 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
|
|
|||||||||||
| |||||||||||||
This topic contains information on the following subjects:
2. Medicaid referral requirements;
3. Cooperation by Medicaid (MAO) clients;
4. Special consideration regarding client cooperation for certain Medicaid categories;
The Division of Medical Assistance (DMA) supervises county departments of social services in the provision of medical assistance called "Medicaid" to adults and children who are below the appropriate federal poverty income limit for a person of their age.
The Eligibility Information System (EIS) maintains data on all Medicaid cases. After receiving notification from CSE that health insurance has been obtained for the dependent child(ren), DMA is able to bill the health insurance provider for the cost of the care paid for by the Medicaid program.
Per Federal regulations, county DSS must refer all Medicaid cases to CSE when the reason for deprivation is based on the continued absence of either one or both parents, including children less than eighteen (18) years of age who are living independently. If a finding or pending action for Good Cause exists, a case should not be referred. Cases that are appropriate for referral should be referred to CSE no later than the disposition date of the Medicaid application.
County DSS is not required to refer Child-Only Medicaid cases when the caretaker of the child does not receive any other Medicaid or Work First, unless the caretaker requests that the case be referred for services or the caretaker is receiving Medicaid FPW (Family Planning Waiver).
If the caretaker of the child(ren) in a Child-Only Medicaid case is receiving Medicaid FPW, county DSS is required to refer the Child-Only Medicaid case to CSE for services. Caretakers who receive Medicaid FPW are required to cooperate with the local CSE agency.
A case should NOT be referred from Medicaid if the child has health insurance or a court order for medical support already in place for the child(ren).
NOTE: If it is determined that an inappropriate referral has been made after the case has been opened, the CSE agency must notify the client that child support services are available but the case will be terminated unless the client desires CSE services.
Local CSE agencies must seek health insurance coverage for children in properly referred Medicaid cases. The client has the option to request that CSE provide the full range of services for the case.
If no order for medical support exists for the case, CSE is required to determine if health insurance is available through the NCP's employer or or other group insurance, in order to pursue establishment of an order for medical support. When CSE establishes an order that includes a provision for the NCP to provide health insurance for the minor child(ren), CSE should provide proof of medical insurance to the client.
If an order for medical support is already in place, CSE is required to enforce the medical support provision in the order.
In order for Medicaid eligibility to be established, the client is required to cooperate with the local CSE agency to:
1. Identify and locate the parent of any child for whom assistance is requested;
2. Establish the paternity of any child born out of wedlock for whom assistance is requested;
3. Obtain medical support coverage information from the NCP for any child for whom assistance is requested; and
4. Assign any medical support payments due the parent remaining in the home and/or any child for whom assistance is requested to the Division of Medical Assistance (DMA).
Other Medicaid aid categories exist that must be given special consideration regarding client noncooperation:
The caretaker of child(ren) who are recipients in a Child-Only Medicaid case can receive assistsnce through the Medicaid Family Planning Waiver (FPW), also known as the "Be Smart" program.
Child-Only Medicaid cases must be referred to CSE by the county DSS if the caretaker of the children is receiving Medicaid FPW. If the child of a caretaker who is receiving Medicaid FPW is later approved for Medicaid, county DSS must refer the case with the child to CSE. The client must cooperate with CSE to receive services. If clients fail to cooperate, CSE must notify the county DSS's Medicaid Unit.
To qualify for Medicaid FPW, the client must not be eligible for coverage in another Medicaid aid program/category. The assistance unit consists of only one person: the client. Services that are available under Medicaid FPW include the following:
1. An annual family planning exam;
2. Counseling and contraceptive supply visits to support the effort to continue a pregnancy spacing plan;
3. Most methods of birth control;
4. Screening and treatment for sexually transmitted infections;
5. Screening for HIV; and
6. Sterilization for men and women over twenty-one (21) years of age.
Clients whose children are eligible for autonewborn benefits under Medicaid for Infants and Children (MIC) are not required to cooperate with CSE concerning the newborn child(ren) during the 60-day post partum period. The case can be referred to CSE at the end of this period. If clients request CSE services, their cases can be referred prior to this time period.
Children on automatic newborn MIC can receive MIC benefits for a year. If the client is not receiving Medicaid nd does not cooperate with CSE, no referral for noncooperation should be made to the county DSS’s Medicaid Unit, since cooperation with CSE is not required. No sanctions can be imposed by county DSS.
Recipients of Medicaid for Pregnant Women (MPW) are not required to cooperate with CSE for either the unborn child or children receiving aid under other categories of medical assistance. Federal regulations require referral of these cases to CSE at the end of the client's 60-day post partum period. At that time the client is no longer eligible for MPW and is required to cooperate with CSE in establishing and enforcing medical support. The case can be referred prior to this time if the client requests the referral.
Children ho receive SSI automatically receive Medical Assistance to the Disabled (MAD). These cases are handled by the local office of the Social Security Administration and are not referred to CSE when child support services are needed. In these situations, the client or caretaker of a child who needs child support due to the absence of a parent is advised to contact the local CSE agency to apply for services.
These cases are to be treated in the same manner as any other MAO case. No application fee is charged. If the child in an existing Non-MAO case becomes an SSI/MAD recipient, the client can elect to receive only medical support services from CSE. A continuation of services notice is NOT sent to the client in this situation.
When the client is declared ineligible for Medicaid, the Medicaid case (regardless of the aid category) is considered a Child-Only Medicaid case. County DSS is not required to refer Child-Only Medicaid cases when the client (caretaker of the child) does not receive any other Medicaid or Work First benefits. These cases are referred to CSE only if the client requests CSE services or is receiving Medicaid FPW (Family Planning Waiver).
Child-Only Medicaid cases can be closed when the caretaker of the child fails to cooperate with CSE.
NOTE: Transitional Medicaid cases are not considered Child-Only Medicaid cases and should not be closed when the client does not cooperate.
CSE caseworkers and supervisors must generate the Case Closure Intent Notice (DSS-4617) with the closure reason code "CNON" (Client not cooperating) as notification to the caretaker that child support services will terminate in sixty (60) days.
Two exceptions exist to the preceding policy regarding the closure of Child-Only Medicaid cases:
Failure to cooperate with the CSE agency can result in the client being declared ineligible for Medicaid. If an MAO client who is receiving the Medicaid benefit refuses to cooperate with CSE, local CSE must notify the county DSS’s Medicaid unit of the client's noncooperation.
The procedures for processing a noncooperation claim in a Medicaid case are the same as those applied in a Work First case.
When the client is declared ineligible for Medicaid, the Medicaid case (regardless of the aid category) is considered a Child-Only Medicaid case. Child-Only Medicaid cases can be closed when the caretaker of the child fails to cooperate with CSE; however, some exceptions exist.
|
For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
| |||||||||||||