101.16.05 TAKING ACTION ON REPORTED CHANGES

Specialists must follow up on information which is reported by the recipient or otherwise becomes known to the agency to determine if the information is a reportable change. If the change is not reportable, the information will be considered at the next regular review. For instance, an income increase reported by the parent of a Medicaid or CHIP child is not a reportable change because of the continuous eligibility provision for children. The impact of an increase in parental income will be considered at the next review. However, if the parent reports an eligible child has moved from the state, that is a reportable change which must be acted upon. Action on a reportable change must be initiated no later than 10 working days from the date the change becomes known to the agency to determine its impact on eligibility and benefit level. NOTE: It is imperative that timely action be taken on reported changes to prevent agency error. For instance, recipients frequently report address changes. Failure to take prompt action on these changes not only results in inconvenience to the recipient, but also may lead to benefits being terminated in error when notices are mailed to the wrong address. If verification of a reportable change is needed from the recipient, DOM-307 will be issued with a 30 day deadline to provide written notice of the required information and due date. Action is taken on changes as follows: • Reported changes with the likelihood that eligibility will be adversely affected require development, which may mean a request for additional information is needed. Failure by the MAGI head of household or ABD recipient or representative to respond to needed information will result in termination of eligibility for any adult(s) affected by the change. Changes can include, but are not limited to, the report of a marriage with additional household income to consider, a new job for a household member or any type of change indicating an additional source of income. • A negative change reported during a review period that affects eligibility for adult(s) is handled at the time of the reported change; however, it is not permissible to take punitive action on the children in a case due to action being taken for the adult’s eligibility. This includes not setting future termination dates for the children at the end of their 12-months of continuous eligibility. Children must be reviewed so their eligibility is assessed at each annual review. For example, an adult reports marriage and is terminated during the review period because spousal wages were requested but not verified. The non pregnant adult’s eligibility is terminated. A future closure would not be set for the children. The child’s eligibility must be reviewed at the next annual review. If information needed at the time of the annual review is not provided, the children’s eligibility would be terminated as a result of the annual review. • If there is a case change, such as the addition of a parent, that results in information that must be requested to confirm the parent’s eligibility, do not require updated information for a child’s eligibility. Handle the child’s eligibility at the next annual review. • Reported changes that will not likely affect eligibility for the household should be developed but if a request for additional information yields no response, it is not permissible to terminate eligibility for a failure to respond to the request. Instead, follow up at the next review. These types of changes may include a change of address for the household when a move out of state is not indicated, loss of an income source to the household, the death of a child’s parent or other types of changes that would not result in a loss of eligibility. • Reported changes or actions taken during a review period can affect one or more household members but not the entire household. The option to perform an early review can be offered but cannot be required for a child’s eligibility. • A change during the review period that results in updated information on all household members can result in eligibility being extended for the household. For example, during the review period a parent applies and is added to the case. All household income is updated and verified. It is permissible to extend eligibility for a new 12-month review period for the children under these circumstances. • Reported changes that would change a child from CHIP to Medicaid must be acted on. Children cannot be switched from Medicaid to CHIP during the child’s 12 months of continuous eligibility Documenting the Case Record The case record/case narrative must reflect the following information about the reported change: • Who reported the change. • When the change was reported. • How the change was reported. • When action was initiated on the change. • What was used to verify the change. • What action was taken regarding the verified information.