Changes

All Pathways members are required to report a change in circumstance to the State which may impact their continued eligibility for the program within 10 days. During all reported changes, Pathways members will be evaluated to determine potential eligibility for all Medicaid classes of assistance other than Pathways.

In addition to reporting changes required by MAGI-Medicaid classes of assistance, Pathways members are required to report changes in:

Participation in qualifying activities that would impact their eligibility for the program (e.g., reduction of hours engaged below 80-hour threshold, withdrawal from full-time enrollment in an institution of higher education, etc.)

Employer access to ESI (e.g., gain of access to ESI that was not indicated in the Medical Assistance application) For Changes in Qualifying Hours and Activities refer to Section 2256 - Pathways Qualifying Activities Reporting .

Failure to Report a Change - If the State is made aware that a member failed to report a change that makes them ineligible for Pathways or any other COA, the member will be terminated effective the first day following the month timely notice expires.

A/Rs who are terminated for failure to report a change in circumstance will receive a notice that their coverage will be terminated along with information on appeals.

If it is discovered that a member has intentionally defrauded the State, the current process for referral, investigation and fraud resolution will be followed.

Transition from Another COA to Pathways at Change - Existing Medicaid A/Rs age 18 or older will have the opportunity to be evaluated for Pathways when reporting a change. If eligible and approved for Pathways, coverage will begin prospectively on the first of the month following authorization of the approval.

Targeted Advance Notice - Gateway will identify A/Rs currently enrolled in other classes of assistance who are coming to a known termination date (due to age) and who are under 120% of the FPL and include a Targeted Advance Notice with their Change or Termination Notice. The Targeted Advance Notice will include information such as the Pathways program overview, and information on submitting a change or new application and reporting qualifying activities for consideration of coverage through Pathways.