Income Changes during the Certification Period
CHIP members are not required to report changes of income during the 12 month enrollment period.
When an income change is reported, only re-determine eligibility when the member 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)
Report of Increased Income
Increased income changes do not require action until the end of the current enrollment period.
Require income verification at the next review.
If the member 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 certification period.
Note: The out of pocket maximum, co-payment and deductibles could also change. The worker must educate the member about how this change may affect their cost-sharing requirement.
If the new income adversely affects eligibility (IE, changes Plan B to Plan C or ineligibility for CHIP), do not act on the change until the next certification period.
Report of Decreased Income
When the individual’s countable household 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 a member 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 member eligible for a lesser cost CHIP plan (i.e. Plan C to B), make the change effective the month of report, when verified timely. Begin a new 12 month certification period.
If it is not verified timely, make the change effective the month it is verified.
NOTE: The out of pocket maximum, co-payment and deductibles could also change. The worker must educate the member about how this change may affect their cost-sharing requirement.
If the change is a decrease in income and it makes the member eligible for Medicaid (without a spenddown 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.
No Request for Income Re-determination or Medicaid: Only make a change at application or review.
If the member 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: Member reports via MyCase a decrease in hours worked. The member 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.