COVID 19 Questions and Answers

Effective Date: May 28, 2021 - February 28, 2023

On March 18, 2020, Public Law 116-127 passed. This law provides an increase in the federal funds a state may receive during the COVID-19 Health Emergency.

The following Q & As are designed to help the Medicaid Eligibility Agency assure eligible individuals receive the correct coverage during the emergency period.

*General*	Follow all normal eligibility policy, for most situations. See resource below.
*Question*	During the COVID-19 Health Emergency, can CHIP eligibility end?
*Answer*	Yes. Closures for CHIP are allowed during the health emergency.
*Question*	What do we do when a child ages off of CHIP?
*Answer*	Close CHIP and help the 19 year old who is aging off CHIP apply for Medicaid.
*Question*	Do we continue coverage for a lawfully present child during the emergency?
*Answer*	If the child is under age 19, follow the same process as for any other CHIP child as described in policy 202-2.1.
*Question*	What happens if someone has a review due during the emergency period?
*Answer*	Follow normal review policy in section 704.
*Question*	How should the agency deal with reported changes?
*Answer*	During the emergency period, if the agency receives information about a change in circumstances, the agency should determine eligibility based on the change information.
*Question*	What if the child becomes enrolled in a health insurance plan?
*Answer*	The CHIP case will close if it is private health insurance or a Federally Facilitated Marketplace insurance plan.
*Question*	If a reported change would make a child eligible for Medicaid, do we move them from CHIP to Medicaid?
*Answer*	Yes. Medicaid without a spenddown is a better benefit. A child can be moved from CHIP to Child Medicaid during the emergency. Once on Medicaid, do not end eligibility for the child through the end of the emergency.
*Question*	What happens if a client enters a public institution?
*Answer*	The child’s CHIP will close and eligibility will need to be determined as normal when the child leaves the facility.
*Question*	What do we do if a client is receiving Continued Benefits pending the outcome of a Fair Hearing?
*Answer*	If the client is receiving continued benefits pending a Fair Hearing, continue CHIP coverage until you get the hearing decision and take appropriate action according to the decision.
*Question*	Will overpayments be assessed if the agency later finds that someone enrolled on March 18, 2020, or who becomes enrolled during the emergency period, really was not eligible?
*Answer*	No. However, if there is suspected fraud, the agency may refer the case for criminal investigation.
*Question*	What happens if a client fails to pay their quarterly CHIP premiums?
*Answer*	Premiums for CHIP households will be suspended during the emergency period. In addition, any premiums the agency has collected since March 1, 2020 must be refunded to the household.
*Question*	What will happen to CHIP late fees during the emergency period?
*Answer*	Fees for making a late premium payment will be suspended during the emergency period. Any fees already collected since March 1, 2020 must be refunded to the household.
*Question*	Do we continue eligibility for an otherwise eligible CHIP child who needs to provide evidence of citizenship or satisfactory immigration status if they do not provide such evidence by the end of the 90 day reasonable opportunity period?
*Answer*	No. If the client has been given reasonable time and does not provide the documents or proof they are working on obtaining it, remove the client from the CHIP coverage with proper notice.
*Question*	Can I accept a ‘testing site’ location as a ‘signature’ for Medicaid?
*Answer*	Starting on June 22, 2020, COVID-19 testing sites will sign applications for Medicaid and the COVID-19 testing group with verbal consent from the client. The testing site will be acting as an authorized representative with limited scope to sign on behalf of the applicant for this coverage only during the PHE. The testing site must be noted in the case record. Once approved, a form 40 and a 61Med will be generated. DWS receives and follows established process (enters enters/ongoing application). When the emergency period ends, a signature must be obtained by the client to maintain ongoing Medicaid coverage.
*Question*	When a client is unable to sign an application (paper/online/in person), what options do they have?
*Answer*	There are two ways. See policy 701. 1. Complete a telephone application with a telephonic signature. 2. The authorized representative will complete an application and form 114COVID. The form 114COVID allows a limited role for an authorized representative to sign and complete an application on the client’s behalf. This option will only be available during the PHE period.
*Question*	Does eligibility continue for a household member on CHIP that leaves the home and remains in Utah during the emergency period?
*Answer*	No. CHIP may close for that household member.
Question	How will the CHIP Out of Pocket Maximum be determined during the public health emergency?
Answer	1. When a CHIP review is complete · The out of pocket maximum will be calculated according to CHIP policy 602, and · Must be met before the household is no longer required to pay co-pays or deductibles. 2. When a CHIP review is not complete · Eligibility ends at the end of the month in which proper notice can be sent.

Resource

During the national public health emergency period, clients who were enrolled in Medicaid or CHIP on March 18, 2020, and those who become eligible during the emergency, may not have their eligibility or coverage end.

In all cases where the member dies, loses residency, was approved due to agency error or requests to have their case closed, the eligibility should end.

We have three tiers of programs. Changes may occur that would normally cause a client to move to a different Medicaid program, any movement between same tier programs is allowed.

A client may request that their case be changed from a higher (Tier 1 or Tier 2) to a lower tier (Tier 2 or Tier 3).

