OBSOLETE POLICY CHIP MANUAL |
Effective: August 1, 2012
Procedure - Changing CHIP Plans Due To Income Changes
CHIP enrollees are not required to report changes in income during the 12 month review period. When an income change is reported, only re-determine eligibility when the enrollee requests a Medicaid determination, asks for a CHIP income re-determination or the reported change is an exception to the 12 month enrollment period. (See Section 703-1 #3, 704)
Increased income changes do not require action until the end of the current enrollment period.
Require income verification at the next review.
IF the enrollee reports the change and requests a new income re-determination, do the following:
If the new income does not adversely affect CHIP eligibility, treat the income change as a review and establish a new 12 month enrollment period.
If the new income adversely affects eligibility (IE, changes Plan A to Plan B/C or Plan B to Plan C), do not act on the change until the next enrollment period.
When the family’s countable income decreases and they request a new income re-determination, they may verify the decreased income and have their premium recalculated starting the month of request, when verified timely. If not verified timely, the change is effective the month it is verified.
Request for an Income Re-determination or Medicaid: If an enrollee submits a new application, asks for Medicaid (in person, via phone, fax, email, in writing), or asks for a new CHIP income determination; re-determine the child’s eligibility for a better benefit. If Medicaid eligible, close CHIP and open Medicaid for all Medicaid eligible household members.
If the change is a decrease in income and it makes the enrollee eligible for a lesser cost CHIP plan (i.e. Plan C to B or A, or, Plan B to A), make the change effective the month of report, when verified timely. Begin a new 12 month enrollment period. If not verified timely, make the change effective the month it is verified.
If the change is a decrease in income and it makes the enrollee eligible for Medicaid (without a spenddown, pregnant woman asset co-payment, or MWI premium), close CHIP and open Medicaid effective the month of report, when verified timely. If not verified timely, make the change effective the month it is verified.
If the change is an increase in income and would make the enrollee ineligible for CHIP, continue CHIP through the end of the enrollment period.
No Request for Income Re-determination or Medicaid: Only make a change at application or review.
If the enrollee reports an income change only, do not determine eligibility for a lower CHIP Plan or Medicaid. Continue CHIP through the end of their enrollment period. See Section 804 for more information about reported changes and Section 201-1 for Medicaid eligibility screening.
Example: Client reports via MyCase a decrease in hours worked. The client has not asked for a better CHIP plan or Medicaid. The CHIP program continues through the end of the current certification period.
If the change becomes known through interface matches or tasks; continue the enrollment period and take action at application or review.
If a family requests a new CHIP income determination or Medicaid coverage for any household member and then fails to verify the decreased income, no action is taken.
Note: These reported changes require that a mandatory review be done at the next review period.
When using the AGI makes a household Medicaid eligible, request actual income verification.
If the actual income shows they are over income for Medicaid, use the actual verified income for the CHIP review; not the AGI.
CHIP coverage cannot be renewed if the household fails to provide requested verification.
When the AGI changes a household from Plan A to Plan B or C; or Plan B to Plan C, and the review is completed using the AGI, the client may choose to provide their current income. If current income makes them eligible for a lower cost plan, use the current income effective the month of report, if verified timely. If not verified timely, the change is effective the month it is verified.
When a CHIP review is completed using the AGI, and current income is later provided by the client which makes them ineligible for CHIP or changes their plan to a higher cost plan, continue the enrollment period using the AGI.
When a CHIP review is completed using the AGI and an enrollee chooses to switch to UPP, (health insurance becomes available and the cost of coverage is 5% or more), request actual income verifications. Establish a new best estimate and begin a new certification period for UPP if all eligibility requirements are met. (See Sections 220-4 and 704-9.)