MEDICAID 101/PROGRAMS
A client calls and states they are receiving Medicare and Medicaid. What is this considered?
What is Dual Eligible?
WHEN DO WE EVALUATE FOR MAFM?
What is: the client is over-income or receiving MAFD and remains eligible for MAFD.
During exparte I find that a client is receiving Medicaid in Atlanta Georgia, because they are currently attending college there. True or False: The client is eligible to keep their Medicaid in NC along with the new insurance in Georgia.
What is False: Clients are not allowed to receive benefits in two different states
What two questions should I always ask when determining the HH size?
Are you a tax filer?
Will you be claimed as a tax dependent by someone else?
A client is up for recert in July of 2026. In what month should the exparte be completed?
What is May 2026
True or False: Medicaid is a federal entitlement program
What is False: Medicaid is a Federal and State program to assist families under the FPL
WHEN DO WE EVALUATE FOR ABD?
What is client is aged, blind, disabled or receiving Medicare.
I am starting an exparte on a client and the online data verified the client as V and B in the SOLQ's. However, FNS just ran save on the client the day before you worked on the case. True or False: I do not have to run save again to verify client's citizenship
False: SAVE needs to be ran at every recert if the client does not verify V and A
Mom (35) children (6) and (7) they all reside with Grandmother. Grandmother is a TF claiming both children. Mom is a Non-Filer. What is each persons HH Comp.
Grandmother-3
Mom-3
Both children- 3
After keying a recertification or a denied recert I must accept the hold either ______ or _______. Once I accept the hold it will generate this notice for eligibility _____.
What is adequate or timely.
What is an 8110 notice.
What programs are people 0-18 eligible for?
What is MICN/MIC1
When do we key MXP overlay?
What is the client receiving: MXP and Medicare
During my research I could not verify the client’s citizenship. I send out a 5097 requesting proof of citizenship. I can accept these documents as proof of citizenship?
What is:
Birth Certificate, Naturalization Card, Green Card, Alien Number
Uncle (45) employed, earning $1750/mo, nephew (20) earning survivors' benefits of $325, and niece (13) also receiving survivors' benefits of $325. Whose income will count for whom?
Every persons income will count for themselves.
Uncle- $1750
Nephew-$325
Niece-$325
You terminated a client on 6/30/2026. The client returned their information on 7/18/2026. True or False: The client is over the 90-day reopen period and will need to reapply
False: the clients 90 day period would be 9/28/2026
You receive a phone call from a client, and she asks about her 25-year-old benefits. Can we give her any information? Why or why not?
What is: No, the 25-year-old is now an adult-aged child, and an auth rep form must be completed.
What does the AU, BU and NU stand for?
What is:
Au-Assistance Unit
Bu-Budget Unit
Nu-Needs Unit
Name 2 post-eligibility items.
What is Child Support and TPI
During exparte I see that a client reported on an FNS application that they have self-employment. True or False: I can use the clients attestation for their self employment and continue to key the case.
During research I notice that a 20020 will need to be sent out to the client. I will also send out a 5097 with the 20020 requesting the client to sign, complete and return the 20020. How many days does the client have to return the requested information?
what is 30 days?
If a client is receiving Medicare, or if their child does not have comprehensive coverage, they are not eligible for which program?
What is MXP
What are the three requirements to be eligible for MAFM?
1. Parent/caretake of a child under 18
2. Pregnant any age
3. Aged 0-20
I am completing a recert on a client. Her husband is in the home with her, but he is not applying for benefits. When I ran the online data for both of them, his results came back as "insufficient data," meaning he has no SSN. True or False: I need to send him a 5097 requesting his SSN or proof of citizenship?
What is False? Since he is not applying we do not need to verify his C/I
I am completing an exparte for a December review. I see that the client has previous income at Walmart listed on the Insurance Affordability. I run the online data and I find that the client is still employed with Walmart as of Q2 2026 but also has a new hire hit for Sports Endeavors on 7/13/2026. What action should I take?
What is send a 20020/5097 requesting wages?
I am completing an exparte and I see at the previous recert there was a HH of 2 a mom and her son. The mother was previously employed at last recert and she was a tf claiming her son. At this recert during exparte you find that the son is now employed earning $5050 a year. Will a 20020 be sent out to the client? Why or why not?
What is: No client will change to TF and be placed on an individual case.