert, DMA-5084, for families that have not returned their reports.

2. On October 24,

a. EIS will automatically transfer the TMA cases that have not returned their reports to MAF-C for the first time.

b. EIS will generate the new “Transitional Cases Due Review” report. The report is listed as ‘DHREJ TRANS CASES DUE REVIEW” in NCXPTR.

IX. Maintenance of Manual

A. Remove MA-3357, pages 1-20

B. Insert MA-3357, pages 1-24

C. Remove Figures 1-3

D. Insert Figures 1-4

E. Remove Tables A-D

If you have any questions, please call your Medicaid Program Representative.

Nina M. Yeager

Director

[This material was researched and written by Dora Boissy, Policy Consultant, Medicaid Eligibility Unit.]

For questions or clarification on any of the policy contained in these manuals, please contact your local county office.