OBSOLETE POLICY CHIP MANUAL |
Effective: August 1, 2012
The enrollee, the enrollee’s parent, or the responsible adult acting on behalf of the enrollee, must report certain changes within 10 days of the day the change becomes known. (See Section 102-3 for a description of changes that must be reported.)
Workers are to take appropriate action to verify reportable changes which may affect the enrollee’s eligibility within 10 days of the date the information is received. (See section 102-4 for more information on date of report.)
If the 10th day is a non-business day, give the client until the first business day following the 10th day.
A report of a change or other information may be received from a source other than the recipient.
Reported changes must be evaluated to determine if they could affect eligibility during the 12 month enrollment period. See section 703.
Only act on income changes when the enrollee requests a Medicaid determination, asks for a new income determination or the reported change is an exception to the 12 month enrollment period. (See Section 703-1 #3 and 804-5.)
Use computer matches and collateral contacts whenever possible to verify items of eligibility.
Do not request hard copy verification of items that are not needed for eligibility or that have previously been verified and are not subject to change.
Provide a written request for verifications that are needed.
Workers must request any necessary verification within 10 days of the date a change is reported or information is received.
Give clients at least 10 days from the date you mail the written request to provide verifications. If the 10th day is a non-business day, give the client until the business day following the 10th day to provide verifications.
If the client does not return all requested verification by the verification for reportable changes due date, the eligibility agency ends benefits the first month it can give 10-day advance notice.
If the reported change was not required and the client fails to follow up with verification, CHIP remains open.
Example: The client reports their income decreased and request a new income determination of the quarterly premium. However, the client fails to verify the decrease of income. The CHIP program remains open and unaffected through the current certification period.
If the client 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.
If the action results in a better benefit, such as a lower cost CHIP plan, make the change effective the month of change report. (See 804-5 #2)
Example: The client reports a decrease in income on March 11th. The children are currently eligible for CHIP Plan C and the client requests the agency to recalculate the quarterly premium based on the new lower income. The income is verified timely and if the children are now eligible for a lower plan (B or A), the lower premium is effective March.
If the action results in a better benefit, such as eligibility for Medicaid, make the change effective the month of change report. (See 703 C1b)
Example: The client reports a decrease in income on June 18th. The client requests the agency to look at Medicaid. The income change is verified timely and the children are found to be Medicaid eligible. Medicaid will start June 1st.
For an adverse action, make the change for the first month the eligibility agency can give 10 day notice.
Example: The client reports on September 27th a child has left the household. The child remains eligible for CHIP coverage thru October 31st.
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.
Mail returned by the post office with no forwarding address indicates a change. See Section 803-2 to decide what steps to take.
When a household reports a change of address, provide the household with voter registration information. (See Section 101).
Failure to make a timely report of a reportable change may result in an overpayment of benefits.