Family Healthcare (FAMIS)

0940.025.00 CHANGES ON ACTIVE CASES (PFS)

DCSE will notify phone center staff via CSE-67 of changes in eligibility. The only issues which effect continued eligibility are insured status and non-participation in the PFS program.

If an NCP successfully exits the PFS program, DCSE will advise the NCP they are no longer eligible for MC+ as a PFS participant, but may be eligible for MC+ as a non-custodial parent. An MC+ application, IM-1UA and IM-1UA (NCP), will be included with the notification from DCSE. The NCP will be instructed to return it to DCSE within 15 days. If returned within 15 working days, DCSE will notify the appropriate phone center via CSE-67 that the NCP is exiting the PFS program. The new MC+ application and a child support payment history for the past six months will be included. If eligible for NCP, change the level of care to “F” with an effective date of the action. Use the IM-32 NCP to notify the non-custodial parent of eligibility for MC+ for NCP. If ineligible for MC+ for NCP, close the MC+ for PFS. Use the MC+ Denial Notice, IM-33 MC, to notify the non-custodial parent of their ineligibility.

If the NCP does not return the completed application to DCSE within the 15 working days, DCSE notifies FSD via CSE-67 that the NCP is exiting the PFS Program. Take action to close the case. An IM-80 is not required as the NCP is notified up front their eligibility is tied to PFS participation. Send a closing letter, IM-33MCC, to notify the client of the date their MC+ coverage ends.

If the NCP misses the 15-day deadline, he may still apply for MC+ for NCP through normal procedures. However, if eligible, coverage will be interrupted.

If the NCP is terminated from the PFS program for non- participation, DCSE sends the participant notification of ending eligibility. An IM-1UA and IM-1UA (NCP) will be included with this notice advising that application for MC+ for NCP may be made by returning the application to FSD. At the same time the client is notified, DCSE will send to the appropriate phone center a CSE-67 indicating the NCP is exiting the PFS program. Discontinue MC+ coverage as a PFS participant. An IM-80 is not required. Send a closing letter to notify the NCP of the date MC+ coverage ends.

If notified by DCSE that the PFS participant has obtained health insurance, send a closing letter stating they no longer meet the uninsured criteria. An IM-80 is not required.