Effective Date: March 1, 2023
On April 1, 2023, the continuous eligibility requirement for Medicaid ended.
The following Q&A provides clarifications regarding continued exceptions during the unwinding of the continuous eligibility requirement for Medicaid.
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Question |
Can an overpayment be assessed for an ineligible month? |
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Answer |
Overpayments for an ineligible month can be assessed after a full review is complete. However, if there is suspected fraud, the agency may refer the case for criminal investigation. If the agency suspects client abuse, refer the case for investigation. If the agency determines the member received eligibility due to member abuse, close the case. The decision does not affect eligibility for the previous months during the PHE. |
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Question |
When will the quarterly CHIP premiums resume? |
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Answer |
Premiums for CHIP households have been separated into three groups during the first quarter after the continuous eligibility requirement ends. · May 1, 2023 the first group of CHIP quarterly premiums reinstated · June 1, 2023 the second group of CHIP quarterly premiums reinstated · July 1, 2023 the last group of CHIP quarterly premiums reinstated. See policy 602 |
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Question |
What happens when the premiums are not paid? |
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Answer |
If premiums are not paid by the due date a late fee will be assessed and then the case will close for nonpayment. See policy 602 In addition, any premiums or late fees the agency collected between March 1, 2020 and the scheduled review is complete must be refunded to the household |