OBSOLETE POLICY CHIP MANUAL |
The CHIP recipient or representative is responsible to report a change in any circumstance which may affect eligibility for CHIP within 10 days of the date of the change. Changes in address, household composition and health insurance availability are among the changes that must be reported.
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.
See Section 102-3 for a description of changes that must be reported.
The eligibility agency may accept client statement for all change reports except for claims of citizenship and immigration status (705)
The agency must promptly determine if the information provided by the client is reasonably compatible with the available electronic data match.
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 recipient requests a Medicaid determination, asks for a new income determination, or the reported change is an exception to the 12 month enrollment period. See Sections 703-1 and 804-5.
If continued eligibility cannot be determined by electronic data match, the agency must request the necessary verification from the client.
Workers must request any necessary verification within 10 days of the date a change is reported or information is received.
Workers must request only verification needed to determine current eligibility.
Give clients at least 10 days from the date on the written request to provide verification. If the 10th day is a non-business day, give the client until the first business day following the 10th day to provide verifications.
If the client does not return all requested verification for reportable changes by the verification due date, the eligibility agency ends benefits for 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 requests a new income determination of their 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.
Example: The client reports a decrease in income on March 11th. The children are currently eligible for CHIP Plan C and the client requests that the agency 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), the lower premium is effective in March.
If the action results in a better benefit, such as eligibility for Medicaid, make the change effective the month of the change report.
Example: The client reports a decrease in income on June 18th. The client requests that the agency 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 that a child has left the household. The child remains eligible for CHIP coverage through Oct. 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.
The agency may begin a new 12-month certification period if it has verified all eligibility criteria after a client change report.
The electronic client information will be transferred to the FFM if the client is no longer eligible for CHIP.
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.