Family and Children's Medicaid MA-3265 MEDICAID FAMILY PLANNING WAIVER

VIII. Reactivating Individuals on the Waiting List

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

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VIII.

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 “F9” denied application.

3. 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. A DMA-5120, Medicaid Family Planning Waiver Program, is mailed by the State to each casehead in a reactivated application.

7. A NCXPTR report titled DHRWDB FAM PLAN APPS REACTIVATED lists reactivated applications by county. The report is sorted alphabetically by casehead. The State mails one copy of the report to each county.

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 the Reactivation Notice DMA-5120, Medicaid Family Planning Waiver Program.

a. The State mails to each casehead in a reactivated application a DMA-5120, Medicaid Family Planning Waiver Program. The letter notifies the case head about the reactivation of the application. It asks the casehead:

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(VIII.B.1.a)

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

(2) To confirm his current address and whether or not the a/r is pregnant or has the ability to have children.

b. The applicant 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 applicant 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-5120, Medicaid Family Planning Waiver Program. Mark “Second Request” at the top of the letter.

Attach a DMA-5097/DMA5097S, 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 applicant no longer lives 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 applicant by phone to verify the current address.

(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 applicant and deny the application.

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(VIII.B.)

2. Reactivation Notice Returned Complete

When the DMA-5120, Medicaid Family Planning Waiver Program, 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 applicant reports no change in income, process the application using the income on file.

b. If the applicant 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 individual is eligible for Medicaid using the changed income, approve the application under the appropriate Medicaid program.

(2) If the individual is eligible for FPW using the changed income, approve for FPW.

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

c. An applicant may have moved since the original application was filed, and he may no longer live in the county where he applied. The county on whose report the applicant 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 DMA-5120, Medicaid Family Planning Waiver Program, 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-5097S, Request for Information, to request the missing information. Make at least two requests with at least 12 calendar days between the requests.

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(VIII. B.)

4. DMA-5120, Medicaid Family Planning Waiver Program, Reactivation Notice Indicates Individual Got Married. It is possible that an individual has gotten married since the original application was made. If the individual has gotten married:

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

b. Request income from any new responsible person in the new household using the DMA-5097/DMA-5097S.

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

d. Before disposing of the case, update the current address on the DSS-8124 to the current address for the individual.

C. Researching Cases

Using the information from the NCXPTR report, DHRWDB FAM PLAN APPS REACTIVATED, and information in EIS, research the reactivated applications prior to disposition to determine if the individual on the original application has been subsequently approved in another aid program/category.

1. Individual on the original application approved in another aid program/category

a. Deny the application if the individual on the reactivated application is now authorized in an ongoing Medicaid case, or

b. The individual termination date is the same as the date of the reactivated application.

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

a. Individual in Pending FPW Application

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

(2) If the reactivated FPW 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 individual is ineligible for FPW, deny with a F9.

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(VIII.C.a.)

(3) If the reactivated application is not processed by the 45th day of the pending

FPW application, process the pending application. Continue to process the reactivated application.

b. Individual in Pending Medicaid or Work First Application

Unless ineligibility is established, do not dispose of the reactivated FPW 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 FPW application.

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

3. Use the information from the most recent application on record and the Notice of Reactivation to process the reactivated application.

4. If the same individual appears in multiple reactivated applications, deny all but one of the reactivated applications.

D. Processing the Medicaid Family Planning Waiver Reactivated Application

There are three possible outcomes for the reactivated FPW applications.

1. Withdrawal

Withdraw the application if the applicant 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 applicant. Follow instructions in the application processing sections.

2. Denial

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

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

(1) The 45th day when the reactivation notice and at least one DMA-5097 were sent or two DMA-5097’s with at least 12 calendar days between them were sent prior to the 45 day processing standard, or

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(VIII.D.2.b.)

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

c. Deny when the applicant fails to provide information on:

(1) The 45th day when the reactivation notice and at least one DMA-5097 were sent or two DMA-5097’s 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 is sent requesting the information after the reactivation notice or the first work day after two DMA-5097’s with at least 12 calendar days between them and the 12th calendar day exceeds the 45 day processing standard.

d. Failure to provide information includes:

(1) The applicant fails to return the Notice of Reactivation,

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

(3) The applicant fails to sign the reactivation notice.

e. If the DMA-5120, Medicaid Family Planning Waiver Program letter, or any other information requested is returned after the case is denied, send a DMA-5063/DMA-5063S . Advise the applicant that he/she has been dropped from the waiting list and that he/she must reapply.

3. Approval

a. Approve the case if the applicant returns the DMA-5120, Medicaid Family Planning Waiver Program letter and is eligible.

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.

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(VIII.)

E. Reports

In addition to the FPW reports already received by the counties, the following reports will be generated and available in NCXPTR.

1 DHRWDB FAM PLAN CAP ENROL DENIAL

This report lists applications denied with code “F9”. The report is run monthly on the 5^th work night. Copies of the report are not mailed to the county.

2. DHRWDB FAM PLAN APPS REACTIVATED

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.

3. DHRWDB FAM PLAN OUTCOME OF REACT

This report shows the outcome of applications that were reactivated and what action was keyed.

4. DHRWDB FAM PLAN ENROLL MGMT REPT

This report will provide information that will enable the State to make decisions

regarding a freeze in enrollment.