Note - For situations not mentioned in this document, consult with a policy specialist from the Department of Health and Human Services for guidance.

This is in alphabetical order. Not in hierarchical order.

Tier 1 Programs
Program	Program to force when not eligible for any other Tier 1
Adult Expansion	Force Adult expansion with or w/o kids as proper. If the client has Medicare and not eligible for MCSP, then force Aged, or Disabled 100% FPL.
Aged, Blind or Disabled with no spenddown	Force Aged or Disabled 100% FPL.
Breast or Cervical Cancer (BCC)	Force Aged or Disabled 100% FPL.
Child 6-18	Force Child 6-18. When the client turns 19, force Adult Expansion.
Child 0-5	Force Child 0-5. When the client turns 6, force 6-18.
Child 1yr	When the client turns 1, force 0-5.
Lawfully Present Medicaid child	Force Child Medical. When client turns 19, force Adult Expansion emergency. Move to Tier 3.
Former Foster Care (age 26)	When the client turns 26, force Adult Expansion.
Foster Care	Force Foster Care.
Foster Care Independent Living	Force Foster Care Independent Living. Client turns age 21 - force Adult Expansion.
Home and Community Based Waivers	Force Aged or Disabled 100% FPL.
Medicaid Work Incentive (MWI) without premium	Force MWI if they still have earnings. Force Aged or Disabled 100% FPL if they do not have earnings.
Medicare Cost Sharing Program only (MCSP) - QMB	Force QMB, SLMB or QI.
MCSP only - SLMB or QI	Force SLMB or QI.
MCSP and Aged, Blind or Disabled (ABD) with no spenddown (Combo cases)	If the client is ineligible for MCSP and ABD with no spenddown, then force only Aged or Disabled 100% FPL. If the client is eligible for SLMB or QI, then open the MN spenddown or MWI with premium. Note: If the client meets the MN spenddown or MWI with premium, close QI according to 320-4.
Nursing Home	Force NH, sanctions do apply. Force applicable tier 1 category of coverage if they leave the nursing home. For example: If the client is disabled force Disabled 100% FPL.
PCR	Force Adult Expansion.
Pregnant Woman	Force Adult expansion when the post partum period ends.
Refugee (not Medicaid)	If not eligible for another program, close Refugee.
Sub Adopt	Force SA for the remainder of the emergency. DCFS will extend the adoption agreement end date on the program evidence for SA IV-E Medicaid. If the Sub-adopt agreement cannot be extended then force Child Medicaid. (coordinate with DCFS) FEAR evidence must be added for the SA Non IV-E Medicaid, to extend coverage beyond age 18.
TAM	Force TAM. If the client has Medicare and not eligible for MCSP, then force Aged or Disabled 100% FPL.
4 Month Extended	Force Adult Expansion.
12 month TR	Force Adult Expansion.
Tier 2 Programs Note - Tier 1 clients may request to be moved to this tier.
Programs	Programs to force when not eligible for any Tier 1
Spenddown (Medically Needy (MN)) or MWI with premium	Force MN or MWI with premium.
Tier 3 Programs Note - Tier 1 and Tier 2 clients may request to be moved to this tier.
Programs	Programs to force when not eligible for any Tier 1 or Tier 2
COVID-19	Force COVID-19.
Emergency Programs	Force emergency.
Presumptive Eligibility	Close at end of PE period, or Medicaid decision.
Tuberculosis	Force TB.
UPP	Keep open with $0 payment.
Other program
Program	Program movement
CHIP	May move from Plan B to Plan C. · If on Plan B, and not eligible for Plan C, then close CHIP allowing for proper notice. · If on Plan C, and not eligible for Plan C, then close CHIP allowing for proper notice. Cannot move from Medicaid to CHIP, but CHIP may move to Medicaid.

Temporary COVID-19 Verification Changes

Follow policy 705, if verification is required from the client per policy, the following temporary exceptions are allowed during the National Health emergency COVID-19 period. The intent is to help people in quarantine or self isolation as information may be difficult to obtain during the emergency period.

Type	Preferred	Allowable
Citizenship & ID	Electronic	Client Statement (CS) if electronic verification is not available and the reasonable time period has expired. (Good faith)
Income (termination)	Electronic verif, Collateral contact	CS if employer is not available or client is in quarantine or self isolation.
Income (new employment)	Electronic verif, collateral contact	CS if employer is not available or client is in quarantine or self isolation.
Income (change)	Electronic verif, pay stubs, employer statement, collateral contact	CS if employer is not available or client is in quarantine or self isolation.
116M	Limit the use of the 116M form to those situations where the health insurance information is required. (Example - Do not send the 116M for health insurance termination.)	· CS if the individual is losing insurance. · CS on access to health insurance (5% test) for UPP and CHIP. · CS is not allowed if the individual is gaining access to health insurance · CS is not allowed to verify the ESI or UPP payment amount.
Medical bills	Recent copies of billing statements, printouts from medical provider, collateral contact with provider	Collateral Contact (CC) is acceptable.
Applications	Allowable application modalities from policy 701	COVID-19 testing sites signed applications for Medicaid and the COVID-19 testing group with verbal consent from the client.