Citizenship & Identity
What is Yes? A citizenship if a requirement which needs verification at application.
_______ __________ is when an individual resides within the state of North Carolina and has an intent to remain.
What is State Residency
What does the acronym MAGI stand for?
We apply this methodology when calculating income for individuals applying for Family & Children's Medicaid.
What is MAGI Budgeting
True/False
Benefits are not issued without an application.
True- person must apply for benefits.
Enumeration is needed for a child by the age of ______.
Would this be an application requirement or a post eligibility requirement?
What is One?
It is not a requirement for a baby at application however it is needed by the age of 1 which makes it a post eligibility requirement.
If yes, what should we do next?
What is Yes we can the application and we should transfer to the client' s county of residence within 24 hours....after 48 hours we must process the application then transfer the case.
Household size is determined by the principles of _____ _________ , ________ and ______- _______ rules.
There are two types of classifications for Family & Children's Medicaid, what are they?
And Define each classification.
Categorically Needy & Medically Needy
Categorically Needy, when an a/b income meets or below the FPL income limit based on their HH size and age... we have to evaluate under the medically needy classification once a/b has exceeded the income limits under categorically needy to see if they can meet a deductible....
How many days does the caseworker have to process an application for Family & Children's Medicaid?
What is 45 days
What is the preferred method to verify Citizenship & Identity?
Please specify.
What is SOLQIC for Citizenship -looking for the SSN Verification Code of A
SOLQIS for Identity tooking for the SSN Verification Code of V
Name a type of verification for state residency.
Residency verification type list from policy: anything from this list
Driver's License, ID, Utility Bill , Voter Registration, DMV, Tax Records, etc.....
Name a tool which is very helpful in helping determine the Household Composition. ( Who is included in whose household?)
What is the MAGI Household Composition Chart
If an a/b is eligible for MXP (Medicaid Expansion) we must first evaluate for all ___________, including __________ ___________.
We must evaluate the client for all programs and see if they can meet a deductible, if they can meet a deductible, they could potentially receive under MAF-M , in the meantime we authorize the MXP application if they meet criteria for the program
Where in NC FAST does the caseworker key and submit an application?
If applicable following person registration, from the person page application tab- reach for star for New MaGI application.... Insurance Affordabilty Application to case
Define Reasoanable Opportunity Period (ROP). How long does this period last? What can the individual receive during this period?
Can this period be extended ? If so, How Long? and what are the reasons for extending the ROP
90 day time frame- plus the 5 days for mailing so 95 days for immigrants to try to obtain their citizenship documentation, if all is remaining of eligibility requirements is their citizenship status during this period they can receive Full Medicaid, there is no limit to the amount of ROP's that can be given. If the client does not provide the verification by the end of the 90 day period/95 days, they may reapply after their Medicaid terminates and will be provided another ROP .... Yes the ROP can be extended for 6 months if the client states they are making a good faith effort, or need more time obtaining documentation /we need more time to gather details in trying to assist client with obtaining documents
An applicant/beneficiary must provide _____ form of verification to verify their state residency at application.
Does state residency have to be re-verified at recertification?
What is One
and no it does not have to be re-verified at application
When figuring out an applicant/beneficiary HH size, you have to remember 3 exceptions to the tax filing rules, what are the 3 exceptions?
What a/b claimed by someone other than a spouse/parent
Child under age 19 living with both parents who will NOT file jointly
Child under age 19 claimed by a non-custodial parent
How do we determine an individual's gross monthly income?
Define the base period at application.Name a countable type of earned/unearned Income. Name a Non-Countable type of Unearned Income.
How do we verify and calculate self employment?
When do we not use the "conversion method"?
By calculating wages verified through the hierarchy TWN, OVS, Agency Records, Employer STatement, Client Statement- use the conversion methods to get gross income based on pay frequency...weekly 4.3. biweekly 2.15. semi monthly 2, annually divide by 12, quarterly divide by 3
Wages/Self Employment, UIB, countable earned, SSA/RSDI Countable Unearned
SSI non countable unearned and child support non countable unearned
Requesting the most recent tax return or if unable to provide their tax return, ledger for their business records, etc. we can provide the DMA 5043 add up all the months and divide by 12 and any operation expenses w/receips divide by 12 and subtract the difference for the gross self employment income or if they provide the tax return divide the amount on Line 31 of schedule c by 12 or however many months they were in business and divide any operational expenses by 12 (remember receipts are still needed)
We do not convert income for Pregnant Women or for a/b requesting retro coverage- we use ActualIf additional information is needed, including items needed as a post-eligibility requirement this form is needed to send out to the client.
What is DHB 5097 Request for Information
Define Emergency Services.
Who can receive this benefit?
How long will this benefit last?
What forms are needed to determine eligibility for Emergency Services?
Only last/covers the span of the emergency - ending once the condition has been stabilized even if resulting in death
Requesting medical records from provider DHB 5133 Request for medical records, DHB 5135 Where we fill in the dates for Emergency/authorization- this is entered through the NC EMS Portal to submit electronically if the packet is too large to submit it can be mailed to Alliant.....there is an attachment feature within the portal to add multiple attachments.
The caseworker should attempt to verify state residency through using ________ ___________, _____ in NC FAST or existing local agency records, prior to asking the applicant to provide verification.
What is electronic sources, OVS
It is important to determine the Household composition _________ for each member, as this helps ensure the correct _______.
For pregnant women, the unborn child (ren) will be included only in the ______ __________ ________
What is separately, ensure the correct program.
pregnant woman household
Let's calculate a deductible...What is the deductible formula?
What is Excess Gross Income
Minus - Deductions (Work Indv. $90 if Two $180)
=$$
Minus- (Chart deduction based on HH size, ex. 242 for HH 1, ex. 317 etc...)
=$$
X by 6 or (3-1 if retro) CP
=Deductible $$
An application worker should not deny before the 45th day for what reason?
How many requests for information need to go out at application prior to denying for this reason?
What is failure to provide information.
2 DHB 5097's
12 days on the 13th day send out the second notice