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Status Not under consideration
Categories Universal Access
Created by Guest
Created on Mar 16, 2020

RELATED IDEAS

Universal Access OOTB - Adding a HH member requesting health coverage feature as a COC vs an application

PMR: WH00010026
https://ibmwatsonhealth.force.com/mysupport/s/case/5001U00000MfHWJQA3/universal-access-ootb-adding-a-hh-member-requesting-health-coverage-feature-as-a-coc-vs-an-application

Adding a household member as part of CoC from the OOTB Universal does not create an application. As per the Federal regs below and the federal template, it needs to be treated as an application.

435.4 Definitions and use of terms.

Applicant means an individual who is seeking an eligibility determination for himself or herself through an application submission or a transfer from another agency or insurance affordability program.

Non-applicant means an individual who is not seeking an eligibility determination for himself or herself and is included in an applicant's or beneficiary's household to determine eligibility for such applicant or beneficiary.



435.906 Opportunity to apply.

The agency must afford an individual wishing to do so the opportunity to apply for Medicaid without delay.



435.916 Periodic renewal of Medicaid eligibility.

(c) Procedures for reporting changes.

The agency must have procedures designed to ensure that beneficiaries make timely and accurate reports of any change in circumstances that may affect their eligibility

and that such changes may be reported through any of the modes for submission of applications described in §435.907(a) of this part.

Please note on this one it states regarding their eligibility which applies to beneficiaries



(1) Prior to making a determination of ineligibility, the agency must consider all bases of eligibility, consistent with §435.911 of this part.

(2) For individuals determined ineligible for Medicaid, the agency must determine potential eligibility for other insurance affordability programs and comply with the procedures set forth in §435.1200(e) of this part.

The “Federal” template for the pre-populated renewal form supports that it is an application – See copy below.

Attachment A : People “applying” - It ask about citizenship, etc…

https://www.medicaid.gov/state-resource-center/mac-learning-collaboratives/downloads/medicaid-renewal-form.pdf

Customer Name North Carolina - Dept of Health and Human Services
  • Attach files
  • Guest
    Reply
    |     Jul 6, 2020

    Hi Michelle,

    We have previously requested more clarifying information. Because the additional information was not provided within 30 days, this request has been closed.

    Thank you for your interest in the Cúram SPM product.
    Shane McFadden, Cúram SPM Product Management team

  • Guest
    Reply
    |     May 22, 2020

    Hi Michelle,

    In order to evaluate your request, we require that you provide more details so that we can fully understand your requirements.

    The CoC [Add a Household Member] can be used in order to include that household member (i.e. a non-applicant based on the above description) in the citizen’s household to determine that eligibility based on that household composition.

    Can more information be provided on the circumstances that this RFE would cover i.e. why a household member would not be included in the household composition and why an option of ‘individual applying on behalf of someone else’ does not suffice?

    Is the expectation that the household member would also have an individual determination of eligibility?

    The Medicaid Renewal form seems to include questions related to Traditional Medicaid (re. whether the person is blind or terminally ill, or in long term care) - would this RFE need to be considered for Income Support and HCR (given the OOTB CoC refers to HCR only)?

    If we do not receive this information within 30 days, this request will be closed.

    Thank you,
    Shane McFadden, Cúram SPM Product Management team

  • Guest
    Reply
    |     Mar 16, 2020

    Hi Michelle,

    Thank you for your enhancement request.
    We require some further analysis to determine whether or not this enhancement can be considered in a future release.
    I will provide another response when our investigation is complete.

    Thank you,
    Shane McFadden, Cúram SPM Product Management team

  • Guest
    Reply
    |     Mar 16, 2020

    Attachment (Description): Supporting Documentation

    RFE Add HH Memb...
    RFE Add HH Member as New Application.pdf
    Open full size
    RFE Add HH Member as New Application.pdf