Family Healthcare (FAMIS)

0905.025.16.05 Ex Parte Review

IM-#193 December 28, 2000

Prior to discontinuing an individual’s coverage under any MC+ category, staff must review the individual’s possible eligibility under all MC+ healthcare programs.  Possible eligibility for Medical Assistance (MA) must also be explored if the individual has an established disability or is blind or aged.  (For example, receiving RSDI or SSI.)  Use information from all available records, i.e. Food Stamp or Childcare records, SDX, Bendex, IIVE, IMES, etc.  Keep in mind, the individual should be moved to the best healthcare benefits package for which they qualify.

If eligibility exists under another category, switch the individual to the appropriate category (an IM-1 is not necessary).  If discontinuing eligibility from one category and approving in another, process both transactions on the same day in order to prevent any disruption in healthcare coverage.  Use the IM-33MCC to notify the recipient of changes in their healthcare coverage if moving to another MC+ category.  Send an IM-32 if changing to MA.