November 2015

102-3 Report Changes
703-1 Length of the Certification Period
704 Eligibility Review
804 Changes

o     To address reportable changes with reviews. 

o     Stating that we will only take actions on reportable changes with reviews if the change occurred prior to 10 day notice of the review month. 

o     Clarify when actions are taken on reported changes at review.   Adding exceptions to the 12-Month Certification Period.


September 2015

412-1 Income for MAGI Methodology
412-4 Calculating Income for MAGI-Based Programs
Removed the inactive link to 412-2 in sections and added the correct links: 410-8 & 402-4


August 2015

215-3 When Unrelated Adults Live in the Home An unrelated adult can be included in a tax filer's household when the tax filer claims the unrelated adult as a tax dependent.


July 2015

410 Earned Income We are removing the reference to severance pay as a lump sum. We have determined that severance pay should be treated as wages/ terminated income. For MAGI, wages should be annualized over the certification period. For Non-MAGI programs, it would be budgeted as terminated income, and counted in the month it was received.
805 Case Closure

o      When a CHIP enrollee request’s UPP, CHIP will remain open through the end of their enrollment period unless the client provides proof of enrollment in their “Employer sponsored health insurance.”

o      Proper 10-day notice applies


May 2015

230-1- The MAGI Household

230-2 Tax Filer's MAGI Household

230-3 Non-Tax Filer's MAGI Household

o      Clarifying that children between the ages of 19-23 who are full-time students may be claimed by a parent on the parent's tax return, and therefore included in their parents' Medicaid household. The income of these dependent adult children is counted only if they are expected to be required to file taxes. These dependents may or may not qualify for a Medicaid category.

o      Adding some examples about household composition.

o      When parents do not expect to file taxes and their dependent child who meets the age criteria will file a tax return, we will use the non-tax-filer rules to determine the child's MAGI household. Count the parents' income, but the child's income will count only if he's expected to be required to file. (CMS clarification)

o      An older child or young adult who is living independently, not with parents, may apply on her own. Apply the MAGI Tax-filer or non-tax-filer rules based on the child's expected filing status. Count income of the child. Do not count the parents' income, even if the parents may claim the child as a dependent on their tax return.

o      Clarified what rules to follow when a child lives with more than 2 parents.

402-9 Income from Rental Property

o      Added additional language to policy to clarify rental income can be earned or unearned.

o      Added a link to refer to policy 410-2 for allowable expenses for rental property to determine the countable income.

701 Application
702 Re-Opening CHIP
704 Eligibility Review

701 & 704  

Clarifies that when TPL information was gathered as part of the failed review, they do not need to provide it again if the client completes the review within 3 months following the case closure.


701 & 702

Added a link to refer the worker to section 704 pertaining to the TPL requirements at review.

704 Eligibility Review

Added verbiage to clarify any changes at an ex parte review that moves an individual from CHIP to other medical program will require the regular review process.



April 2015

102-3 – Report Changes

703-1 - Certification Period

704 – Eligibility Review

804 – Changes

804-5 Income Changes

Section 102-3 (Report Changes)

o      Adding new policy defining what is a reportable change with Reviews. 


Section 703-1 (Length of the Certification Period)

o      Adding new exceptions to the 12 month Certification Period: 

·       A recipient fails to provide verification of access to affordable health insurance when requested with reviews.

o      Clarification when to establish a new 12 month certification period when completing a review on another program.

·       Client must request a re-determination and does not cause an adverse action.


Section 804 (Changes)

Clarified when and how to take actions on reported changes.

o      When clients report changes prior to 10-day notice in the review month and it is a reportable change:

·       Determine if client must provide verifications.

o      If verifications are not needed:

·       Stop the new certification period and re-determine eligibility for the new certification period.

o      If verifications are needed:

·       Stop the new certification period.

·        If the agency cannot give 10-day notice before re-determining eligibility for the new certification month, extend benefits to the following month. (due process) if needed.

o      If  the client returns verifications:

·       Make change effective the first month in which 10-day notice can be given.

o      When client report changes after 10-day notice in the review month.

·       Agency must determine if the change is a reportable change and if it will affect the new certification period.

·        If it is a reportable change, the agency will treat the report as a change report just as we do today.


Section 704

Access to affordable health insurance.

o      As access to affordable health insurance is not required to be verified with every ex parte review, we clarified when it might be the appropriate time in requesting it post review.

·       If access to affordable health insurance has not been previously verified.

·       If the Agency is questioning access to affordable health insurance.

o      Added content and a link to refer the worker to policy 804 to determine what actions to take for changes reported post review.


o      Added content and a link to clarify what actions to take when an income change is reported in response to the ex parte review notice as the process is different from an income changes during certification period. 

·       Refers client to section 804 to define “Taking actions on reported changes with ex parte reviews”.



March 2015

412-3 Whose Income Counts for MAGI Households

This section has been updated with the 2014 figures for:

o      Earnings of when an individual would be "expected to be required" to file taxes.

o      The income limit of when a tax filer can no longer claim a dependent, when the person is not a spouse or qualifying child of the tax filer.

Table I - Income Limits
Table I-A 5% FPL Deduction Amount



February 2015

220-4 Access to Employer Sponsored Health Insurance

703-1 Length of the Certification Period

704 Eligibility Review

MAGI-based programs are being added to the ex parte review process based on federal regulation requirements.  Non-MAGI-based programs started the ex parte review process in September 2014.  

Workers will complete an ex parte review by initially checking all available electronic resources to determine eligibility before involving the client.

·       If the client remains eligible, workers approve the review and notify the client.

o   TPL verification will be done post eligibility via the approval notice

o   The 116M for CHIP and PCN programs will be done post eligibility

o   UPP cases will not be reviewed as ex parte

·       If eligibility can’t be approved with electronic sources, a pre-populated review form will be sent to the client to complete.

Added new exception to CHIP policy explaining when an enrollee may lose eligibility before the end of the 12 month certification period.

Added clarification that a yearly accounting review needs to be completed for special needs and pooled trusts.  The yearly trust review should align with the yearly case review.  Reviews of other types of trusts should be completed when questionable.


Added that a signature is required for a review that involves client participation.

704 Eligibility Review

804 Changes

804-5 Income Changes

Removing all policy references to reviews completed in 2014 as they will no longer be applicable in 2015.


January 2015

402-9 Income From Rental Property
410-2 Self-employment Income
705-2 What is Acceptable Verification

Self-employed individuals no longer have to provide receipts to verify business expenses. They may provide ledgers if they do not have current tax forms or if the ledgers are more representative of anticipated expenses.  Tax forms can also be used if they are representative of anticipated expenses.  Receipts would be needed if the person does not keep other types of records of expenses.


The MAGI programs allow self-employed individuals to deduct such as expenses as SEP, SIMPLE and Qualified Plans.


The standard mileage rate was updated to 56 cents per mile.