Eligibility Online Manual
M1404 Closure
Purpose: This section will provide information on termination (closure of cases).
Current Policy Effective Date: July 1, 2023
Date Last Reviewed: June 28, 2023
Previous Policy: October 1, 2022
POL M1404: CLOSING CASES
1. Closing Aged, Blind, Or Disabled Or Medicare Savings Programs Cases
A client's case must be closed when one or more of the following conditions are met:
Client is no longer in a nursing home or on a Home and Community Based Services Waiver
Resources, income, status, or other eligibility factors have changed and the client is determined no longer eligible
Client has not completed the review process
Client has not cooperated in establishing continued eligibility
Client requests case closure
Client moves out of state
Client dies
2. Closing Cases For Clients Under 19
DO NOT close a client under age 19 from the time of approval or periodic review until the end of the 12 month period, unless one of the following occurs:
Client moves out of state
Client requests case closure
Client dies
Client turns age 19
3. Closing Family Care Cases
Close adult clients when:
A child under age 18 no longer lives in the home
Income, status or other eligibility factors have changed and the client is determined no longer eligible
Client has not completed the review process
Client has not cooperated in establishing continued eligibility
Client is reported in non-cooperation status with Child Support Enforcement
Client requests case closure
Client moves out of state
Client dies
4. Closing 4 Month Extended Medical Cases
Close cases for 4 Month Extended Medicaid for the following reasons:
Client has moved out of state
Four month period has passed and client is no longer eligible under another Medicaid group
5. Closing 12 Month Extended Medical Cases
Close cases for a 12 Month Extended Medical coverage group for the following reasons:
Client moves out of state
Child in the household turns age 18
Close the client age 19 or over in the 7th month when the income at review is equal to or more than 185% FPL
When the 12 month period has passed and the client is no longer eligible under another Medicaid group, the case must be closed
6. Closing Pregnant Women Cases
The Pregnant Women case will close when any of the following occur:
Client moves out of state
Client requests case closure
Client dies
Client is determined no longer eligible
Client has not completed a renewal by the end of the 12 month postpartum period
7. Closing Pregnant By Choice Cases
The Pregnant By Choice case will close when any of the following occur:
Client does not complete review
Client requests case closure
Client turns age 45
Client moves out of state
Client dies
Client determined no longer eligible
12-month period ends and client is no longer eligible
8. Closing Newborn Cases
Client moves out of state
Client dies
Client requests case closure
9. Eligibility Will Close On The First Day Of The Next Month When A 15-day Closure Notice Is Sent
Clients who do not receive a 15-day closure notice will receive an additional month of eligibility to allow time for notice
10. Some Cases Do Not Require A 15-day Closure Notice
Client moves out of state
Client dies
Client requests closure
11. Incarcerated Clients Will Have Benefits Suspended, Not Closed
Clients who are reported as incarcerated in a jail or prison will have their benefits suspended
Clients must still meet all eligibility criteria for their current coverage group
Clients must renew at the regular interval
Reference:
Defining Requirement: 42 CFR 431, Subpart E
42 CFR 435.912
42 CFR 435.919
Social Security Act § 19
Consolidated Appropriations Act of 2023
Clarifying Information:
Worker Responsibilities:
Closing Cases
1. Send 15-Day closure notice when adverse action has occurred.