Iowa Admin. Code r. 441-76.15 - Report of changes
As a condition of enrollment and continued enrollment for medical assistance, applicants and members shall report changes in circumstances as required in this rule.
(1)
Report of changes for eligibility
prior to January 1, 2014.
a. In
coverage groups for which Medicaid eligibility is determined using the family
medical assistance program (FMAP) income and resource policies, members shall
report changes as follows:
(1) At the annual
review or upon the addition of an individual to the eligible group, members
shall report any change in the following:
1.
Income from all sources, including any change in care expenses.
2. Resources.
3. Members of the household.
4. School attendance.
5. A stepparent's recovery from an
incapacity.
6. Mailing or living
address.
7. Payment of child
support.
8. Receipt of a social
security number.
9. Payment for
child support, alimony, or dependents as defined in 441-paragraph
75.57(8)"b. "
10.
Health insurance premiums or coverage.
(2) Applicants and members shall report any
change in the following within ten calendar days of the change:
1. Members of the household.
2. Mailing or living address.
3. Sources of income.
4. Health insurance premiums or
coverage.
(3) Members
described at 441-subrule 75.1(35) shall also report any change in income from
any source and any change in care expenses within ten calendar days of the
change.
b. In coverage
groups for which Medicaid eligibility is determined using income and resource
policies related to the supplemental security income (SSI ) program, members
shall report any change in the following to the department within ten calendar
days of the change. EXCEPTION: Persons actually receiving SSI benefits are
exempted from these reporting requirements unless the persons have a trust or
are applying for or are receiving home- and community-based waiver services.
(1) Income from all sources.
(2) Resources.
(3) Members of the household.
(4) Recovery from disability.
(5) Mailing or living address.
(6) Health insurance premiums or
coverage.
(7) Medicare premiums or
coverage.
(8) Receipt of social
security number.
(9) Gross income
of the community spouse or of the dependent children, parents or siblings of
the institutionalized or community spouse living with a community spouse when a
diversion is made to the community spouse or family. (See definitions in rule
441-75.25 (249A).)
(10) Income and resources
of parents and spouses when income and resources are used in determining
Medicaid eligibility, client participation or spenddown.
(11) Residence in a medical institution for
other than respite care for more than 15 days for home-and community-based
waiver services recipients.
c. Individuals in the breast and cervical
cancer coverage group are required to report when health insurance coverage
begins, or when their living or mailing address changes, within ten calendar
days.
(2)
Report
of changes for eligibility on or after January 1, 2014. A change in
circumstance that may affect the eligibility of applicants and members must be
reported within ten days of the date the change occurred. Changes required to
be reported are described in this subrule.
a.
In coverage groups for which Medicaid eligibility is determined using the
modified adjusted gross income methodology, any change in the following must be
reported:
(1) Income from all
sources.
(2) Members of the
household.
(3) School
attendance.
(4) Mailing or living
address.
(5) Receipt of a social
security number.
(6) Health
insurance premiums or coverage.
(7)
Alien or citizenship status.
b. In coverage groups for which Medicaid
eligibility is not determined using the modified adjusted gross income
methodology, any change in the following must be reported. EXCEPTION: Persons
actually receiving SSI benefits are exempted from these reporting requirements
unless the persons have a trust or are applying for or are receiving home- and
community-based waiver services.
(1) Income
from all sources.
(2)
Resources.
(3) Members of the
household.
(4) Recovery from
disability.
(5) Mailing or living
address.
(6) Health insurance
premiums or coverage.
(7) Medicare
premiums or coverage.
(8) Receipt
of social security number.
(9)
Gross income of the community spouse or of the dependent children, parents, or
siblings of the institutionalized or community spouse who are living with a
community spouse when a diversion is made to the community spouse or family.
(See definitions in rule
441-75.25 (249A).)
(10) Income and resources
of parents and spouses when income and resources are used in determining
Medicaid eligibility, client participation or spenddown.
(11) Residence in a medical institution for
other than respite care for more than 15 days for home-and community-based
waiver services recipients.
c. Individuals in the breast and cervical
cancer coverage group are required to report changes in their health insurance
coverage and changes in their living or mailing address.
d. Individuals receiving Medicaid based on
the receipt of Title IV-E-funded foster care or based on an adoption assistance
agreement are required to report changes in health insurance coverage, when
their living or mailing address changes, receipt of a social security number,
and termination of the adoption assistance agreement.
e. Individuals receiving state-only funded
Medicaid are required to report any change in the following:
(1) Income from all sources.
(2) Mailing or living address.
(3) Receipt of a social security
number.
(4) Health insurance
coverage.
(5) Alien or citizenship
status.
(3)
Failure to report. When a change is not reported as required
by this rule, any Medicaid expenditures for care or services provided when the
member was not eligible shall be considered an overpayment and subject to
recovery from the member .
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.