| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | NEW FAMIS REINVESTIGATION MODEL FOR TEMPORARY ASSISTANCE, MEDICAL ASSISTANCE FOR FAMILIES, AND MC+ FOR CHILDREN |
DISCUSSION:
Effective August 6, 2007, a new reinvestigation model is implemented in FAMIS for Temporary Assistance, Medical Assistance for Families (MAF), and MC+ for Children cases in FAMIS. The reinvestigation model displays eligibility factors that are required to be reinvestigated annually. Other case factors may be updated as needed. Reinvestigations are initiated by FAMIS on the 15th day of the month prior to the month the reinvestigation is due. In addition, the eligibility specialist may initiate a reinvestigation as needed. The controlled flow must be completed on a converted case before a reinvestigation can be completed on the case.
Policy regarding other actions that meet the annual reinvestigation requirements is not changed. Completion of the following actions continues to meet reinvestigation requirements in the FAMIS system for Temporary Assistance cases:
- A food stamp application initial approval or recertification when all members of the Temporary Assistance Eligibility Unit are in the Food Stamp Eligibility Unit; or
- An add-a-person approval for Temporary Assistance.
Similarly, completion of the following actions meets reinvestigation requirements in FAMIS for Medical Assistance for Families and MC+ for Children:
- A food stamp application initial approval or recertification when all members of the Medical Assistance for Families or MC+ for Children Eligibility Unit are in the Food Stamp Eligibility Unit;
- A Temporary Assistance application approval when all members of the Medical Assistance for Families or MC+ for Children Eligibility Unit are in the Temporary Assistance Eligibility Unit; or
- An add-a-person approval for Temporary Assistance, Medical Assistance for Families, or MC+ for Children.
Medicaid for Pregnant Women (MPW), Newborn (NBN) and Transitional Medical Assistance (TMA) cases are not required to be reinvestigated annually. Therefore, no reinvestigation process is initiated on these types of assistance.
This memorandum introduces new screens used to capture information in FAMIS for reinvestigations.
REINVESTIGATIONS INITIATED BY FAMIS
FAMIS mails the FA202 reinvestigation form and FA601 Informational Notice for Temporary Assistance or the FA402 Family Medical Assistance reinvestigation form on the 15th day of the month prior to the month the reinvestigation is due. The form must be returned by the recipient the first day of the month the reinvestigation is due.
FAMIS will set an alert “annual reinvestigation due” for the eligibility specialist and create reinvestigation factors the day the reinvestigation form is mailed to the recipient. When FAMIS creates a reinvestigation it displays on the new TA/MA Reinvestigation History (FM57 or REINVEST) screen by Eligibility Unit (EU) and reinvestigation date. The status shows pending (PEN) and the date the status was set. The alert elevates to the supervisor on the first day of the month the reinvestigation is due. If the receipt of the reinvestigation form is not entered into FAMIS by the first day of the month, FAMIS will generate a notice of adverse action to close the case.
Refer to the Completing a Temporary Assistance/Medical Assistance Reinvestigation in FAMIS User Guide for assistance in completing a reinvestigation for Temporary Assistance, Medical Assistance for Families, or MC+ for Children.
REINVESTIGATIONS INITITATED BY THE ELIGIBILITY SPECIALIST
Temporary Assistance, Medical Assistance for Families, and MC+ for Children reinvestigations may also be initiated by the eligibility specialist at any time prior to the annual review, if needed.
FAMIS mails the FA202 reinvestigation form and FA601 Informational Notice for Temporary Assistance or the FA402 Family Medical Assistance reinvestigation form, sets an alert “annual reinvestigation due” for the eligibility specialist, and creates reinvestigation factors the day the reinvestigation form is mailed to the recipient. Reinvestigation forms initiated by the eligibility specialist are due to be returned in ten days.
When FAMIS creates the reinvestigation requested by the eligibility specialist it displays on the new TA/MA Reinvestigation History (FM57 or REINVEST) screen by Eligibility Unit (EU) and reinvestigation date. The status shows pending (PEN) and the date the status was set. The alert elevates to the supervisor on the day the reinvestigation form is due back from the recipient. If the receipt of the reinvestigation form is not entered into FAMIS by the tenth day after it was mailed to the recipient, FAMIS will generate a notice of adverse action to close the case. Reinvestigations initiated by the eligibility specialist must be completed by the end of the month containing the 45th day after the reinvestigation is initiated.
Refer to the Completing a Temporary Assistance/Medical Assistance Reinvestigation in FAMIS User Guide for assistance in initiating a reinvestigation.
NEW FAMIS SCREENS
The new TA/MA Reinvestigation History (FM57 or REINVEST) screen displays the EU, rein date, status, and status date. When a reinvestigation is completed, the method of completion is displayed. Completion method may be by eligibility specialist, food stamp approvals, Temporary Assistance approvals, or add-a-person approvals. If the completion method shows not applicable, the case was previously closed while a reinvestigation was in pending status. The TA/MA Reinvestigation History (FM57 or REINVEST) screen is shown below.
The Reinvestigation Audit Detail (FM55) screen displays the SCN, EU, reinvestigation status, status date, expected completion date, notice sent date, notice received date, and comments. The notice sent date is the date the reinvestigation form is mailed to the recipient. The notice received date is the date the eligibility specialist enters for the date the form was returned by the recipient. The Reinvestigation Audit Detail (FM55) screen is shown below.
The TA/MA Reinvestigation Factor (FM4Z) screen displays SCN, EU, reinvestigation status date, reinvestigation status, reinvestigation factors to be reviewed for that eligibility unit, and No. of persons review completed. The No. of persons review completed field shows the number of individuals to be reinvestigated for the factor and the number completed. After a factor is reviewed, the date the factor was reviewed and completion method displays. If the factor was reviewed and completed by the eligibility specialist, this field displays CASEWORKER: and the eligibility specialist's worker ID. Factors may show completion by eligibility specialists, food stamp actions, Temporary Assistance actions, or add-a-person actions. The TA/MA Reinvestigation Factor (FM4Z) screen is shown below.
FAILURE TO COMPLETE A REINVESTIGATION
If the reinvestigation form is not returned and entered into FAMIS by the due date, FAMIS will initiate an Adverse Action Close (AACL) with a reason “REI” failed to return the rein form. FAMIS will close the case when the adverse action expires and send the closing notice.
Because FAMIS is an integrated/automated system it is very important that information be entered into FAMIS as received. When information is not entered FAMIS cannot make accurate decisions for other cases as required. Counties should develop a plan for entering information into FAMIS as received.
NECESSARY ACTION:- Review this memorandum with appropriate staff.
- Complete TA/MA reinvestigations using new reinvestigation process beginning August 6, 2007.