KFMAM Manual - 11/22/2009

06000

                                                                                                  08000

07000: Reporting Changes -

07100 Reporting Changes -

7110 - Households receiving medical assistance are required to report changes. The specific reporting requirement is determined by the program and the circumstances of the household. The requirements for reporting changes are listed in this section. No additional reporting requirements shall be placed on either reporting group.

7111 Households Exempt from Monthly Reporting - All medical only households are EXEMPT from monthly reporting requirements. These households are required to report certain changes in circumstances within 10 calendar days from the date the change is known. See 7211.01.

07120 Household Responsibility Prior to Approval - New Applications and Applications Filed after a Break of One Month or More in Assistance - Clients must report all changes of circumstances prior to case approval.

The client must report within 10 calendar days from the date the change is known. The Case Manager is responsible for requesting or otherwise obtaining other information or verifications necessary to determine the household's eligibility for any month.

07200 Non-Monthly Reporting Households -

7210 - All households listed in 7111 shall be referred to as non-monthly reporting households. Reporting responsibilities and agency actions for non-monthly reporting households are discussed in this section.

7211 Responsibility after Approval for Non-Monthly Reporting Households - Those households exempt from monthly reporting are required to report the following changes in circumstances within 10 days of the date the change becomes known to the household.

7211.01 - Change Reporting Requirements for all medical Non-Monthly Reporting Households -

(1) - Changes in the source of income (earned and unearned) For Poverty Level MCD SSI income is the only required income to be reported.

(2) - When the amount of earned income being counted increases or decreases by more than $100.00 per month. This requirement is for Family Medical Programs only.

(3) - When the amount of unearned income being counted increases or decreases by more than $25.00 per month This requirement is for Family Medical Programs only.

(4) - Changes in household composition, including marriage, separation, or divorce. This requirement is for all medical programs.

(5) - Changes in residence, including moving into or from an institution or hospital. This requirement is for all medical programs.

(6) - Entitlement to or termination of Medicare coverage, change in any third party insurance plan. This requirement is for all medical programs except HealthWave 21.

Households may report a change in their circumstances by telephone or in writing. Other changes in circumstances are not required to be reported until review, including changes in medical expenses for food stamps.

7212 Processing Changes Reported by Non-monthly Reporting Households - Processing a Change - When the agency receives information that a change has occurred, the Case Manager shall act on the changes within 10 days after the date the change is reported by taking the following actions:

(1) - Document in the case file the reported change, the date the change occurred, and the date the change was reported;

(2) - Determine if verification or additional information is required (see 1325.01);

(3) - Contact the household to request needed information or verification as soon as possible;

(4) - Determine eligibility issuance month according to the provisions of 6100.

(a) Households reporting changes which would result in a change in benefits must provide any required verification within 10 days of the date of agency request. No change in benefits shall be granted if the household does not provide the required verification. If no verification is required or if the verification required is received within 10 days from the date of verification request, the change in benefits are to be granted effective the month following the month the change is reported. If the verification is received after 10 days from the date the verification was requested, the change benefits would be effective the first month following the month the verification is received.

(b) Changes resulting in ineligibility or a decrease in benefits shall effect eligibility the first month possible considering timely notice requirements

7213 Notices to Households NOT Subject to Monthly Reporting - The agency shall provide the household with adequate notice, as defined in 1422.01, of any changes from its benefit. Additionally, the notice of action must meet the definition of timely and adequate notice, as defined in 1422, if the household's benefits are being terminated. Refer to 1420 for exceptions to these notice of action requirements.

07220 Failure to Report - If the agency discovers that the household has failed to report a change, as required in 7200 and, as a result, received benefits to which it was not entitled, a claim shall be filed against the household. If the discovery is made within the review period, the household is entitled to a timely and adequate notice of adverse action if the household's benefits are reduced.

A household shall not be held liable for a claim because of a change in household circumstances which it is not required to report in accordance with 7200. Individuals shall not be disqualified for failing to report a change unless disqualified in accordance with fraud disqualification procedures.

07230 Whereabouts of Recipient Unknown - Except for person continuously eligible for medical coverage, in instances when the agency does not know the whereabouts of a recipient, the agency shall send an Informational Notice to the last known address which will advise the recipient to inform the agency as to his whereabouts by a given date or his case will be closed. If there is no contact by the required date, the case is to be closed and a final Notice of Action is to be sent to the last known address. (See 1423.06.)

