OBSOLETE POLICY CHIP MANUAL |
Reporting Requirements
The CHIP client 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. See Section 102-3 for 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 client.
The eligibility agency may accept client statement as verification for most change reports. (See Section 705-2)
The agency must promptly determine if the information provided by the client is reasonably compatible with the available electronic data match.
Taking Action on Reported Changes During a Certification Period
Reported changes must be evaluated to determine if they could affect eligibility during the 12-month certification period. (See Sections 102-3 & 703-1).
The agency must take action on reported changes within 10 calendar days of report.
Only act on income changes when the client requests a Medicaid determination, asks for a new income determination, or the reported change is an exception to the 12-month certification period. (see Sections 703-1 and 804-5).
Workers must use available electronic data sources to verify the change before requesting information from the client.
If continued eligibility cannot be determined by electronic data match, then the agency must request the necessary verification from the client.
Workers must only request required verifications needed to determine eligibility.
Give the client at least 10 days from the date of the notice to provide verifications.
If the 10th day is a non-business day, give the client until the first business day following the 10th day to provide the verification.
The agency must provide a 10 day advance notice of any adverse actions taken on the case. (See Section 803 for notification)
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. (See Section 806)
Taking Action on Reported Changes with Ex Parte Reviews
When an ex parte review is completed, a notice will be sent to the client listing all reportable changes. The client will be given 10 days from the mailing date of the notice to report any changes that apply. (See section 102-3 to determine reportable changes)
Changes reported prior to 10-day notice in the review month:
The agency must determine how the change will affect the new certification decision. (see 102-3).
If a determination can be made without requiring the client to provide verifications, re-determine eligibility for the new certification period.
The agency must send proper notice with the new eligibility decision.
If verifications are needed to determine eligibility:
Stop the new certification period.
Allow the client 10 days from the notice mailing date to provide verifications.
If the agency cannot give 10-day notice before determining eligibility for the new certification period, extend benefits to the following month. This is called the “due process month”.
If the client provides all requested verifications and a decision can be made prior to 10-day notice in the review month:
The agency proceeds with the eligibility decision and re-determines eligibility effective the first month of the new certification period.
The agency must send proper notice with the new eligibility decision.
If the client provides requested verifications, and a decision cannot be made prior to 10-day notice in the review month:
The agency will re-determine eligibility effective the first month in which the eligibility agency can give 10-day notice.
The agency will send proper notice with the new eligibility decision.
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.
Changes reported after 10-day notice of the review month.
After 10 day notice in the review month, the ex parte review decision cannot be changed.
Treat all reported changes after this date as a change reported during a certification period.
Refer to section B above to determine what action to take on changes reported during a certification period.
See section 102-3 for reportable changes.