CHIP - Changes in Income|
OBSOLETE POLICY CHIP MANUAL |
Effective: January 1, 2011 - March 31, 2011
CHIP enrollees are not required to report changes in income during the 12 month renewal period. However, if the enrollee does report an income change, or the report is received from another source, it must be acted upon.
Increased income changes do not require action until the end of the current enrollment period. However if the enrollee reports the change, do the following:
If the new income does not adversely affect eligibility (i.e. Changes them from A to B, A to C or B to C) treat the income change as a renewal and renew eligibility for another 12 months.
If the new income adversely affects eligibility, do not act on the change until the next enrollment period. Require the next review.
Decreased Income Reported to Recalculate Quarterly Premiums:
When a family closed for non-payment of their quarterly premium, reports decreased income; they may verify the decreased income and have their premium recalculated.
1) If the reported income is within Medicaid guidelines and the family does not want to proceed with a Medicaid determination, they cannot have their premium adjusted. They must pay the original outstanding premiums to be reinstated.
2) If the reported income results in a reduced premium and they verify the new income, they must pay the decreased premium to be reinstated.
Other Reports of Decreased Income
If the family does not request Medicaid for any member of their household, including an individual who does not qualify for CHIP, but the reported change makes an enrollee eligible for Medicaid without a spenddown, note the information on the CAAL screen and act on the change at the next renewal period.
When the reported decrease would change the family from plan C to plan B, or from plan B to plan A, and they would also qualify for Medicaid, if they do not want to switch to Medicaid, do not change their plan. Make sure to act on the change at the next renewal period.
If the reported change does not make any child eligible for Medicaid, 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, redetermine income eligibility and authorize a new 12 month renewal period.
If a family requests 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, must be removed from CHIP and opened for Medicaid. If other children remain eligible for CHIP, treat the income change as a renewal and renew for another 12 months.
Note: These reported changes would require that a mandatory renewal be done at the next renewal period.
Adjusted Gross Income Tax Commission Interface Used at Renewal (See section 704-9.)
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 renewal; not the AGI.
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 certification period.
When a CHIP renewal 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 certification period using the AGI.
When a CHIP renewal 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.)