0840.000.00 Annual Renewals and Change in Circumstance

0840.015.05 Pre-closing Ex Parte Review

IM-193 December 28, 2000

If a change in circumstances results in a determination of ineligibility for MA, ineligibility for all Medicaid/MC+ categories must be established prior to taking action to close the case.  All available information must be carefully reviewed.  If potential eligibility exists under another category, change the case address if necessary, and continue Medicaid under MA while exploring the other eligibility.

Do not ask the claimant to provide new information that is available to the agency or to re-verify current case information.  In some situations it may be necessary to obtain additional information from the client to determine eligibility in another category.  Do not close while attempting to complete the new eligibility determination.

If the claimant is determined eligible under another category, switch the individual to the appropriate category (an IM-1 is not necessary).  If the new category uses a type of assistance “M” (MA-WD, BCCT, MA Section 1619, etc.) change the level of care and reason code in the IMU5 system to make the change.  Do not close and re-open the case.  If the new category uses a type of assistance other than “M” (MAF, MPW, etc.) process both closing and approval transactions on the same day in order to prevent any disruption in Medicaid coverage.

If no other eligibility exists, initiate action to close the case by sending an advance notice of adverse action (IM-80).  If a hearing is not requested close the active MA case once the IM-80 expires and notify the claimant in writing (IM-33) confirming the closing.