IM-185 12/14/00 TEMP ASSIST RECIPIENTS WHO LOST MED COVERAGE
| SUBJECT: |
| TEMPORARY ASSISTANCE RECIPIENTS WHO LOST THEIR MEDICAL COVERAGE |
| DISCUSSION: |
| Nationally, there has been concern that
families closed for Temporary Assistance were also losing medical coverage
when they should have remained eligible. Health Care Financing Administration
(HCFA) has directed states to reinstate medical coverage for categories
of persons who may have lost coverage for which they were eligible when
their cash assistance terminated.
To comply with HCFA directives, we are reinstating former recipients who lost medical coverage when their Temporary Assistance closed from December 1, 1996 through February 29, 2000, unless they were an active Medicaid/MC+ recipient on March 1, 2000 or later. The reinstatement period covers January 1, 2001 to February 28, 2001. These recipients will also be given retroactive coverage for services received from March 1, 2000 through January 1, 2001. I. Reinstatement Process: On December 16, 2000, cases will be reinstated in the IMU5 system. The cases reinstated will appear in the system as Medical Assistance for Families (MAF) only and will be fee-for-service. On December 29, 2000, a letter will be mailed to the family explaining that they were reinstated for Medicaid. The letter contains the Medicaid number of the family members and is to be used in place of the Medicaid/MC+ card when receiving medical services. Included with the letter is a "Medicaid Reinstatement Form" and a prepaid reply envelope addressed to the area MC+ Phone Center. Preprinted on the form are the case name, address, DCN, the original pay county, and a special county to identify the Area MC+ Phone Center. If a family wishes to continue healthcare coverage after February 28, 2001 they need to respond by February 28, 2001. This can be done by completing the "Medicaid Reinstatement Form" and returning it in the prepaid reply envelope. Upon receipt of the reinstatement form, a code indicating responded is to be immediately entered in the system. A new screen, IMED, was created for this purpose. Use the form to evaluate the family for continued eligibility under all Medicaid/MC+ programs. All forms received are to be reviewed for continued eligibility by March 31, 2001. If a family does not respond, a series of three letters (Reminder letter, Adverse Action letter, and Closing letter) will be system generated over the two-month reinstatement period. If no response is received, the system will close the case on the night of February 28, 2001. Reinstated families with active Food Stamp and Child Care cases will not be mailed the reinstatement form. Their continued eligibility will be based on the information in the Food Stamp or Child Care record. NOTE: A red MC+ card will not be issued to the reinstated individuals until they have been determined eligible for Medicaid/ MC+ on a regular basis, unless the household requests them. II. SYSTEM CHANGES: Identification of Reinstated Cases Cases will be reinstated as MAF only with a special identifier in Field 27 (Case Identifier), as follows:
All individuals activated will have a level of care "T", with an "R" in field 13G2 (Reason for Title XIX only). The reason for Title XIX only will be added to the IXIX screen. All reinstated cases will have a residence county of 201 through 207, which will identify the MC+ phone center handling the case. For example, county 201 would be the Area 1 phone center. The pay county will remain the same, as it was when the case originally closed. The worker number on the cases will be from 90201 to 90207, which will correspond to the appropriate MC+ phone center. The load number for these cases will be 88888. IMED Screen The IMED screen was created to update Field 27 of IMU5 and track the status of the reinstatement cases. Only the casehead will be on IMED. To access IMED, enter IMED space TOA space DCN. Entries made on IMED will transfer to IMU5, but no turnaround will be generated. Only cases with an "N" (notified of reinstatement) in Field 27 will appear on IMED. Allowable entries on IMED are "R" for responded and "U" for undeliverable. An entry of "U" can be changed to an "R" but a "R" cannot be changed. An updated address or worker number can be entered on IMED, at any time. The worker number should be changed if the case will be handled at a site other than the MC+ Phone Center. If the code "N" is not changed by the end of the reinstatement period, the system will close the case with reason code 70. If the case is coded as "U" at the end of the reinstatement period, the