Family and Children's Medicaid MA-3420 RE-ENROLLMENT

XIII. REOPENS

A. A case which terminates for not cooperating with the re-enrollment process may be reopened if certain criteria listed below are met: This includes information requested during the MIC/NCHC ex parte process.

1. The case meets criteria in MA-3215, Processing the Application.

2. The re-enrollment form and all information necessary to approve eligibility is received by the 10th of the month following termination.

a. If the NC Health Choice client received notification of the enrollment fee, it must be paid by the 10th of the month.

b. If an enrollment fee is due, it must be paid by the 10th of the month following termination. If it has not been paid, do not reopen the case. If the client is not notified that a fee is due until the 10th day, give the client 12 calendar days to pay the fee.

3. Reopen the case in EIS as an administrative application. Enter “Y” in the ADMIN field on the DSS-8124 screen. The date of application is the first day of the month following termination.

B. Do not reopen the case if a completed re-enrollment form is required and the completed form is received after the 10th of the month.

1. Treat the signed re-enrollment form as an application. Do not require the recipient to complete and sign a DMA-5063.

2. Enter a reapplication in EIS. All application processing standards apply. The application counts in the report card.

3. The date of application is the date the re-enrollment form is received and is complete.

4. If income can’t be verified through other current agency records, request verification of income.

5. Verify other eligibility factors as necessary. Use current agency records.

REVISED 07/01/11 – CHANGE NO. 12-11

(XIII.B.)

6. If an enrollment fee is due for NC Health Choice, allow the recipient 12 calendar days to pay the fee before denying the application. Refer to MA-3255, NC Health Choice.

C. Do not use the re-enrollment form as an application if a re-enrollment form is required and was previously received, but information needed to process the re-enrollment is not received until after the 10th of the month. Require the recipient to complete a DMA-5063 to start the application process over.

1. Call or write the recipient and explain that he or she must reapply for benefits.

2. Send the recipient a DMA-5063 and return the enrollment fee if applicable.

3. When the completed DMA-5063 is received, follow application processing procedures in MA-3255, NC Health Choice, or MA-3215, Processing the Application.