OBSOLETE POLICY CHIP MANUAL |
Effective Date: February 1, 2012
The eligibility agency may use various methods to conduct the review.
Use all available resources to determine continued eligibility. (See Section 705)
Determine if any child would be eligible for Medicaid.
Consider only those factors of eligibility relevant to determining the continued eligibility of each member of the household. (See Section 705)
CHIP has two types of review forms and processes, a mandatory review and a simplified review. (See Section 704)
Mandatory Review
When the eligibility agency sends out a Mandatory Review, the review form will inform the client of the review requirement and the date by which the client must respond.
If the client responds by the due date, or sometime during the review month, request needed verification from the client. The agency must send a written request and give the client 10 days to provide the verification.
If the client does not return all requested verification by the due date, eligibility ends at the end of the month for which the eligibility agency can give 10-day notice.
If the agency cannot give 10-day notice before deciding eligibility for a new certification period, extend benefits to the following month. This is call the “due process month”. (See 803-1 for exceptions to 10-day advanced notice.)
Benefits cannot be extended during the eligibility review for a CHIP eligible child who turns age 19 in the review month.
If the client provides all the requested verifications by the verification due date, the eligibility agency proceeds with the eligibility decision.
The agency continues eligibility into the following month (the “due process month”) if needed while it makes a decision.
Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give a 10-day notice.
If the client provides all requested verification after the due date and before the end of the review month, proceed with the eligibility decision.
The agency continues eligibility into the following month (the “due process month”), if needed, while it makes a decision.
Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give 10-day notice.
If eligibility is continued into the “due process month”, the client must provide verification by the verification due date.
If the client provides verification by the due date, complete the review and send the notice of the eligibility decision. Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give 10-day notice.
If the client fails to provide verification by the due date, close the case and send notice.
If the client provides requested verification after the verification due date and before the end of the due process month, the date the verification is received is a new application date. Eligibility does not continue while the agency makes a decision. The new benefit effective date is the first day of the month after the due process month.
If the client provides all requested verification in the month after the effective closure date (the review month or the due process month), the date all of the verifications are received is a new application date. (See Section 701-3)
If the client fails to respond during the review month to the request to complete a review, eligibility ends at the end of the review month. If the client fails to respond to the review by the last day of the month following the review month, the client must reapply. (See Section 701 and 701-3 application rules.)
If an overpayment investigation determines individuals were not eligible in the review month and a due process month was established, the referral must include the due process month.
Simplified Review
When a simplified review form is sent, the household reviews the preprinted information on the form and only has to respond if there has been a change. (See Section 704)
Simplified review is either not returned, or is returned by the client reporting no changes.
The eligibility system will automatically update the re-certification period for another 12 months. Assume the enrollee had no changes to report.
Simplified review is returned by the client reporting changes.
Treat the review as a mandatory review; and follow the policy above for how to conduct a mandatory review.
Simplified review is returned after the new certification period is established.
When a client failed to report information that affects their eligibility and the information is received too late to correct the first month of the new certification period, take the following action:
If the change can be made in the second month of the certification period, make the change. No overpayment exists.
If the change is a decrease benefit and cannot be made in the second month of the certification period, make the change and refer all months that issued incorrectly as an overpayment. (See Section 806-2)