804-5 Income Changes

Effective:  April 1, 2011 - January 31, 2012

Previous Policy

CHIP enrollees are not required to report changes in income during the 12 month review period.  If an income change is reported, only act on the change 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)

1. Increased Income:

Increased income changes do not require action until the end of the current enrollment period. However if the enrollee reports the change and requests a new income determination, do the following:

1. If the new income does not adversely affect eligibility (i.e. changes them from Plan A to B, A to C or B to C) treat the income change as a review and establish a new 12 month enrollment period.

2. If the new income adversely affects eligibility, do not act on the change until the next enrollment period.  Require income verification at the next review.

2. Decreased Income Reported to Recalculate Quarterly Premiums:

1. When the family’s countable income decreases prior to the first month of the quarter and they request a new income determination, they may verify the decreased income and have their premium recalculated for the quarter.

• If the reported income is within Medicaid guidelines proceed with a Medicaid determination.  If Medicaid eligible without a spenddown, pregnant woman asset co-payment or MWI premium, open the child for Medicaid.

• If the child is not Medicaid eligible and the reported income results in a reduced premium, they must pay the decreased premium within 30 days.

3. Other Reports of Decreased Income

1. When the family asks for a new income determination or requests Medicaid for any member of their household, including an individual who does not qualify for CHIP, and the reported change makes an enrollee eligible for Medicaid without a spenddown, pregnant woman asset co-payment or MWI premium, the Medicaid eligible child must be removed from CHIP and opened Medicaid.   

2. When the family asks for a new income determination to see if they qualify for a lower cost CHIP plan and it’s determined that a child is Medicaid eligible without a spenddown, pregnant woman asset co-payment or MWI premium; remove the child from CHIP and open Medicaid, even if there was no request for Medicaid. If the reported change does not make any child eligible for Medicaid, and the household is enrolled in CHIP benefits on plan B, and the change makes them eligible for plan A, or they are on plan C, and the change makes them eligible for plan B or plan A, redetermine income eligibility and authorize a new 12 month enrollment period.

3. If a family requests a new income determination or Medicaid coverage for any household member and does not withdraw the application before an eligibility determination is made, any child who is Medicaid eligible without a spenddown, pregnant woman asset co-payment or MWI premium, must be removed from CHIP and opened for Medicaid.  If other children remain eligible for CHIP, treat the income change as a review and renew for another 12 months.

Note:  These reported changes would require that a mandatory review be done at the next review period.

  CHIP - Changes in Income

4. Adjusted Gross Income Tax Commission Interface Used at Review (See section 704-9.)

1. 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.  

2. When the AGI changes a household from Plan A to Plan B or Plan C; or Plan B to Plan C, and the review has been updated using the AGI, the client can choose to provide their current income.  When the current income makes them eligible for a lower cost plan, use the current income and establish a new 12 month enrollment period.

3. When a CHIP review was updated using the AGI, and current income is 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.

4. When a CHIP review was updated 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.)