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, as appropriate, 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 (see Article IV.C.2.d. page 48). 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:
a. The member’s functional eligibility as determined by the Long-Term Care Functional Screen using procedures specified by the Department;
b. The average monthly amount of medical/remedial expenses the member pays for out-of-pocket;
c. 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 F of this article);
d. Non-payment of any required cost share (post eligibility treatment of income);
e. The member has died;
f. The member has been incarcerated;
g. The admission of a member who is age 21 or over and under age 65 to an Institute for Mental Disease;
h. The member has moved out of the county or service area;
i. Any known changes in the member’s income or assets;
j. Any disqualifying Medicare coverage elections (Partnership and PACE only);
k. Changes in the member’s marital status.
Providing Information that May Affect Eligibility. Members have a responsibility to report certain changes in circumstances that may affect Medicaid eligibility to DFR within ten
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 PO has information about a change in member circumstances that may affect Medicaid eligibility, the PO 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. Members who receive SSI benefits are required to report certain changes to the Social Security Administration rather than the local IM agency. POs should assist members in meeting these reporting requirements since loss of SSI has a direct impact on Medicaid eligibility. Reportable information includes:
a. The member’s functional eligibility as determined by the LTCFS using procedures specified by the Department;
b. The average monthly amount of medical/remedial expenses the member pays for out-of-pocket;
c. 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 D of this article;
d. Non-payment of any required cost share (post eligibility treatment of income);
e. The member has died;
f. The member has been incarcerated;
g. The admission of a member who is age 21 or over and under age 65 to an Institute for Mental Disease;
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, as appropriate, 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 (see Article IV.C.2.d. page 53). 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:
a. The member’s functional eligibility as determined by the Long-Term Care Functional Screen using procedures specified by the Department;
b. The average monthly amount of medical/remedial expenses the member pays for out-of-pocket;
c. 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 F of this article);
d. Non-payment of any required cost share (post eligibility treatment of income);
Providing Information that May Affect Eligibility. The MCO and member share responsibility to provide information that may affect member’s eligibility to the Department or county income maintenance agency within ten (10) calendar days (see Article IV.C.2.d, page 43). Such information includes:
a. The member’s functional eligibility as determined by the Long-Term Care Functional Screen using procedures specified by the Department;
b. The average monthly amount of medical/remedial expenses the member pays for out-of-pocket;
c. 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 F of this article);
d. Non-payment of any required cost share (post eligibility treatment of income);
e. The member has died;
f. The member has been incarcerated;
g. The admission of a member who is age 21 or over and under age 65 to an Institute for Mental Disease;
h. The member has moved out of the county or service area;
i. Any known changes in the member’s income or assets;
j. Any disqualifying Medicare coverage elections (Partnership and PACE only);
k. Changes in the member’s marital status.
