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facilities, and secure facilities not licensed as child-care facilities, state law requires the juvenile court that adjudicated the delinquency to notify the DFR of the detention.
During the period of suspension, case management activity such as redetermination, processing data exchange updates, etc., will not occur when there are no other eligible recipients in the case.6
2237.10.00 REINSTATEMENT OF BENEFITS FOR SUSPENDED INDIVIDUALS
Once it is reported that member is no longer incarcerated or has been released from the psychiatric facility, the Medicaid category should be reinstated. Benefits for individuals who are in suspend status in accordance with Section 2237.05.00, are to be reinstated without a reapplication if the individual returns to an eligible living arrangement.
The DFR can use the member or AR’s self-attestation as verification of release from incarceration, unless questionable.
Coverage for HIP members should start first of the month in the month release date is reported.
In HIP cases the individual will be opened in Basic, with a potential plus flag, regardless of whether they are below or above 100% of the FPL. The member will be given 60 days, from the date of authorization, to pay the PAC payment. If the PAC is not paid within 60 days, members who are below 100% of the FPL will remain in Basic and members who are above 100% of the FPL will be closed.
Coverage for non-HIP members can retro back up to 90 days prior to the month of report, if the member was not incarcerated for those months. In the case of MA10 or MADW with a premium, the AG must be conditionally approved within the 40 days of release/discharge. Follow up verification of eligibility factors is required on reported information and discrepant information.
2238.00.00 DISCONTINUANCE
When an Assistance Group (AG) fails to meet the eligibility requirements of any category within a program, assistance is discontinued for that program. Discontinuance is effective the first day of the month following the expiration of the required timely notice. Refer to IHCPPM 1610.50.00 for pregnancy-related change processing.
2238.05.00 DISCONTINUANCE DUE TO DEATH
When a recipient is deceased, the Person-Details page needs to be updated with the date of death and verification would need to be selected. This action will invoke ED/BC and the AG can then be closed. It is crucial to enter the correct date of death to ensure claims will not be paid in error.