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Effective: June 1, 2011 |
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03.10.10ar2 - Change in Basis of Eligibility (Archive) |
Archived: October 1, 2011 |
When you become aware of a change in circumstances for a Medical Assistance (MA) enrollee, evaluate the effect of the change on the enrollee's basis of eligibility (or major program). If you need to re-determine the basis (or program), leave MA open while the re-determination is in process as long as the enrollee is cooperating in providing necessary information.
Depending on the change, a new application may or may not be required; see Application Required and Application Not Required. The budget period for the household may continue, or it may need to be interrupted; see Certification Period.
Some of the changes that may affect basis of eligibility or major program include:
Change in Disability or Blindness Status.
Change in Household Composition.
There are a number of changes to eligibility that may result from a change in age.
l When a person turns 65, determine MA eligibility beginning with the month of the 65th birthday.
n Approve MA effective the first of the month in which the person turns 65 if all eligibility factors are met.
n Do not require a new application.
l When MA enrollees turn 21, determine if they have another MA basis.
l When the only child of a parent receiving MA with a parent/caretaker basis turns 18, determine if the parent continues to meet an MA basis. Eligibility for a parent/caretaker basis continues if the child still meets the definition of a dependent child . If there is not a continued parent/caretaker basis, determine if the parent meets another MA basis.
l When a disabled child turns 18, do not deem the parent’s income beginning the month after the 18th birthday.
Note: Parents of TEFRA children may be liable for parental fees through the month of the child's 18th birthday.
Change in Disability or Blindness Status
When people receiving MA with a families with children basis of eligibility are certified blind or disabled, they may have multiple bases of eligibility from which to choose.
Change in Household Composition
When the only child of a parent who receives MA with a parent/caretaker basis leaves the household and the absence is not temporary, determine if the parent meets another MA basis.
When a child moves in with a parent or eligible relative caretaker, determine if the parent meets a parent/caretaker basis for MA. Give the parent an opportunity to apply for MA. Allow at least 10 days for the parent to return the application.
Note: If the child is open on MA, the parent or relative caretaker can be added to the child’s case without requiring an application.