Eligibility Online Manual

M1601 Determining Changes to be Reported


Purpose: This section will define what changes need to be reported and the resulting actions.


Current Policy Effective Date: September 1, 2018

Date Last Reviewed: July 9, 2018

Previous Policy: November 1, 2015

POL M1601: DETERMINING CHANGES TO BE REPORTED

1. Changes Must Be Reported Within Ten Days

Clients must report changes within ten days of identifying the change. They may do so by phone, in person, or in writing.

2. Clients May Be Required To Report Changes In Resources

All clients enrolled in programs with a resource test must report changes.

3. Clients May Be Required To Report Changes In Living Circumstances

Changes in the following must be reported:

    • Marital status.

    • School enrollment.

    • Household size.

    • Living arrangements.

    • Address.

    • Eligible child leaves household.

    • Eligible child turns 18.

4. Clients May Be Required To Report Changes In Earned Income

Changes in the following must be reported:

    • Source of income.

    • Beginning/Ending employment.

    • Rate of pay.

    • Increase/decrease in number of work hours.

5. Clients Must Report Changes In Unearned Income

Clients must report new sources of unearned income or changes to existing unearned income.

6. Clients Must Report Changes In Health Insurance Coverage

Clients must report new health insurance coverage or changes to existing health insurance coverage.

7. Clients May Report Uncovered Medical Expenses

Reporting uncovered medical expenses may change patient contribution.

8. Agency Must Act On Change Within Ten Days

The agency has ten days from the date of the client’s report to act on the change.

9. Agency Must Provide 15-Day Notice Of Adverse Action

The agency must provide a fifteen calendar day notice of adverse action. Adverse action is a decision to deny, decrease, or close benefits.

10. Agency Must Require An Application

Client must submit a new application after:

  • 60 days from denial or 90 days from closure for all programs.

Reference:

Defining Requirement: 42 CFR 435.916

Clarifying Information:

1. Children under age 19 have 12 months of continuous benefits and do not need to report changes in income until review.

Worker Responsibilities:

Issuing Notice of Adverse Action For Incomplete Information Received

1. If information received is incomplete, request missing information or information required for verification.

1A. Issue a notice to request missing or required information and/or verification.

2. If requested, assist the client in obtaining information/verification.

Re-determining Eligibility

1. Receive reported change.

2. Document the date of the re-determination in the case record in all instances recording the information and method used to arrive at the best estimate.

3. Review case to determine if changes reported affect eligibility.

4. If eligibility is not affected, no further action is required. If the change increases the benefits, send an approval notice for the new program.

5. If determined no longer eligible, close case and send 15-Day Notice.

5A. Close case the first of the following month when a closure notice can be provided at least fifteen days prior to the end of the month.

5B. Close case the month after next if notice cannot be provided at least fifteen days prior to the end of the month.

Closing For Ineligibility, Non-Response, Or Missing Information/Verification

1. Close benefits the first day of the following month when a closure notice can be provided at least fifteen days prior to the end of the month.

2. If notice cannot be provided at least fifteen days prior to the end of the month, close benefits the month after next.

3. Issue a Notice of Adverse Action.

Receiving Information/Verification After Closure Or Denial

1. If information/verification is received more than 60 days from denial or 90 days from closure, require completion of a new application. See Section M401.

1A. Refer to program policies to determine eligibility.

2. If information/verification is received within 60-days from denial or 90 days from closure, accept the information/verification and process without requiring a new application.

2A. Refer to program policies to determine eligibility.

3. If eligible, reopen the case and authorize benefits in the first month of eligibility.

4. If ineligible, issue a notice of adverse action.