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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL D-520 Division of Welfare and Supportive Services CHANGES

Medical Assistance Manual QUESTIONABLE INFORMATION AND/OR UNREPORTED 24 Jan 25 MTL 02/24 D-520 QUESTIONABLE INFORMATION AND/OR UNREPORTED CHANGES

If a household has circumstances that are questionable due to a reported change, third party information, or because the household fails to report a change (i.e., birth of a child, critical age change, obtains insurance from a job, etc.), take the following steps:

a. Contact the household to obtain an explanation for factors of eligibility that allow customer statement.

b. Send a request for information using Form 2429–EE when clarification and/or verification are required to determine continuing eligibility.

c. Allow the household at least 10 days to respond to the request for information, clarification and/or verification.

Exception: Victims of domestic violence approved for fictitious address through the Secretary of State's CAP program must be allowed 17 days to provide verifications due to mail forwarding. Follow adverse action and processing time frames.

d. If the household fails to respond or does not provide enough information to continue the case, resulting in a reduction or termination of benefits, a Notice of Decision must be mailed at least 13 days prior to the effective date of the reduction/termination.

If a third party (other than the authorized representative) does not cooperate in providing information or provides incomplete information, DO NOT close the case. Work with the customer and information already on file (includes income) to arrive at a prudent decision or resolution based on the best information available. Document the circumstances in the CLOG.

D-525 PROCESSING REQUIREMENTS

Update the mailing address as soon as a change is reported. If a reported change of address is not updated by cut-off, the Notice of Decision (NOD) and/or Medicaid card will be mailed to the old address. The NOD and Medicaid card will also be returned if the address is not updated.

D-525.1 Returned Mail

If mail is returned by the U.S. Post Office with an out-of-state forwarding address or no forwarding address; ensure the out-of-state address is updated on the case prior to posting and close the case waiving adverse action.