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Title 8: Medicaid Page 1 Iowa Department of Health and Human Services Employees’ Manual Chapter G: Case Maintenance Overview Revised November 4, 2022

Overview This chapter covers policies relating to how to handle changes involving active Medicaid cases. The first section deals with the client’s responsibility to report changes in household circumstances and worker actions based on the information received about changes. Reported changes may result in reinstatement or automatic redetermination, which are topics that follow the discussion on changes. The next two sections relate to specific MAGI-related and Non-MAGI-related case maintenance issues. Reporting fraud or misuse of Medicaid services by clients or providers comprises the final section of the chapter. Client Reporting Requirements Client reporting requirements include: ▪ Supplying requested information or verification. ▪ Reporting changes. NOTE: “Clients” include applicants, members, people who are conditionally eligible, and people whose income or assets are considered in determining eligibility for an applicant or member. All clients are responsible for reporting changes timely as they occur. However, the specific changes required to be reported and the time frames within which they must be reported may differ depending on whether the member receives Non-MAGI-related or MAGI-related Medicaid. The following sections explain requirements for: ▪ Supplying information and verification ▪ Reporting changes ▪ Interviews due to questionable information Supplying Information and Verification Legal reference: 42 CFR 435.916, 435.952(c)-(d), 441 IAC 75 (Rules in Process) 441 IAC 76 (Rules in Process), 76.8(2)-(3), 86.3(7)(c) Policy: For MAGI-related Medicaid, the client shall not be required to provide additional verification if attested income meets the Department’s standards for ‘reasonable compatibility’ as defined in 8-A, Definitions, and if the Department can verify all other required information through an Electronic Data Source. If attested income does not meet the Department’s standards for ‘reasonable compatibility’ or if the Department is not able to verify other required information through an Electronic Data Source, send a written request for the additional information or verification. Before terminating or reducing benefits, a request must be sent to members for information that cannot be obtained electronically or is obtained electronically but is not reasonably compatible with information provided by or on behalf of the individual.