Eligibility Online Manual

M1404 Closure


Purpose: This section will provide information on termination (closure of cases).


Current Policy Effective Date: October 1, 2022

Date Last Reviewed: September 21, 2022

Previous Policy: September 1, 2017

POL M1404: CLOSING CASES

1. Closing Aged, Blind, Or Disabled Or Medicare Savings Programs Cases

Clients cases 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 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 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

    • Eligible child in the assistance unit 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 dies

    • Client is determined no longer eligible

    • Client has not completed and returned a renewal form within the 60 day 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 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

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 until they are released

Reference:

Defining Requirement: 42 CFR 431, Subpart E

42 CFR 435.912

42 CFR 435.919

Social Security Act § 19

Clarifying Information:

Worker Responsibilities:

Closing Cases

1. Send 15-Day closure notice when adverse action has occurred.