Family and Children's Medicaid MA-3255 NC HEALTH CHOICE

VIII. reactivating Children on the Waiting LIST

When additional funding is available, children can be reactivated from the waiting list. The state notifies counties via a terminal message that children may be reactivated. Follow these steps to reactivate children on the waiting list.

A. Reactivating Applications in EIS

1. Reactivated applications are identified using the waiting list database. EIS reactivates the applications using the information in the database.

2. The reactivated application contains the same individuals who were listed on the original “C4” denied application.

3. Applications originally keyed as type 6 add-on applications are reactivated as type 6 add-on applications using the same case ID number that was used on the original “C4” denied application. All other reactivated applications are opened as new applications and have a new case ID number.

4. Reactivated applications have an indicator for identification purposes that is invisible to the county. The indicator allows the identified cases to be approved at the county level once eligibility is established.

5. These applications appear on the county application management report but are administrative applications.

6. DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program, is mailed by the State to each casehead in a reactivated application.

7. A report titled DHREHC NCHC APPLICATIONS REACTIV found in NCXPTR lists reactivated applications by county. The report is sorted alphabetically by casehead. The State mails one copy of the report to each county.

REVISED 04/01/11 – CHANGE NO. 01-11

(VIII.)

B. Notifying Clients and Requesting Information

Income and basic information must be re-evaluated for reactivated applications. The information is obtained from the reactivation notice the applicant completes. DMA notifies counties via terminal message when applications are reactivated.

1. Mailing Reactivation Notice

a. The State mails to each casehead a DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program. The letter notifies the casehead about the reactivation of the application. It asks the casehead:

(1) If there has been a change in income since he applied. The casehead’s statement of income on the letter is acceptable if he indicates a change in income.

(2) Confirm his current address and whether the child has health insurance.

b. The casehead has 12 calendar days to return the letter. If the 12th day, falls on a weekend or holiday, allow until the end of the first business day following the weekend or holiday for the return of the letter. If the casehead does not respond by the deadline:

(1) Research agency records, both paper and computer, to ensure the letter was mailed to the most current address.

(2) Mail a second DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program. Mark “Second Request” at the top of the letter. Attach a DMA-5097 (DMA5097, Spanish), Request for Information, to the letter.

(3) Allow twelve calendar days from the date mailed for return of the second letter.

c. If the letter is returned to the agency because the casehead and child no longer live at the address:

(1) If a forwarding address is provided, mail the notice to that address.

(2) If no forwarding address is provided, check the original application for a phone number. Attempt to contact the casehead by phone to verify the current address.

REVISED 04/01/11 – CHANGE NO. 01-11

(VIII. B.1 c.)

(3) If no forwarding address or phone number is available, search all agency

records, both paper and computer, for a current address. See MA-3410, Terminations and Deletions, for the definition of current address.

d. If no current address or phone number can be located, document all attempts to locate the casehead and deny the application.

2. Reactivation Notice Returned Complete

When the DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program, letter is returned complete (all questions, except date, are answered, income statements are complete and not questionable and the form is signed), process the reactivated application.

a. If the casehead reports no change in income, process the application using the income on file.

b. If the casehead reports a change in income and includes a complete statement regarding the changed income, use that statement to process the reactivated application.

(1) If the child is eligible for Medicaid using the changed income, approve the application under the appropriate Medicaid program.

(2) If the child is eligible for NCHC using the changed income, approve for NCHC.

(3) If the child is ineligible for NCHC based on the changed income, deny the reactivated application using the appropriate denial code.

c. A casehead and his family may have moved since the original application was filed, and they may no longer live in the county where they applied. The county on whose report the casehead appears is responsible for dispositioning a reactivated application. After approving the case, follow transfer procedures in MA-3340, County Residence.

3. Reactivation Notice Returned Incomplete

If the Notification of Reactivation letter is returned but is incomplete (not all questions are answered, income statement is incomplete or questionable or the form is not signed), use the DMA-5097 (DMA-5097, Spanish), Request for Information, to request the missing information. Make at least two requests with at least 12 calendar days between the requests.

4. Notice of Reactivation Lists Children Not Included on the Original Application

a. Mail or give the family a DMA-5063 (DMA-5063 Spanish), Medicaid/NC Health Choice Application, to apply for the other child. Inform the casehead that he must apply for this child.

REVISED 04/01/11 – CHANGE NO. 01-11

(VIII.B. 4)

b. When the casehead returns the DMA-5063 for the additional child, process that application following policy in the application processing sections. The child, if eligible for NCHC, will be added to the waiting list.

5. DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program, Indicates Child Moved to Another Household

It is possible that a child has moved into another household since the original application was made. If the DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program, indicates that the child has moved into another household:

a. Research the case. See VIII.C. below.

b. If the same child appears in multiple reactivated applications, follow instructions in VIII.C.3. below.

c. If the child does not appear in another reactivated application with the new casehead:

(1) Request income from any financially responsible person in the new household using the DMA-5097/DMA-5097, Spanish, Request for Information.

(2) Based on the new household’s income, evaluate eligibility first for Medicaid. If ineligible for Medicaid, the child must be evaluated for Health Choice. Because this income was never verified, a statement of income is not acceptable to process these Health Choice cases. Income in these cases must be verified following policy in MA-3300, Income.

(3) Before disposing of the case, change the address on the DSS-8124 to the current address for the child. If the child is eligible with the new casehead, follow instructions in EIS 3101 to change the casehead once the case is approved.

C. Researching Cases

Using the information from the NCXPTR report, DHREHC NCHC APPLICATIONS REACTIV, and information in EIS, research the reactivated applications prior to disposition to determine if any child on the original application has been subsequently approved in another aid program/category or if the child or casehead appears multiple times in the reactivated applications.

1. Reactivated Child in Ongoing Case

If the child on a reactivated application has already been approved and is active in an ongoing case:

REVISED 04/01/11 – CHANGE NO. 01-11

(VIII.C.1.)

a. Deny the application if all children on the reactivated application are now authorized in an ongoing case, or

b. Delete the active child from the reactivated application if there are children on the reactivated application who are not authorized in an ongoing case. Delete the active child on the DSS-8125 at the time the reactivated application is approved for the other children. The individual termination date is the same as the date of the reactivated application.

2. Reactivated Child in Another Pending Application (Not A Reactivated Application)

a. Children in Pending NCHC Application

(1) If the reactivated application is approved prior to the 45th day of the pending application, deny the pending application.

(2) If the reactivated application is denied prior to the 45th day of the pending application, process the pending application. If the freeze is still in effect for new enrollments and the children are eligible for NCHC, deny with a C4.

(3) If the reactivated application is not processed by the 45th day of the pending application, process the pending application. Continue to process the reactivated application.

b. Children in Pending Medicaid or Work First Application

Unless ineligibility is established, do not dispose of the reactivated NCHC application until the pending Medicaid or Work First application has been dispositioned. Reactivated applications may pend for more than 45 days in these situations.

(1) If the pending Medicaid or Work First application is approved, deny the reactivated NCHC application.

(2) If the pending Medicaid or Work First application is denied, process the reactivated NCHC application.

3. Same Reactivated Child in Multiple Reactivated Applications

A casehead may apply for the same child more than once during a freeze. Counties are directed to disposition each application and, if appropriate, deny each using the “C4”

denial code. This means that the same child may appear in multiple reactivated applications and the casehead could receive more than one DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program.

REVISED 04/01/11 – CHANGE NO. 01-11

(VIII.C.3.)

a. Use the information from the most recent application on record and the DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program, to process the reactivated application.

b. If the same children appear together in multiple reactivated applications, deny all but one of the reactivated applications.

For example, Sue Smith applied January 3 for her children, John, Jane and Jimmy. She applied again on March 1 for the same children. Ms. Smith may have two reactivated applications. Deny one application. Use information from the March 1 application to process the reactivated application.

c. If a child appears in multiple reactivated applications but with different children and casehead:

(1) Determine where the child is currently living.

(2) Include the child on the payee’s case where he currently lives. Use information from that payee’s application to process the case.

(3) Delete the child from the other reactivated applications. Key the individual termination date on the DSS-8125 at the time the remaining children on the reactivated application are approved. The individual termination date is the date of the reactivated application.

For example, Jill Johnson applied January 5 for her children, Barry, Sara and Will. Barry left the household and went to live with his father, Sam. Sam Johnson applied for Barry on March 1. Barry will appear on both reactivated applications. Barry is still living with his father. Process the reactivated application for Barry based on information from the March 1 application. When NCHC is approved for Sara and Will, delete Barry from that application.

4. Same Casehead in Multiple Reactivated Applications

A casehead may also apply more than once during the freeze but for different children. This means that the same casehead can appear multiple times on the report with different children. The casehead can have only one NCHC case in EIS.

a. Deny all reactivated applications with the same casehead.

b. Key a DSS-8124 administrative application to reopen the reactivated application. The application type is 1. The application date is the same as the denied reactivated application.

REISSUED 04/01/11 – CHANGE NO. 01-11

(VIII.C.4.)

c. This reopened application includes all the children for whom the casehead applied and whose application has been reactivated.