system will close the case with reason code 71. No turnaround will be generated for these closings. III. PROCEDURES: Client Responds: A recipient can respond by phone, in person, by returning the reinstatement form, or by submitting an IM-1UA. If a recipient responds by phone, fill out the Medicaid Reinstatement Form and code the case as "R" on IMED. If a reinstated recipient walks into a local office have them fill out the reinstatement form and enter "R" on IMED. If a recipient sends in an IM-1UA instead of the reinstatement form, enter "R" on IMED, and follow the procedures outlined for processing the Medicaid Reinstatement Form. When a Medicaid Reinstatement Form is received do the following:
NOTE: If a family is in managed care region, changing the residence county will generate information to First Health to begin enrollment in a health plan.a. Enter a case action '35' in IMU5,
All undeliverable reinstatement letters will be returned to STATE Office. A "U" (for undeliverable) will be entered on the IMED screen. Failure To Respond: No action is necessary by staff. If a family fails to respond to the initial mailing, a reminder letter (with a reinstatement form) will be system generated and mailed on January 29, 2001. If the family fails to respond to the reminder letter an adverse action letter will be generated and mailed on February 16, 2001 stating that eligibility will terminate on February 28, 2001. A closing letter will be sent on March 1, 2001 to advise the family of the closing on February 28, 2001. The adverse action and closing letters will contain hearing rights. If contacted by a recipient requesting a hearing, staff are to immediately code the IMED screen as a "R. If the request is made in person or by phone, attempt to obtain any needed information to determine continued eligibility while talking to the client. Reinstated Cases With Active Food Stamp or Child Care case Reinstated cases with active child care or food stamp cases will not be on IMED. A letter will be mailed to the family stating they have been reinstated, and continued eligibility will be based on information in their Food Stamp or Child Care case record. These cases will remain active as MAF until an eligibility determination is made by the worker. The worker will determine eligibility for Medicaid/MC+ based on information in the food stamp or child care record. If family members remain eligible make the appropriate entries in the IMU5 system and notify the family. If family members are ineligible send an IM-80 to notify them of the reason for ineligibility. A listing by caseload of reinstated cases with Food Stamps or Child Care will be sent to each county with this type of case. IV. RETROACTIVE COVERAGE: Reinstated recipients that have incurred medical expenses between March 1, 2000 and January 1, 2001 should notify the provider of their eligibility and give them their Medicaid/ MC+ number. If a recipient paid for medical expenses during the retroactive period they need to call the Division of Medical Services Recipient Services toll free number: 1-800-392-2161 to request reimbursement. V. COMMUNITY OUTREACH: DFS is attempting to work with community groups to locate and encourage reinstated clients to respond. Flyers with the reinstatement form printed on the back have been developed for outreach efforts by community groups. If you receive one of these flyers with a completed form on a reinstated family process it as a responded case. Treat it as a MAF/MC+ application, if it is from a non-reinstated family. Please cooperate with all interested community groups in these outreach efforts. |
| NECESSARY ACTION: |
Distribution #6 Form not available on-line, hard copy only |
| Sample Reinstatement Letter
Dear Parent or Guardian: When your family stopped getting a Temporary Assistance (TANF) cash grant sometime between December 1, 1996 to February 29, 2000, you lost your Medicaid/MC+ benefits. Some families may have been able to keep their medical benefits at that time. WHAT DOES THIS MEAN FOR YOU? 2 MONTHS OF MEDICAL BENEFITS 1. We are giving the family members listed below two (2) months of medical benefits from January 1, 2001 to February 28, 2001 through Medicaid/MC+. 2. Show this letter to your medical providers, and make sure they are Medicaid Fee-For-Service. 3. YOU MAY BE ELIGIBLE FOR MEDICAL BENEFITS FOR LONGER THAN TWO (2) MONTHS. Complete the enclosed Medicaid Reinstatement Form and return it in the prepaid reply envelope by February 15, 2001. This way we can check to see if you're eligible for medical benefits to continue after the 2 months is up. If you return this form, Medicaid/MC+ benefits will continue until the MC+ Service Center sends you a decision. 