Failure to Comply - Family Medicaid

Do not include an adult in the AU if s/he fails to comply with Basic Eligibility Requirements. A non-compliant adult is included in the BG if s/he is a parent or spouse of an AU member.

Remove from the Family Medicaid AU, but not the BG the adult who fails to comply with any of the following requirements:

cooperation with his/her own Enumeration

when Reasonable Opportunity Period (ROP) has expired

when the AU contains at least one qualifying child

identification and provision of information regarding any TPL available to the AU

referral to and cooperation with DCSS

EXCEPTION:

Pregnant women in any COA are not referred to and are not required to cooperate with DCSS for an unborn child.

Pregnant women are not referred to, and are not required to cooperate with DCSS for an existing child

A referral to DCSS is not required for a Medicaid-eligible individual age 19 years or older.

A referral to DCSS is NOT made for child-only Medicaid cases.

A child-only Medicaid case is defined as a Medicaid AU in which no adults are receiving Medicaid under the same case as the child or under any related case. An AU which contains a penalized adult is NOT considered a child-only case.

Refer to specific Basic Eligibility Requirements in this Chapter.

Remove the child from the AU if the responsible adult in the AU or BG fails to enumerate the child and/or ROP has expired for the child. For FM-MN, the child may be included or excluded in the BG at the request of the A/R.

These requirements do not apply to Newborn Medicaid, or Medicaid applications for deceased individuals. For EMA only, citizenship/immigration status/identity and enumeration do not apply.