Coverage shall not be terminated for persons eligible under the continuous eligibility provision of 2300, 2310, and 2320. If the agency becomes aware that residency requirements of 2050 are no longer met coverage shall be terminated.

07300 Transfer of Assistance - When a recipient requests a case be managed by another service center due to a move or other reason, the worker and the client or responsible party shall determine where the case should be managed based on the best interests of the client. If the recipient chooses to have benefits and services established and maintained in the service center for the new county, the current office is responsible for transferring the case to the new office. All existing paper files and electronic cases should be transferred to the new office at the time of the case transfer.

If the recipient now resides in another county, but chooses to continue to have the case managed by the current office, Clearinghouse/EES staff in the current office should process the change in accordance with 7212. KAECSES should be updated with the known changes.

7301 Pending Applications - When an applicant requests the case be managed by another service center due to a move or other reason prior to application processing, the worker and the client or responsible party shall determine where the case should be managed based on the best interests of the client. If the applicant chooses to have benefits and services established and maintained in the service center for the new county or a service center different from the current one, the current office shall immediately forward both the electronic file and the paper file to the new office processing any expedited benefits prior to transfer. An informational notice shall be sent to the client to advise of the action and of the new office responsible for the application.

7302 Open Cases - If a case is in open status both the old county and the new county has responsibilities in completing the transfer. Supervisory review is required prior to transferring an open case to the new county. The original review period remains for all programs.

7302.01 Sending County’s Responsibilities - Prior to sending a case to the client’s new county of residence, the current county must complete the actions listed, including those for specific program involvements.

7302.02 Case Instructions - Once the sending county has been notified of the change of address it shall complete the following steps:

(1) - Correct address information on KAECSES. When a client moves without providing a new address, use procedures in 7230.

(2) - Update KAECSES with known changes including notifying CSE of the change in address or any other change in absent parent.

(3) - Send a notice advising the client the case has been transferred. If a review, application, or monthly report form is needed, the sending county is also responsible for mailing these documents. NOTE: When a recipient reports a move to the new county, the new county shall inform the old county of the move in order for the old county to initiate the transfer process as specified above.

(4) - For all medical programs, authorize the last paid benefit month (after updating ADDR) to ensure proper managed care assignment in the new county.

(5) - Set a worker alert for the new county to review the current record. The alert shall have a due date of the 5th of the month following the month the transfer is reported. The alert message shall read "ICT Complete."

(6) - Enter the new caseload number on KAECSES and transfer both the electronic and paper file to the new county using the appropriate procedures as outlined in the KAECSES User Manual, Volume II, Special Procedure 611.

7302.03 Program Instructions - The sending county is also responsible for completing the following actions for the following open programs and documenting any other information known that may impact eligibility:

For MA CM programs no action to adjust eligibility based on the shelter standard for the new county or changes in household arrangements shall be taken by the sending county.

07320 Receiving County Responsibility -

7321 Receiving County’s Responsibilities - Receiving County’s Responsibilities - Once the worker alert is received by the new county announcing the move, the new county assumes the following responsibilities. Any resulting adjustments in eligibility because of changes occurring as a result of the move are to be made no later than two months following the month of transfer following the reporting rules of 7212 as appropriate. Any required reviews or applications are also the responsibility of the receiving county to process.

7322 Closed Cases - If the case is in closed status in the old county, the old county is responsible to transfer the case to the new county. On KAECSES, a closed case may be transferred to the new county following normal procedures.

The application may be used to transfer a closed case to a new county when the client reapplies prior to the effective date of closure but subsequent to be closure notice being issued and when reapplication occurs within the month following the month of closure. If the client reapplies after the month following the month of closure, an application shall be required.

07330 Reviews -

7331 - All categories of assistance require periodic review. At the expiration of the review period, entitlement of benefits ends. Further eligibility must be determined through the review process based on a new application and verification as required.

7332 Review Process - The review process is a complete re-examination by the agency concerning all factors of eligibility. In the process, the appropriate review form shall be used along with the rest of the agency record. The purpose of the review is to give the client an opportunity to bring to the attention of the agency his or her needs and to give the agency an opportunity to re-examine all factors of eligibility in order to determine the client's continuing eligibility for assistance.

