CRITICAL AGE
A critical age review is completed on a child a/b when they turn 18 (TRUE OR FALSE)?
False, the review is not on the child, it is on the parent/caretaker (if applicable).
Julie (18) currently has MAFC. She lives with her parents but is her own tax filer/non dependent. At review she is now over income for MAFC due to a new job. Can she potentially get TMA?
No, TMA is only for parent/caretakers and potentially the parent/caretaker's child.
True - we CAN take statement of bank accounts without the account number if the client doesn't know or have the account number.
Where do you go to view someone's Prepaid Health Plan selection?
Person page, PHP-PCP/AMH tab.
When evaluating a pregnant woman, we should evaluate MAFM first before MPW?
We evaluate MPW first then MAFM
Jackson (5) was certified MICN 10/20 - 9/21, but since he turns 6 in June 2021, his CP was shortened to 6/21. We were counting $1,200/mo income for him with a HH size of 2. What should happen at this critical age review?
A] Run matches, process recert if reasonably compatible, give a new 12 month CP
B] Check agency records for any changes reported. If none, process review and give him a new 12 month CP
C] Check agency records for any changes reported. If none, process review and align him back to his original CP end date of 9/21
D] Since the income at last review keeps him MICN, narrate, and add medical continued elig evidence on the PDC to give him the remainder of his original CP and choose "within existing CP" as the reason.
D] Since the income at last review keeps him MICN, narrate, and add medical continued elig evidence on the PDC to give him the remainder of his original CP and choose "within existing CP" as the reason.
John and his wife Mary have MAFC as parent/caretakers for Patience (5). John now reports he gets unemployment of $275/wk. Mary now has a job working at Little Caesars earning $400/wk. Are John and Mary potentially eligible for TMA based on their earnings?
No, the unearned income alone makes them over income for MAFC. They cannot get TMA due to new/increased unearned income that alone puts them over for MAFC. They could get TMA if the UIB was under for MAFC and Mary's wages added to that make them over.
Per COVID-19 Admin Letter 06-20, if the client states they are a NC resident, we can automatically add "Written Declaration from Third Party" as our 2 residency verifications? True or False
False, we still must check agency/electronic records for residency verifications BEFORE using the admin letter.
You have a case for Pia (25) and her daughter Rachel (1). You are working on the review and when you submit the review, you notice in determinations NCF is giving Rachel a HH size of 3 instead of 2. There is no extra HH members on the case. What evidence should you look for/go to to correct her HH size?
Pregnancy evidence - make sure the due date is not still there. It should be ended.
What is the entity called that acts a "middle man" for the client when they have issues with the Enrollment Broker or PHP?
NC Ombudsman
Megan (5) was certified MICN 11/20 - 10/21, but since she turns 6 in July 2021, her CP was shortened to 7/21. We were counting $1150/mo income for her with a HH size of 3. What should happen at this critical age review?
A] Run matches, process recert if reasonably compatible, give a new 12 month CP
B] Check agency records for any changes reported. If none, process review and give her a new 12 month CP
C] Check agency records for any changes reported. If none, process review and align her back to his original CP end date of 10/21
D] Since the income at last review keeps her MICN, narrate, and add medical continued elig evidence on the PDC to give her the remainder of her original CP and choose "within existing CP" as the reason.
D] Since the income at last review keeps her MICN, narrate, and add medical continued elig evidence on the PDC to give her the remainder of her original CP and choose "within existing CP" as the reason.
Walt receives MAFC as a caretaker for his nephew Ben (11). Walt has had MAFC since 1/2020. Walt is up for recert and we find new employment at Wal-Mart with a start date of 6/15/20. Walt is over income now for MAFC. Walt did not report the change timely. When should Walt's potential TMA start?
Started job 6/15/20. Add 10 days for the client to have reported the change = 6/25/20. If we were to send a timely 8110 to term MAFC on 6/25, the change could not occur until 8/1/20. his TMA potentially starts 8/1/20.
Per COVID-19 Admin Letter 06-20, For MAFM, we can automatically take client statement of medical expenses as long as they give us the date of service, provider name, and amount of the expense
False, although we can take client statement for medical expenses, we must verify the bills have not been used for a deductible previously AND attempt at least one contact with the provider to verify the expense. At that point, we can take client statement if complete
If you have an ongoing and retro app dated 5/3/21 OVS and WORK# ran on those apps when they were keyed. You realize the client will need to meet a deductible so you admin deny the MAGI Retro and key a Traditional Retro. Does OVS and WORK # need to be ran on the Traditional App?
No, OVS carries across NCF. You do NOT need to re-run OVS as it was already ran for this evaluation.
False, we must complete an exparte by running matches and re-determining her eligibility for pregnancy MA
What are the 6 critical ages we may need to complete a redetermination at?
1, 6, 18, 19, 21, 26
A client turns in their TBR, They did not complete the wages section but signed the TBR. What should you do?
At a minimum circle the parts they need to correct and mail back to them. The TBR must be complete. It is recommended to call the client so they understand.
Pandemic Stimulus check and non-countable Pandemic Unemployment are not countable for 12 months from date of receipt.
After you complete a County Transfer in NCF, where should you go to verify the case transferred to the new County?
Either:
Benefit history and check the Admin County #
OR
Case details tab/Transfer History
When working a review, a child (17) that was reported previously to be a non-filer/tax dependent of their parent now has a job hit. Since they previously reported being a non-filer/tax dep, we do not need their income because their income will not count? True or false?
False, any situation that could change someone's tax filing status when they previously reported to be a non-filer must be followed up with to see if the change has affected their tax filing status.
Jacqueline (20) has FPP 1/21 - 12/21. She turns 21 in July 2021. Do we need to complete a critical age review on her in July 2021?
No, We do not shorten the CP of FPP for critical age.
Jennifer receives MAFC as a caretaker for her daughter Whisper (15). Jennifer has received MAFC since 1/2019.We were counting $300/mo Self-Employment for Jennifer based on her 2019 tax return. We receive her 2020 tax return and Jennifer is now over income for MAFC. The caseworker calls Jennifer who states "Because of the nature of my business, the income fluctuates yearly. There was not a single event that caused my income to increase". Does Jennifer potentially qualify for TMA?
No, Fluctuating SE income does not allow TMA eligibility. There would have to be a reason her earnings increased to be eligible for TMA.
The hospital submits an application for Gary. The hospital signs the application and does not provide an authorized rep form. The IMC calls Gary and he states he does want the hospital to be his authorized rep. Does the IMC need to send Gary an authorized rep form to sign?
No, not during the COVID-19 Admin Letters. Per Admin Letter 07-20, the client can authorize someone to be their A/R without a signed 5202C. We would complete the form by phone with Gary and file in the record.
No,
If someone was not marked as applying on a case and you know want them to be applying, you must key an application and merge the application into the existing IA.
For online applications (ePASS & FFM), when we deny, we automatically key a MCV app for the a/b's because the app does not show insurance. True or false?
FALSE, online apps do not show questions answered if left blank. Because we cannot see if the client answered NO or did not answer, we must follow up with the client to get an insurance attestation.