Assisting Members to Maintain Medicaid Eligibility. The MCO is responsible for assisting members in their responsibility to maintain Medicaid eligibility. This may include:
Assisting Members to Maintain Medicaid Eligibility. The MCO is responsible for assisting members in their responsibility to maintain Medicaid eligibility. This may include: Reminding members of the required annual Medicaid recertification procedure and assisting them to get to any needed appointments; Assisting members to understand any applicable Medicaid income and asset limits and as appropriate and needed, supporting members to meet verification requirements; Assisting members to understand any deductible, cost share or patient liability obligation they may need to meet to maintain Medicaid eligibility; Assisting members to understand the implications of their functional level of care as it relates to the eligibility criteria for the program; If appropriate and needed, assisting members to obtain a representative payee or legal decision maker; and Referring members as needed to other available resources in the community that may assist members in obtaining or maintaining eligibility such as Elder and Disability Benefits Specialists and advocacy organizations. Coordinate with residential provider to assist member in completing Medicaid review. Providing Information that May Affect Eligibility Members have a responsibility to report certain changes in circumstances that may affect Medicaid eligibility to the income maintenance agency within ten (10) calendar days of the change. Notwithstanding the member’s reporting obligations, if the MCO has information about a change in member circumstances that may affect Medicaid eligibility, the MCO is to provide that information to the income maintenance agency as soon as possible but in no event more than ten (10) calendar days from the date of discovery (see Article IV.C.2.c.). Members who receive SSI benefits are required to report certain changes to the Social Security Administration rather than the local IM agency. MCOs should assist members in meeting these reporting requirements since loss of SSI has a direct impact on Medicaid eligibility. Reportable information includes: The member’s functional eligibility as determined by the LTCFS using procedures specified by the Department; The average monthly amount of medical/remedial expenses the member pays for out-of-pocket; The housing costs the member pays for out-of-pocket, either in the member’s own home or apartment or in a community-based residential care facility (see Section E of this article); Non-payment of any required cost share (post eligibility treatment of income); The member has died; The member ha...
Assisting Members to Maintain Medicaid Eligibility. The PO is responsible for assisting members in their responsibility to maintain Medicaid eligibility. This may include:
Assisting Members to Maintain Medicaid Eligibility. The MCO is responsible for assisting members in their responsibility to maintain Medicaid eligibility. This may include: Reminding members of the required annual Medicaid recertification procedure and assisting them to get to any needed appointments; Assisting members to understand any applicable Medicaid income and asset limits and as appropriate and needed, supporting members to meet verification requirements; Assisting members to understand any deductible, cost share or patient liability obligation they may need to meet to maintain Medicaid eligibility; Assisting members to understand the implications of their functional level of care as it relates to the eligibility criteria for the program; If appropriate and needed, assisting members to obtain a representative payee or legal decision maker; and Referring members as needed to other available resources in the community that may assist members in obtaining or maintaining eligibility such as Elder and Disability Benefits Specialists and advocacy organizations. Coordinate with residential provider to assist member in completing Medicaid review. Providing Information that May Affect Eligibility Members have a responsibility to report certain changes in circumstances that may affect Medicaid eligibility to the income maintenance agency within ten (10) calendar days of the change.