4. Medical benefits do not count toward the 60-month clock for TANF cash benefits. There are no time limits on medical benefits. Family income can be higher for medical benefits than for cash benefits. Children in a family of three may be eligible for medical benefits if gross family income is less than $3,538.00 per month. For a family of four, gross family income can be up to $4,263.00. 5. We may be able to pay for some of your past medical bills from March 1, 2000 through December 31, 2000. If you have past medical bills from this time, please call Medical Recipient Services toll free number: 1-800-392-2161. QUESTIONS? Call the MC+ Service Center toll-free number: 1-888-275-5908 Sincerely, Denise Cross
Family Member reinstated for Medicaid/MC+: Name Medicaid/MC+ Number
Sample FS/CC Letter Dear Parent or Guardian: When your family stopped getting Temporary Assistance (TANF) cash grant sometime between December 1, 1996 to February 29, 2000, you lost your Medicaid/MC+ benefits. Some families may have been able to keep their medical benefits at that time. WHAT DOES THIS MEAN FOR YOU? 2 MONTHS OF MEDICAL BENEFITS 1. We are giving back to the family members listed below two (2) months of medical benefits from January 1, 2001 to February 28, 2001 through Medicaid/MC+. 2. Show this letter to your medical providers, and make sure they are Medicaid Fee-For-Service. 3. YOU MAY BE ELIGIBLE FOR MEDICAL BENEFITS FOR LONGER THAN TWO (2) MONTHS. By using information from Food Stamps/Child Care Records your Medicaid/MC+ will continue until we have sent you a decision. 4. Medical benefits do not count toward the 60-month clock for TANF cash benefits. There are no time limits on medical benefits. Family income can be higher for medical benefits then for cash benefits. Children in a family of three may be eligible for medical benefits if gross family income is less than $3,538.00 per month. For a family of four, gross family income can be up to $4,263.00. 5. We may be able to pay for some of your past medical bills from March 1, 2000 through December 31, 2000. If you have past medical bills from this time, please call Medical Recipient Services toll free number: 1-800-392-2161. QUESTIONS? Call the MC+ Service Center toll-free number: 1-888-275-5908 Sincerely, Denise Cross
Family Member reinstated for Medicaid/MC+: Name Medicaid/MC+ Number
Sample Reminder Letter Dear Parent or Guardian,
On December 29, 2000 we sent you a letter about reinstatement of family members for MEDICAID/MC+ BENEFITS from March 1, 2000 to February 28, 2001. We sent you a Medicaid Reinstatement Form to fill out to help us decide if you are eligible for Medicaid/MC+ benefits for longer than two (2) months. As of January 31, 2001 we have not heard from you. If you have already sent in the form, please call 1-888-275-5908 to check to see if we have received it. If you did not already send the form in, please do so by February 15, 2001. If you return this form by then, Medicaid/MC+ will continue after February 28, 2001 until the MC+ Service Center sends you a decision. We have included another Medicaid Reinstatement Form and prepaid reply envelope that you can use. QUESTIONS??? Call the MC+ Service Center toll free number: 1-888-275-5908. Sincerely,
Denise Cross
Sample Adverse Action Letter Dear Parent or Guardian, Your Medicaid benefits may be stopped! Please read carefully! On December 29, 2000, we sent you a letter indicating that we were giving you two (2) months of Medicaid /MC+ benefits. We sent you a form to fill out to help us decide if you are eligible for Medicaid/MC+ for longer than two (2) months. According to our records, you have not returned your completed form. As we cannot establish your eligibility for continued Medicaid/MC+, your Medicaid/MC+ for the person(s) listed below will end on February 28, 2001. Section 208.010 RSMo. If you have already sent in the form, please call 1-888-275-5908 and let us know. If you believe this decision is wrong or if you have more information for us to consider, you have 90 days to request a hearing. To request a hearing by phone, call 1-888-275-5908. To keep your Medicaid/MC+ while you wait for the hearing decision, you need to request a hearing by February 26, 2001 If you request a hearing, we will notify you of the time and place of the hearing. At the hearing, you may present information yourself or you may be represented by your own attorney or other persons who know your situation. If you do not have an attorney, or cannot afford one, you may be able to get legal help from Legal Aid or Legal Services in your area. You have the right to bring witnesses to testify at the hearing and to question witnesses who appear for the Division of Family Services. If you agree with this decision, you do not have to request a hearing. If you do not request a hearing, we will stop your Medicaid/MC+ following the date indicated above. Sincerely,
