147 CHANGES THAT DECREASE BENEFITS SR 13-35, 10/13 (MAM-A)

When an individual reports a change in earned income that will reduce or terminate medical assistance benefits:

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

• if collateral contact is unsuccessful, verify the change using the information that the client provided. No additional paper verification is needed.

Exception: Standard verification procedures must be used for:

• changes in earned income discovered through the New Hire Match. Attempt collateral contact first but if it is unsuccessful, send DFA Form 756, Employment Verification, to the employer, and allow 10 days for the required verification; or

• insufficient or questionable client information which does not allow the FSS to verify the change based upon the client’s statement.

For all other changes that will reduce or terminate medical assistance benefits, take action as follows:

• Determine whether the change will decrease or terminate medical assistance benefits within 10 working days after the individual reports the change.

• Terminations are effective the last day of the ANP. Decreases in level of eligibility are effective the day after the ANP expires.

• If verification is not provided when the individual reports the change and you cannot determine if the result will be a decrease or termination, allow the individual 10 calendar days to provide verification of the change.

If verification is not provided within the time frames, terminate the case.

Process a claim if an overpayment or overissuance occurs.