I. Ex-Parte Review

The following reports will be produced at least 30 days in advance of the 24-month termination date.

FIM-31345-01, Extended Transitional Medical Assistance Cases that Eligibility Ends the End of the Following Month.

FIM-31345-02, Non-Custodial Parent Cases That Eligibility Ends During (month, year).

FIM-31345-03, Extended Women's Health Services Cases that Eligibility Ends the End of the Following Month

These reports will list all active persons on the case.  Staff must review each individual's possible eligibility under other MC+/Medicaid categories.   Determine eligibility using information from the record and other available records, i.e. Food Stamp or Childcare records, SDX, Bendex, IIVE, IMES, etc.  If eligibility exists under another category, switch the individual to the appropriate category (an application is not needed).  If discontinuing eligibility under 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.  Use the IM-32NCP if switching to Non-Custodial Parent.

II. Pre-Closing Review
A system generated notice of ETMA, NCP and EWHS termination will be sent to the family at least 30 days in advance of eligibility ending.  These letters also inform the recipients of other possible basis for eligibility and serves as the Pre-Closing Review Notice (See attached).  The individual will be allowed ten (10) days to respond.

A. No Response from Client:

If eligibility was not established in the ex-parte review and there is no response from the individual indicating any other possible eligibility, allow the system to close the ETMA, NCP or EWHS case at the end of the eligibility period.  A system generated closing letter will be sent (See attached).

B. Response from Client:

1) Extended Transitional Medical Assistance

If eligibility is not established in the ex-parte review but the individual responds to the Pre-Closing Notice indicating other possible eligibility, register the appropriate (MA, MC+ for Pregnant Women, Non-Custodial Parent) application in IAPP.  Allow the current eligibility for that particular individual to remain open pending the eligibility determination for the other category.  This is done by updating the IMU5 with a re-entry of case action 29, re-entering the closing reason and entering a new date in Field 32 of three months in the future.  This action will prevent the system from closing the ETMA at the end of the original time limit.

No new signed application from the individual is required to switch categories.  If disability or blindness is claimed, use the IM-2D when determining eligibility under Medical Assistance.  Use the IM-1UA (NCP) when determining eligibility under Non-Custodial Parent program.  One category of coverage should not be stopped before the other category is approved or determined ineligible.

NOTE:  The termination date in Field 32 may be lengthened as deemed necessary by a re-entry of case action 29, re-entry of reason for closing and changing date in Field 32 to the last date of a future month.

2) Non-Custodial Parent

If eligibility is not established in the ex-parte review but the individual responds to the Pre-Closing Notice indicating other possible eligibility, register the appropriate MA or MC+ application in IAPP.  If disability or blindness is claimed, use the IM-2D when determining eligibility under Medical Assistance.  If a change in income or family composition is reported, evaluate eligibility for other possible MC+ categories.  Allow the current eligibility for individual to remain open pending the eligibility determination for the other category.  This is done by updating the IMU5 with a case action 35 and entering a new date in Field 32 of three months in the future.  This action will prevent the system from closing the NCP at the end of the original time limit.

3) Extended Women's Health Services (EWHS)

If eligibility is not established in the ex-parte review but the individual responds to the Pre-Closing Notice indicating other possible eligibility, register the appropriate (MA, MC+ for Pregnant Women, Non-Custodial Parent) application in IAPP.

Allow the system to close the EWHS case at the end of the original time limit.

NOTE:  If the individual does not respond to the Pre-Closing Review Notice within ten (10) days, but does respond indicating other possible eligibility prior to the termination of the ETMA, EWHS or NCP, follow the same instructions above.  If they respond indicating other possible eligibility after the case is closed, treat as a new application.

C.  Eligibility Established in Another Category:

If eligibility is established under another category, close the current ETMA, NCP or EWHS case and approve the other category the same date.  Use the IM-32 to notify the client of the switch to MA, the IM-33MCC to notify the client of switch to other MC+ categories and the IM-32NCP to notify the client of the switch to Non-Custodial Parent.   Each notice should include a statement that eligibility no longer exists under ETMA, NCP or EWHS as the 24-month time limit has been exhausted. 

D.  Ineligible for Another Category:

If a NCP or ETMA recipient is determined ineligible based on reported pregnancy, disability, blindness, change in circumstances or child support payments, send an IM-80, Advance Adverse Action Notice.  Address the reason for the denial of the new category as well as the reason for loss of eligibility for ETMA or NCP.  A separate rejection notice for the new category is not required as the IM-80 notifies the client of ineligibility for all MC+/Medicaid categories and provides appeal rights.  Close the active ETMA or NCP case when the IM-80 expires.  The closing notice should contain both reasons for ineligibility as well.

Since the EWHS case was/will be allowed to close at original time, it will be necessary to send the appropriate denial notification when determined ineligible for another category of assistance.  The system will generate the closing notice for the EWHS case.

E.  Additional Reports:

The following reports are being produced for information purposes only.  This report will provide a listing of cases and individuals that were systematically closed at the end of the 24-month time limit.

