*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: November 1, 2011 |
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16.05.05 - Referral Process |
Archived: June 1, 2016 (Previous Versions) |
The worker's role in the medical support referral process is outlined below. It is important to note that it is the county child support IV-D agency, and not the worker, that is responsible for making determinations of non-cooperation.
For information on when to make a referral, see:
l When to Refer for Medical Support, which explains when to make a referral when a child lives with one parent, and
l Minor Child Lives Apart from Both Parents, which explains when to make a referral when a child lives apart from both parents.
Roles of Worker and IV-D Agency.
Referral Forms and Other Referral Documentation.
Roles of Worker and IV-D Agency
The worker:
l Determines if a medical support referral to IV-D is required, then requests, tracks and attains medical support forms and any supporting information.
l Makes the referral to the IV-D agency.
l Closes eligibility for non-cooperation if instructed to do so by the IV-D agency.
l Re-opens eligibility when a client who was closed for non-cooperation begins to cooperate when instructed to do so by the IV-D agency.
l Refers the case to the Good Cause Committee if good cause is requested.
l Takes action in response to the Good Cause Committee’s decision.
The IV-D agency:
l Determines if the client is cooperating.
l Notifies the worker if an enrollee must be closed for non-cooperation.
l Notifies the worker when a client previously closed for non-cooperation can be re-opened.
Good Cause Committee:
l Determines if the client has good cause for non-cooperation.
l Notifies the worker and IV-D if good cause has been granted.
For more information on the Good Cause Committee see Good Cause for Non-Cooperation.
1. See When to Refer for Medical Support and Minor Child Lives Apart from Both Parents to determine when to make a referral.
See Who Must Cooperate to determine if the caretaker is required to cooperate with IV-D.
2. Send the medical support forms to the client when a referral is required.
l Allow 30 days from the date you send the forms for the caretaker to return them.
l Do not delay, deny or close health care program eligibility due to non-receipt of medical support referral forms.
l Do not require medical support referral forms before approving Medical Assistance (MA) or MinnesotaCare (for MinnesotaCare, case is "pending awaiting payment").
Note: For MinnesotaCare, do not refer any information to the IV-D agency until you have determined that the children are eligible and the case is active (the household has paid the initial premium).
3. Check if the MinnesotaCare case is active or if MA has been approved when the client returns the referral forms.
l Send the referral to the county IV-D office within two working days if the case is open.
l Do not send the referral until the MinnesotaCare case is active or MA has been approved.
l If the MinnesotaCare case becomes active or MA eligibility is approved at a later date, send the referral within two working days.
4. Refer available information to IV-D if the caretaker does not claim good cause but fails to return completed forms within 30 days of being requested to do so and the MinnesotaCare case is active or MA eligibility is approved.
5. Refer the case to the Good Cause Committee if the caretaker requests good cause for non-cooperation and the MinnesotaCare case is active or MA is approved.
Note: Pregnant women are not required to cooperate; see Pregnant Women and Newborns for more information.
Referral Forms and Other Referral Documentation
For all referrals in which Good Cause has not been claimed or a claim of Good Cause has been denied, send the following to the IV-D office in the caretaker's county of residence:
l The Child Support Enforcement Notification (DHS-2686A).
l The Referral to Support and Collections (DHS-3163B), if received.
l The Client Statement of Good Cause (DHS-2338), if received.
l A copy of the applicable court order, if available.
Exception: For MA, do not send the forms or referral documentation to the county IV-D office if MAXIS initiates an automated PRISM referral. Keep the forms and referral documentation in the case file.
In addition to the above:
l For MA, workers must also complete the appropriate MAXIS screens; see POLI/TEMP TE09.25 (PRISM Interface) for further information.
l For MinnesotaCare, workers must also include both of the following:
n A printout of the MMIS RCIN screen for all cases.
n A printout of the RCAD screen if the client does not complete the referral form.
The IV-D agency will notify the county agency if the caretaker fails to cooperate. Send 10-day notice to terminate coverage for caretakers who fail to cooperate without good cause.
If the non-custodial parent has health insurance coverage for eligible children, the IV-D agency will provide this information to the DHS Benefit Recovery Section through a systems interface between PRISM and MMIS.
After the initial referral, use the DHS-2686A to notify IV-D of case closings or other changes.
l When a caretaker reports a change in circumstances (for example a parent leaves an active household), determine if you need to make a referral for medical support. If yes:
n Send the Referral to Support and Collections (DHS-3163B) and the Client Statement of Good Cause (DHS-2338) to the custodial parent or other primary caretaker to complete.
n Request that the forms be returned within 30 days.
n Make the referral within two working days after receiving the forms.
n Refer available information to IV-D within two working days of the missed due date if the caretaker fails to return the forms within 30 days and has not claimed good cause.
n IV-D will notify the health care program worker if the caretaker is ineligible due to non-cooperation.
l If IV-D reports that a caretaker who was removed from coverage for non-cooperation has now cooperated:
n For MinnesotaCare, reinstate the caretaker's coverage beginning the first available month after cooperation.
n For MA, reinstate the caretaker's coverage back to the first of the month of cooperation. There is no minimum sanction period.
Example:
Rose and her two children have MinnesotaCare coverage. On February 10 the
child support officer notifies the worker that Rose has failed to cooperate
in obtaining medical support. There is no good cause claim. Rose is removed
from health care coverage effective March 1. On March 15, the child support
officer notifies the worker that Rose has cooperated.
Action:
Reinstate Rose's coverage effective April 1 (the first available month
after cooperation). Send the DHS-2868A to notify IV-D of the reinstatement.
Note: Rose's coverage would have been reinstated effective March 1 (the first of the month of cooperation) if she had been eligible for MA.