Combination Cases 430-05-67-15-15

(Revised 08/01/07 ML3095)

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Combination Medicaid Cases

The worker must determine if a change reported for Medicaid results in an increase or decrease in food stamp benefits using the following procedures:

 

  1. Enter the verified changes on the benefit calculator or do a hand budget.
  2. If the changes result in an increase in benefits, the changes must be made to the case in TECS.

Exception:

In combination FS/MA cases when processing the cost of living adjustment changes in December of each year, if the recipient liability is being averaged, do not change the amount allowed as a medical expense deduction for food stamp purposes. The change is not acted on until recertification.

  1. If the changes results in a decrease in benefits, the changes are not acted on until the six month report or recertification, whichever occurs first, and benefits continue as previously authorized.  A copy of the benefit calculator or hand budget must be retained in the casefile.

Exception:

If the change meets the criteria to reduce benefits, the change must be acted on within 10 days from the date the change was reported and a 10 day advance notice must be sent.  If the change is reported in writing and signed by the household, a 10 day advance notice is not required.  Adequate notice is required.

 

Examples:

  1. In a combination FS/MA case if the entire recipient liability is being allowed as a medical expense deduction and it changes as a result of a change in income reported by the household, change the amount of income being used and allow the new recipient liability if it results in an increase in benefits.  

If the change in income reported by the household and resulting change in recipient liability results in a decrease in benefits, the change is not acted on until the six month report or recertification, whichever occurs first.

 

If MA closes for RL not being met, and this results in a decrease in benefits, do not remove the RL amount until recertification.    

  1. Ongoing FS/MA case.  Client requests the employer fax verification of base month income to the worker.  The income must be used to determine eligibility and level of benefits.    As the verification was provided by the primary source of the information (the employer), the worker must act on the change regardless of whether it results in an increase or decrease in benefits.
  2. Ongoing FS/MA case.  Client is paid weekly and provides four of the five pay stubs from the base month.  The fifth pay stub is not required by Medicaid.  The worker must use the four pay stubs to convert the income.  If the change results in an increase in benefits, the change must be acted on.  

If the change results in a decrease in benefits, the change is not acted on and the benefits stays the same.  

  1. Ongoing FS/MA case.  Client resides in a group home and each month the case manager provides a listing of earnings for individuals in the group home to the county office.  If the change results in an increase in benefits, the change must be acted on.

If the group home is also the employer (primary source), the worker must act on the change regardless of whether it results in an increase or decrease in benefits.  

 

If the change results in a decrease in benefits and the group home is not the employer, the change is not acted on and the benefit stays the same.

  1. Ongoing  FS/MA case.  Household provides base month and all of the processing month pay stubs. The processing month pay stubs must be used to determine the effect on the benefit, as it is the most current information.
  2. Ongoing FS/MA case.  Household provides pay stubs for Medicaid.  Actual income on the pay stubs is not over the gross income limit.  Worker converts the income as the individual is paid biweekly which results in the converted income exceeding the gross income limit.  

If the household is eligible for a benefit, no change is made, as it would result in a decrease in benefit.  The worker must send the F741 to the household.   

 

If the household is not eligible for a benefit, the worker must send the F419 to determine if the income will continue.

 

If the household responds and indicates the income will continue or the household does not respond, the case must be closed for excess income.  

 

If the household responds and states they do not know if the income will continue to exceed the gross income limit for the household size, the case must be closed.  If the household verifies by the last working day of the processing month that gross income is below the gross income limit for the household size, the worker must revert the case to open and determine eligibility and level of benefits based on the newly verified income.

 

If the household responds and states they do not expect the income to continue, the household must provide verification other than client statement that their income will not continue to exceed the gross income limit for their household size.  If the household does not provide the verification, the last reported converted income is used to close the case.

 

Combination Child Care Assistance Cases

For household that provide a completed day care billing form along with verification of earnings on a monthly basis for Child Care Assistance, the changes must be acted on to increase or decrease benefits as the child care billing form is signed by the primary source (child care provider).    

Examples:

  1. In a combination FS/CCAP case, the household submits wages stubs along with the child care billing form.  The change must be acted on as the child care billing form is signed by the primary source of the information.
  2. Ongoing FS/MA case applies and is approved for CCAP. If the change in income and child care expenses results in an increase or decrease in benefits, the change must be acted on.