Name Medicaid /MC+ Number
Sample Closing Letter Dear Parent or Guardian, Your Medicaid has stopped! Please read carefully! On December 29, 2000, we sent you a letter indicating that we were giving you two (2) months of Medicaid/MC+ benefits. We sent you a form to fill out to help us decide if you are eligible for Medicaid/MC+ for longer than two (2) months. Your Medicaid/MC+ coverage has ended for persons listed below effective February 28, 2001 because you did not complete the form we sent you. Without the information from the form, we cannot establish your eligibility for continued Medicaid/MC+. Section 208.010 RSMo. If you believe this decision is wrong, you have the right to request a hearing within 90-days from the date of this letter. To request a hearing by phone, call 1-888-275-5908. If you request a hearing within the 90-days, we will notify you of the time and place of the hearing. At the hearing, you may present information yourself or you may be represented by your own attorney or other persons who know your situation. If you do not have an attorney, or cannot afford one, you may be able to get legal help from Legal Aid or Legal Services in your area. You have the right to bring witnesses to testify at the hearing and to question witnesses who appear for the Division of Family Services. If you agree with this decision, you do not have to request a hearing. Sincerely,
Name Medicaid/MC+ Number
Missouri Department of Social Services
Important Notice about Reinstatement of Medicaid/MC+ to Families! In December the Division of Family Services (DFS) will reinstate Medicaid/MC+ benefits to families who lost medical benefits when they stopped getting a Temporary Assistance (TANF) cash grant. These families lost benefits sometime between December 1, 1996 and February 29, 2000. Advocacy groups worked with DFS to develop a reinstatement program for Missouri that is consistent with the directives from the federal Health Care Financing Administration (HCFA). The Medicaid/MC+ benefits for identified families will be reinstated for two months, January 1, 2001 through February 28, 2001. All families will be encouraged to provide information regarding their eligibility for benefits beyond the reinstatement period. Mailings to Families At the end of December, DFS will send a notice to the head of household of each identified family. The notice will inform the family of the reinstatement of Medicaid/MC+ benefits for two months and will request completion of a questionnaire if the family wishes to continue coverage for any family member. The questionnaire must be returned to DFS within a specific time frame.
Please do what you can to make sure families who lost Medicaid/MC+ benefits are aware of this program (make announcements at meetings, post this notice). DFS reviewed data systems to identify the families who will receive the mailings but they may not have a correct address.
Did you lose medical benefits when you went off Welfare? If this happened to you or someone you know, call: 1(888) 275-5908 The Division of Family Services (DFS) is looking for families who lost Medicaid medical benefits when they stopped getting a Temporary Assistance (TANF) cash grant. These families lost benefits sometime between December 1, 1996 and February 29, 2000. DFS will send a letter to families in January 2001. This letter will: 1. give the families 2 months of free medical
benefits;
Medical benefits do not have time limits and do not count toward the 60 month clock for cash grants. As long as a family qualifies, they can get medical benefits. If you did not receive a letter and would
like Healthcare coverage please call the toll free number: 1-888-275-5908
or fill out the back of this form and send it to the address nearest you:
MC+ Phone Center
MC+ Phone Center
MC+ Phone Center
MC+ Phone Center
MC+ Phone Center
MC+ Phone Center
MC+ Phone Center
IMED C XXXXXXXX
11/09/00
CASE-IDENTIFIER: N WORKER: 90207 ACTION DATE: MTH/DAY/YR OLD ADDRESS
NEW ADDRESS
MESSAGE: ENTER REINSTATEMENT DATA FOR CLIENT
INSTRUCTIONS The following fields are available for change in the IMED screen by workers.
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