Forms/ Notices
This form allows the customer to validate the information we have/found using agency records/ electronics sources.
What is 20020?
When eligibility can be determined for the same or better program and there has not been any changes that effect eligibility; complete the _________ process.
What is exparte?
What date should the 8110T be sent in October for it to be sent by the system?
October 13th
This notice is sent to inform the customer of a positive/ neutral change in their benefits.
What is 8110A?
True or False
A beneficiary cannot move from MAFC to MXP unless we send the 20020/5097.
What items must be requested when quoting a deductible?
What is medical bills, resources, and income
What happens to a case when there's been no notice or recertification completed by pull check?
What is the case gets extended?
Customer (26) was receiving MXP from 10/1/2025 - 9/30/2026. Recert started 8/15/2026, and customer reports to you that she is pregnant with a due date of 4/12/2027. You see she has income of $1650/month. What program and what is her new cert period?
What is MPW? and What is 10/1/2026 - 4/30/2028?
What notices MUST be sent when pending a recertification for the first time?
What is 5097 and 20020?
An adult child over the age of 21, must be moved to their own case once ongoing benefits have been determined. This process is called _____?
You receive a case and the beneficiary is receiving IASCN. Who do we email to complete their ongoing recertification?
What is Cassie Desha?
True or False:
Current CP: 10/1/2025 - 9/30/2026
Recert started 8/3/2026. Doing research and worker realizes the customer will be eligible for the same program. A timely notice will be sent to inform of change of coverage starting 10/1/2026.
What is False?
If the recertification ends 10/31/2026. The 20020/5097 was sent timely quoting a deductible. What is the ongoing certification period quoted on the 5097 notice?
What is 11/1/2026-4/30/2027
Jennifer(50), spouse Sammy(52), daughter Faylen (23), and Jordan(17), are all up for recertification. You realize that you have to pend. What notice(s) are you going to send to Faylen?
What is 5097, 20020, 5202C?
True or False
Melanie (26) years old, Refugee is receiving MPW until 11/30/2026. Her baby was born 11/1/2025. Electronic sources were ran including SAVE. SAVE indicates Refugee status only. You send the 20020/5097 and it will expire 10/15/2026. She has not provided the 20020/5097 nor contacted the agency. Terminate for failure to provide (FTP).
What is False?
It is time for Ronnie's (65) recertification. He currently receives MAFDN “FPP”. He has no income. Which action must be taken?
What is approve MAFD/ FPP and Spin-off to AMED.
CP: 11/1/2025 - 10/31/2026
Recert started 9/22/2026. Worker realizes the customer will be over the income limit for all programs. Called and completed the 20020 information over the phone and customer will still be ineligible. When can the worker terminate the case?
What is 10/31/2026?
Client was approved for MAF-C on 8/1/2021.
True certification period is August to July.
COVID extensions were given to 3/2025.
The system completed STP recertification in 3/2025.
Client was authorized from 4/1/2025 to 3/31/2026.
03/2026 STP process failed, and manual intervention is needed.
Client is eligible for ongoing MXP. What is the ongoing certification period?
What is 4/2026-3/2027
True or False:
NC FAST automatically generates and sends the DHB-2187, Notice of Potential Change in Medicaid Eligibility, 180 calendar days (6 months) prior to the end of the certification (except for FPP).
What is True?
Recertification Straight Through Processing "STP" will "fall out"/stop and is incomplete when ___________.
a. The case has been modified by a caseworker.
b. There are outstanding issues on the Integrated Case.
c. There is a potential change in benefit.
d. All the above
What is D, All of the Above?
Naomi(34), her spouse Jordan (40) and their son Harlem (16) are receiving FPP/FPP/MIC-1.
Naomi works 30 hours and is paid $15.hr. Paid weekly.
Jordan is self-employed and earns $50K/year. What is the deductible amount?
What is $33,328.02
If working on a recertification in 10/2026, when must the 5097/20020 be sent if an 8110T has to be sent in order to terminate the case effective 11/30/2026?
What is 10/7/2026?
500. James applied and was approved for MXP starting 2/1/2025 - 1/31/2026. No recert was completed and the case got extended until 9/30/2026. Worker starts the recert 8/5/2026, and was able to approve the recert. What will the new cert period be?
What is 10/1/2026 - 1/31/2027?