CHIP Policy

804 Changes

Effective Date:  November 1, 2015

Previous Policy

 

Reporting Requirements

Members must report certain changes at any time during the certification period and certain changes at review.

• The agency will determine what actions to take depending on the change.  (See Section 102-3 for reportable changes)
• The agency must take action on reported changes within 10 days.

Taking Action on Reported Changes Required During a Certification Period

Evaluate a reported change to determine if it could affect eligibility during the 12-month certification period.  Take the following actions on changes that are reportable during the certification period. (See Sections 102-3 & 703-1).

1. The agency must take action on reported changes within 10 calendar days of report.
2. When an income change is reported see section 804-5 to determine which actions to take.
3. Use available electronic data sources to verify the change before requesting information from the member.
4. If the agency cannot determine continued eligibility by electronic data match, then the agency must request the necessary verification from the member.

• Workers must only request verification needed to determine eligibility.
• Give the member at least 10 days from the date of the notice to provide verification.  
• If the 10th day is a non-business day, give the member until the first business day following the 10th day to provide the verification.
• The agency must provide a 10 day advance notice of any adverse actions taken on the case. (See section 803 for notification requirements)

5. If the member does not provide all requested verification for reportable changes by the verification due date, the eligibility agency ends benefits for the first month it can give 10-day advance notice.

• If the reported change was not required and the member fails to follow up with verification, CHIP remains open.

6. If the member provides all requested verification by the verification due date, or by the end of the report month, whichever is later, the agency continues with the eligibility determination.
   1. If the action results in a better CHIP plan, make the change effective the month of change report.
   2. If the action results in a better benefit, such as eligibility for Medicaid, make the change effective the month of the change report.
7. For an adverse action, make the change for the first month the eligibility agency can give 10-day notice.

• See section 703-1 to ensure the adverse action meets an exception to the 12-month certification period.

Example: The member reports on September 27th that a child has left the household.  The child remains eligible for CHIP coverage through Oct. 31st. Do not re-determine eligibility for any remaining eligible children.

8. If the eligibility agency receives all requested verification by the last day of the month following the effective closure date, consider this a new application with application time frames.
9. Individual information will be transferred to the FFM if the individual is no longer eligible for CHIP.
10. Mail returned by the post office with no forwarding address indicates a change.  (See Section 803-2 to decide what steps to take.)
11. When a household reports a change of address, provide the household with voter registration information. (See Section 101)
12. Failure to make a timely report of a reportable change may result in an overpayment of benefits.  (See Section 806)

Taking Action on Reported Changes Required at Reviews

The agency may complete an ex parte review or a review requiring member participation. In either case, the agency notifies the member of the review decision. If the member is eligible for a new certification period, the notice tells the member to report any changes that occurred during the current certification period and prior to the start of the new certification period. 

• Take client statement on the effective date of the change unless the agency has information that conflicts with the client statement.   
• Only act on changes that occurred prior to 10-day notice in the review month.  (See section 102-3 to determine reportable changes)
• A member may report a change that could affect eligibility for the current certification period. Only change the current certification period if the change is an exception to the 12-month certification period, or when the member asks for a re-determination. (See section B. above to determine what actions to take.) If the change affects the current certification period, re-evaluate the decision for the new certification period.

 

Re-determine eligibility for the new certification period

13. If the change is a reportable change, re-determine eligibility for the new certification period. (See section 102-3 for reportable changes.) If verification is needed to determine eligibility, give the member at least 10 days from the date of the notice to provide verifications.
14. If the change results in an adverse action on the member, make the change effective the first of the month for which the eligibility agency can give proper 10-day notice

• When the member remains eligible for CHIP, but the change will become effective in a month after the first month of the new certification period, establish a new 12-month certification period.
• If the member is no longer eligible for CHIP, end the CHIP benefits effective the month for which the agency can give proper 10-day notice.
• Refer the case for a possible overpayment if the member reported the change late and CHIP eligibility was issued in error.  (See Section 806)

15. If the change makes the member eligible for a better benefit, make the change effective the month of report when verified timely, but not earlier than the first month of the new certification period.

• A better benefit would be a lower cost plan, lower out of pocket cost or Medicaid eligibility.
• Verification is timely if received by the verification due date, or by the end of the report month, if later.
• If verification is not received timely, make the change effective the month it is verified.

16. If the member does not return all requested verification for reportable changes by the verification due date, end benefits effective the first of the month for which the agency can give proper 10-day notice.