For example, Beth White applied for her child, Ben, on January 11. On February 15, she applied for another child, Jessica. Both applications are reactivated by EIS. Deny both applications and key one DSS-8124 that includes Ben and Jessica.

d. Key the DSS-8125 for approval. An on-line error message will appear stating that the application cannot be approved. Put the form on hold. Contact Medicaid EIS and provide the form numbers of the DSS-8124 and DSS-8125 as well as the county number. These cases will be processed at the state level. Do not take any further action on the forms or they will not process.

5. Add-on Applications

Some cases on the waiting list may be keyed as add-on applications to existing NCHC cases. These cases are reactivated as type 6, add-on applications.

Research these cases to ensure the existing NCHC case is still active.

a. If the NCHC case to which the child was being added is still active, process the reactivated application as an add-on.

b. If the application was placed on the waiting list as an application type 1 or 2 instead of type 6, deny the application. Register another application as a type 6. Contact EIS for assistance with these cases.

c. If the NCHC case to which the child was being added has been closed:

(1) Deny the reactivated application.

(2) Key a DSS-8124 administrative application. The date of application is the same as the denied reactivated application. The application type is 1.

d. If the case ID of the NCHC case to which the child was being added is now linked to a non-NCHC case:

(1) Deny the reactivated application.

(2) Key a DSS-8124 administrative application. The date of application is the same as the date of the denied reactivated application. The application type is 1.

e. Anytime the county denies the reactivated application and keys the administrative DSS-8124, the State must process the case. Follow directions in VIII.C.4 above to have the case processed.

REVISED 04/01/11 – CHANGE NO. 01-11

(VIII.)

D. Processing the NCHC Reactivated Application

There are three possible outcomes for the reactivated NCHC applications.

1. Withdrawal

Withdraw the application if the casehead contacts the DSS and states he/she no longer wants the assistance. The caseworker must document the reason for withdrawal and the alternatives to withdrawal that were discussed with the client. Follow instructions in the application processing sections.

2. Denial

a. Deny any time ineligibility is established (for example, changed income exceeds the income limit).

b. Deny when the casehead fails to provide information on:

(1) The 45th day when the reactivation notice and at least one

DMA-5097/DMA5097, Spanish, Request for Information, were sent or two with at least 12 calendar days between them were sent prior to the 45 day processing standard, or

(2) The first work day after the 12th calendar day when the second DMA-5097/DMA-5097, Spanish, Request for Information, is sent requesting the information after the reactivation notice or two DMA-5097’s with at least 12 calendar days between them and the 12th calendar day exceeds the 45 day processing standard.

c. Failure to provide information includes:

(1) The casehead fails to return the DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program.

(2) The casehead reports a change in income but has not provided a complete statement of the changed income,

(3) The casehead does not report on the status of health insurance for all of the children originally included on the application.

(a) Delete children for whom the status of health insurance is not reported when the family fails to respond to the requests for information.

(b) If the status of health insurance is not reported for any of the children and the casehead does not respond, deny the application.

REVISED 04/01/11 – CHANGE NO. 01-11

(VIII.D.2.c.)

(4) The casehead does not list all of the children who were included on the original application.

(a) Delete children not listed when the casehead fails to respond to the requests for information.

(b) If none of the children are listed on the DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program, and the casehead does not respond, deny the reactivated case.

(5) The casehead fails to sign the reactivation notice.

d. Follow current NCHC policy for denying cases due to failure to pay the enrollment fee or when the child has comprehensive health insurance.

e. If the DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program, letter or any other information requested is returned after the case is denied, send a DMA-5063 (DMA-5063, Spanish), Medicaid/NC Health Choice Application. Advise the casehead that the child has been dropped from the waiting list and that he must reapply.

3. Approval

a. Approve the case if the casehead returns the DMA-5127/DMA-5127S, Notice of Reactivating The Health Check/Health Choice Program. letter, remains eligible, pays the enrollment fee, if applicable, and does not have health insurance on the child.

b. Authorize the case when all the eligibility requirements are met but no earlier than the first of the month of the reactivated application. The certification period will begin the same month the case is authorized and will be twelve months.

E. Reports

In addition to the NCHC reports already received by the counties, the following reports will be generated. Both reports are available in NCXPTR.

1. DHREHC NCHC LIMITED FUNDING

This report lists applications denied with code “C4”. The report is run monthly on the 5^th work night. Copies of the report are not mailed to the county.

2. DHREHC NCHC APPLICATIONS REACTIV

This report lists the reactivated applications by county. Each county will receive one paper copy of the report. The report is sorted alphabetically by casehead, not by the order the child appeared on the waiting list.