Obsolete 0117 - What's New 2016

December 2016

101 Enrollee Rights
To comply with section 1557 of the Affordable Care Act, language was added about applicant/recipient rights to language services for people with limited English proficiency and, access to auxiliary aids and services to people with disabilities.


September 2016

202-1 U.S. Citizens
202-3 Verification of Alien Status
705-6 Verification of SSA Benefits
706-1 Sources of IEVS Data
Table IV - Proof of U.S. Citizenship and Identification
  • eFind is being replaced by eVerifs and the term 'eFind' is being replaced with 'electronic verification'.  

  • sCHIP is a new method of verifying citizenship, identity and SSN.  The term sCHIP has been added to Table IV.

402-4 Unearned Income Exclusions
  • Section changed to match Medicaid's 342-2 regarding the treatment of tribal income.  



August 2016

402-4 Unearned Income Exclusion WTE is now GA.



July 2016

102-3 Report Changes
202 Citizenship and Alien Status
202-2 Qualified Aliens
202-2.1 Lawfully Present Children
211-3 Who Does Not Have to Provide a Social Security Number

o     We are adding a new section 202-2.1 identifying categories which those newly eligible children must fall into to qualify for Medicaid or CHIP.

o     We are adding "change in alien status" to 102-3 as a reportable change.  

o     Once these children getting Medicaid meet the qualified alien and/or have met the 5 year bar, the CHIP enhanced rate will end and the State will receive the normal Medicaid Federal rate.


402-4 Unearned Income Exclusions

o     ABLE accounts are savings accounts for disabled individuals.

o     These are exempt assets.

o     Any distributions from the account for qualified disability expenses are not countable as income.  Qualified disability expenses are expenses related to the eligible individual’s blindness or disability, which are made for the benefit of the eligible individual.

o     An individual whose SSI is in suspended status due to an ABLE account with a balance greater than $100,000 is considered an SSI recipient when determining Medicaid eligibility.

o      The state is treated as a creditor of the ABLE account, and may file a claim to recover funds to the extent of prior Medicaid assistance expended on behalf of the beneficiary.


June 2016

102-1 Completion of an Application

220 Health Insurance

220-2 Coverage under a health insurance plan

220-8 Termination of Health Insurance Coverage

220-9 Coordination with the Federally Facilitated Marketplace (FFM)

701 Application

701-1 Date of Application

701-2 Effective date of Certification

701-3 What to do with an application

703 Certification Period

804-3 Added Eligible Children to Open CHIP Cases

Policies were updated to create a seamless transition from the Federally Facilitated Marketplace (FFM) to Medicaid or CUP programs. 

The following changes were made:

The FFM application transfer process was better defined.

How a new person can be added to a current Medicaid, PCN, CHIP or UPP program.

An exemption to the 180-day sanction period for PCN was added for individuals transferring from the FFM.

An exemption to the 90-day sanction period for CHIP and UPP was added for individuals transferring from the FFM.

Added effective date policy for individuals transferring from the FFM to CUP programs.


May 2016

410-8 Earned Income Exclusion Deducting health insurance premiums at review was causing household members to move back and forth between Medicaid and UPP. Only allow the employer sponsored health insurance premiums as an allowable deduction for individuals not receiving UPP benefits.  This includes reviews, applications and re-determinations.



March 2016


702 Re-Opening CHIP Updated the language to state if a case was closed for failure to pay the CHIP premiums we will not require the client to pay any premiums if it's been 3 months since closure.
Table I Income Limits
Table IA 5% Federal Poverty Level Deduction Amount
poverty updates


February 2016

Table V - Telephone Numbers

o     Added Marcel Larsen Jones as the Nursing Home and Waiver Medicaid Programs Policy Specialist.

o     Added Gayle M. Six as the UPP & PCN Program Manager.

o      Added Baby Your Baby and Hospital Presumptive Eligibility with Tiffany Cruz as the program specialist.