7333 Notice of Expiration - A notice of expiration of the review period shall be sent to each household. The local agency shall provide an application form with the notice of expiration. When a review must be made and it is known that the recipient is temporarily visiting away from his or her residence, the notice of expiration and appropriate form should be mailed to the temporary address.

In all programs, a notice of expiration shall be mailed to the household no later than the first day of the last month of the current review period.

NOTE: This provides timely notice of the ending of benefits; therefore, further timely notice is not required to affect benefits for the start of the new review period.

07400 Client Requirements for Timeliness -

7410 Application - For all programs, the application for review must be received by the 15th day of the last month of the review period.

7411 Information/Verification - All information and/or verification shall be provided by the requested date. Clients must submit any required verification or additional information within 10 days from the date of the initial request in order to ensure the rights to uninterrupted benefits, provided the deadline to submit such verification does not occur prior to the date the application was timely filed.

Follow the verification requirements at initial application, except that non-citizen status, providing an SSN, residency, and identity, do not have to be reverified unless a change has been reported or it is questionable.

07420 Agency Action of Reviews - Agency Action of Timely Reapplication - If reapplication for benefits is filed timely and all review requirements are met, the agency shall act upon the information to ensure uninterrupted benefits. Workers shall take action on timely filed reapplication within the following time standards.

For all households that have timely filed an application for review and met all required review procedures, the Case Manager shall approve or deny the application and notify the household of its determination by the end of the current review period. Reviews processed by the last work day in the last month of the review period are considered timely.

07430 Failure to Act -

7431 Household Failure to Act - A household which submits a timely application for review but submits all verification in an untimely manner shall lose the right to uninterrupted benefits. If eligible, these households shall be provided benefits within 30 calendar days after the application was filed.

A household which fails to submit required verification, shall lose its right to uninterrupted benefits and shall be denied by the end of the current review period.

Any application for review not submitted in a timely manner shall be treated as an initial application. The timeliness provisions of 1405 apply.

7432 Agency Failure to Act - Agency failure to provide normal issuance of benefits to an eligible household, which submitted a timely application for review, in accordance with the above provisions shall be considered an administrative error. These households shall be entitled to restoration of benefits if, as a result of such error, they were unable to receive benefits for the month following the expiration of the review period.

07440 Frequency of Reviews -

7441 Frequency of Reviews - For all programs, cases are to be reviewed via the application form. The length of the review periods are noted below; however, all programs allow a review period for less than 12 months to be established when needed to match the review period on an existing program.

7442 All other medical-only cases shall be reviewed once every 12 months (see 7442.03 for TransMed provisions). -

7442.01 - For the Medicaid poverty level and HealthWave programs for children, the review period should usually correspond to the 12 months in which there are both Medicaid and HealthWave eligible children, the Medicaid review period can be extended beyond 12 months when the case is initially established to link the Medicaid and HealthWave periods together.

A review may be completed when an application or review for other program benefits is received (see 2312 and 2453) or when a request for continuing coverage is made for a child moving into a new household without an open MP, MA CM or TAF program (see 2340.02 and 2460.02). Reviews are not required in these situations, but may be completed if it is in the best interest of the family to do so.

7442.02 - For SSI cases, reviews need only be done when information is received on EATSS that the individual's benefits have been suspended or terminated, except as noted in KEESM 2639.

7442.03 For TransMed programs, the review period shall be set at a six - For TransMed programs, the review period shall be set at a six-month interval. The first six month review is not an official review, but a review of the family's income only. As such, the TransMed Income Report form will be used for the six-month income review instead of an application/review form. If the family qualifies for continuing TransMed coverage at the six-month income review, another six-month review period will be set. At the end of the 12 months of TransMed coverage, eligibility for other family medical programs for all family members covered by TransMed will be examined and approved if appropriate. A new 12 month review period and continuous eligibility period shall be set for those individuals who qualify for coverage under another family medical program (continuous eligibility does not apply to the MA spenddown program). If the family does not qualify for the second six months of TransMed eligibility at the six-month income review, the children on the case and any pregnant women, if applicable, will continue to be covered through the appropriate continuous eligibility period (See sections 2300 and 2310 and sub-sections). Any non-pregnant adults on the case will lose coverage at the end of the sixth month of TransMed.