143 ACTIONS ON CHANGES (MAM)

____________________________________________________________

All reported actions must be acted upon within 10 business days of the date the change is reported. Actions on changes vary depending upon the type of medical assistance (MA) received: Modified Adjusted Gross Income (MAGI) MA or non-MAGI MA.

MAGI Medical Assistance

Because verification requirements differ for MAGI MA, when a change is reported during the eligibility period, do the following:

. record the reported change and the date.

. If a change is reported in residency, household composition, tax filing status, pregnancy, caretaker relative status, or application for other benefits, consider the reported information as verified and after entering the change, no further action is necessary.

. if a change is reported in earned income, do the following:

- if the earned income that is reported by the recipient is within 10% of the verified amount currently associated with the case, or the difference in income exceeds 10% but the difference will not affect eligibility in any way, consider the reported information verified. Enter the change and require no further proof.

- if the earned income exceeds the 10% threshold and will affect eligibility, follow the steps below for when a change is reported in earned income for Non-MAGI MA.

. for all other types of changes that have occurred, notify the individual of any needed verification because of the reported change using New HEIGHTS-generated AE0055, Proof Needed to Determine Your Assistance. If New HEIGHTS is unavailable, use paper backup DFA Form 808, Proof Needed to Determine Your Assistance. Allow the individual 10 calendar days from the date the change occurs to provide any needed proof of the change. Exception: If a change is reported in unearned income, only request verification if the unearned exceeds the 10% threshold and eligibility will be effected.

Non-MAGI Medical Assistance

When a change is reported in earned income, do the following:

. first attempt collateral contact. If collateral contact is successful, consider the reported information as verified and no further action is necessary.

. if collateral contact is unsuccessful, verify the reported change by using:

- information provided by the client, if the change is expected to decrease benefits. See PART 147, CHANGES THAT DECREASE BENEFITS; or

- standard verification procedures, if the change is expected to increase benefits. See PART 145, CHANGES THAT INCREASE BENEFITS.

For other reported changes that have occurred associated with a non-MAGI MA case, take all of the following actions:

. Record the reported change and the date.

. Notify the individual of any needed verification because of the reported change, using New HEIGHTS-generated AE0055, Proof Needed to Determine Your Assistance. If New HEIGHTS is unavailable, use paper backup DFA Form 808, Proof Needed to Determine Your Assistance.

. Allow the individual 10 calendar days from the date the change occurs to provide verification of the change.

. Determine the effect of the change on the individual's eligibility and medical assistance benefits.

Exception: Schedule a redetermination appointment prior to the change if policy requires that assistance be terminated in the month in which the change takes place.

All Types of Assistance

For other reported changes that are expected to occur, take all of the following actions:

. Record the reported change and the date the change is expected to occur.

. Within 10 working days of the date the change was expected to occur, contact the individual to request verification of the change, if needed.

References: He-W 606.01, He-W 606.100, He-W 636.01(b), He-W 644.01(c), He-W 684.01(a)(5), He-W 842.02, RSA 167:4-a, RSA 167:17, 42 CFR 435.945, 42 CFR 435.952, 42 CFR 435.956, 45 CFR 206.10(a)(9)