Page 34

Document the change in the case record assuring that each changed eligibility factor is addressed. Assure that all supporting verifications are in the case record. Close the AG Medicaid case in VaCMS Reopen the individual in his new Medicaid covered group in VaCMS. Update the renewal date in VaCMS. Send a “Notice of Action (for AG)” to the individual and his representative to notify them that Medicaid eligibility continues. If ineligible for Medicaid Document the closure and the reason for it in the case record. Assure substantiation of ineligibility is included in the case record. Example: If the individual is ineligible due to excess income, the case record must include verification of the income and the calculations used to determine ineligibility. Send a “Notice of Action (for AG)” to the individual and his representative to notify them of the Medicaid closure. State the reason Medicaid was closed and cite the appropriate Medicaid manual references. At the end of the 10-day advance notice period, close the case in VaCMS. Send the Provider/DSS Communication Form to the ALF/AFCH to notify the provider that the AG has been suspended. Upon receipt of an SSI reinstatement decision, evaluate the change. AG Approval/Continuing Eligibility The agency determines the individual meets all eligibility requirements and eligibility will continue.