Report FIM31032-01, Extended Transitional Medical Assistance Cases That Have Closed
Report FIM31032-02, Non-Custodial Parent Cases That Have Closed
Report FIM31032-03, Extended Women's Health Services Cases That Have Closed

Name                                                                             Date:
Address
Address

Dear

Your MC+ healthcare coverage will end ______________ as you will have exhausted the twenty-four (24) months of benefits allowed under the Extended Women's Health Services per 13 CSR 70-4.090.

Your case is being reviewed to determine if you qualify for continued MC+ healthcare coverage in another category of assistance.  Based on information on file, a determination of eligibility under MC+ for custodial parents and Medical Assistance for Families programs will be completed.  If under the age of 19, eligibility will be determined under the MC+ for children program.  You will be notified if your MC+ healthcare coverage changes.

Eligibility may exist for MC+ healthcare or other medical assistance programs if any of the following apply:

• You have a physical or mental disability which is expected to prevent employment for at least 12 months;
• You are pregnant;
• You are blind; or
• A change in circumstances has occurred, such as a change in income; or
• As a non-custodial parent, you are current in paying child support.

     Sincerely,
 
 

     MC+ Service Representative
 
 
 
 

Name                                                                            Date:
Address
Address

Dear

Your MC+ healthcare coverage will end ______________ as you will have exhausted the twenty-four (24) months of benefits allowed under the Non-Custodial Parent program
 per 13 CSR 70-4.090.

Eligibility may exist for MC+ healthcare or other medical assistance programs if any of the following apply:

• You have a physical or mental disability which is expected to prevent employment for at least 12 months;
• You are pregnant;
• You are blind; or
• A change in circumstances has occurred, such as a change in income; or
• As a non-custodial parent, you are current in paying child support.

     Sincerely,
 
 

     MC+ Service Representative
 
 

Name                                                                               Date:
Address
Address

Dear

MC+ healthcare coverage for the following person(s) will end ______________ as you will have exhausted your twenty-four (24) months of benefits allowed under the Extended Transitional Medical Assistance program per 13 CSR 70-4.090.
 
 
 
 

Your case is being reviewed to determine if the above listed person(s) qualify for continued MC+ healthcare coverage in another category of assistance.  Based on information on file, a determination of eligibility under MC+ for Custodial Parents and Medical Assistance for Families programs will be completed.  If under the age of 19, eligibility will be determined under the MC+ for children program.  You will be notified if your MC+ healthcare coverage changes.

Eligibility may exist for MC+ healthcare or other medical assistance programs if any of the following apply:

• You have a physical or mental disability which is expected to prevent employment for at least 12 months;
• You are pregnant;
• You are blind;
• A change in circumstances has occurred, such as a change in income; or
• As a non-custodial parent, you are current in paying child support.

     Sincerely,
 
 

     MC+ Service Representative

Name                                                                                    Date:
Address
Address

Dear

Your Extended Women's Health Services healthcare benefits ended ______________ as you exhausted the twenty-four (24) months of benefits allowed (13 CSR 70-4.090).  We do not have any information that indicates eligibility for any other MC+ or medical assistance program.

You may call 1-800-TEL-LINK (1-800-835-5465) to identify where to go for family planning services and a variety of other services for families.

You have the right to appeal decisions made involving your coverage.  You can request a hearing within 90 days from the date of this letter by contacting your MC+ Service Representative.  If you request a hearing, you may present your information yourself or be represented by your own attorney or by other persons who know your situation.  You have the right to present witnesses in your behalf and to question witnesses who appear at the request of the MC+ Service Representative.

     Sincerely,
 
 

     MC+ Service Representative

Name                                                                                   Date:
Address
Address

Dear

Your MC+ healthcare coverage ended ______________ as you exhausted the twenty-four (24) months of benefits allowed under the Non-Custodial Parent program
 per 13 CSR 70-4.090.  We do not have any information that indicates eligibility for any other MC+ or medical assistance program.

You have the right to appeal decisions made involving your coverage.  You can request a hearing within 90 days from the date of this letter by contacting your MC+ Service Representative.  If you request a hearing, you may present your information yourself or be represented by your own attorney or by other persons who know your situation.  You have the right to present witnesses in your behalf and to question witnesses who appear at the request of the MC+ Service Representative.

     Sincerely,
 
 

     MC+ Service Representative
 

Name                                                                                Date:
Address
Address

Dear

Your MC+ healthcare coverage for the following person(s) ended _________________ as you exhausted the twenty-four (24) months of benefits allowed under the Extended Transitional Medical Assistance program per 13 CSR 70-4.090.  We do not have any information that indicates eligibility for any other MC+ or medical assistance program.
 
 
 
 

You may call 1-800-TEL-LINK (1-800-835-5465) to identify where to go for family planning services and a variety of other services for families.

You have the right to appeal decisions made involving your coverage.  You can request a hearing within 90 days from the date of this letter by contacting your MC+ Service Representative.  If you request a hearing, you may present your information yourself or be represented by your own attorney or by other persons who know your situation.  You have the right to present witnesses in your behalf and to question witnesses who appear at the request of the MC+ Service Representative.

     Sincerely,
 
 

     MC+ Service Representative

• Review this memorandum with all appropriate staff.

• Explore all other categories of assistance before allowing the EMTA, NCP or EWHS case to close.

• Implement these procedures upon receipt of the monthly reports.

• File copies of the letters and reports in the Forms Manual.