9100 Household Responsibility to Report Changes

9100 Household Responsibility To Report Changes

Households receiving medical assistance are required to report changes. The specific reporting requirement is determined by the program and the circumstances of the household. The requirements for reporting changes are listed in this section.

9110 Household Responsibility Prior to Approval

Applicants must report all changes of circumstances prior to case approval. For changes which occur before the date of the notice of approval, change reporters must report within 10 calendar days from the date of the approval notice. The worker is responsible for requesting or otherwise obtaining other information or verifications necessary to determine the household's eligibility or benefit amount for any month.

This provision applies to both new applications and applications filed after a break in assistance of one or more months.

9120 Household Responsibility for Reporting Changes After Approval

Medical assistance households are required to report certain changes in circumstances. Section 9121 describes the 10 day change reporting requirement. All households are to be notified of the appropriate reporting requirements upon approval for benefits. Staff are to utilize the appropriate informational notice(s).

9121 Households Responsibility to Report Changes

Households are required to report certain changes in circumstances within 10-days of the date the change becomes known to the household. See subsection (2) below.  Households may report a change in their circumstances by telephone, in person, or in writing.  Changes which are not required to be reported need not be reported until the next review.

1. The following are the types of changes that are required to be reported for each category of assistance:
   1. All medical program recipients: 
      1. Change in the source of income (earned and unearned). 
      2. Change in the amount of income (earned and unearned). 
      3. Change in household composition, including marital status (marriage, separation or divorce).  
      4. Change in residence, including moving to or from an institution, hospital, or jail/prison.  
      5. Resources reach or exceed the applicable resource limit. 
      6. Entitlement to or termination of Medicare coverage.
      7. Change in any third party health insurance coverage. 
      8. Decrease in health insurance premium amount.
      9. Transfer of resources. 
      10. Loss of SSA disability status (Medically Needy only).   
   2. SSI program recipients:
      1. SSI payments begin or end.
      2. Change in residence, including moving to or from an institution, hospital, or jail/prison.
      3. Entitlement to or termination of Medicare coverage.
      4. Change in any third party health insurance coverage.
      5. Transfer of resources.
      6. Loss of SSA disability status. 
2. For purposes of this provision, the term "becomes known to the household" is defined as the following: 
   1. Change in the source or amount of earned income - Receipt of the first pay check.
   2. Change in the source or amount of unearned income - Receipt of first payment.  
   3. Change in household composition - Day the person enters or leaves the residence, day of marriage, separation, or divorce.
   4. Change in residence - Day of the move.  
   5. Resources reach or exceed to applicable limit - The last day of the month in which resources exceed the limit.
   6. Entitlement to or termination of Medicare coverage - The effective date of the change.  
   7. Change in any third party health insurance coverage - The effective date of the change.
   8. Decrease in health insurance premium amount - The effective date of the change.
   9. Transfer of resources - The effective date of the change.  
   10. Loss of SSA disability status - The effective date of the change.   

9121.1 Processing Changes Reported by Change Reporting Households

When the agency receives information that a change has occurred, the worker shall act on the changes within 10-days after the date the change is reported or becomes known to the Agency per 1323. The following actions are required:

1. Document in the case file the reported change, the date the change occurred, and the date the change was reported.  
2. Determine if verification or additional information is required (refer to 1322.1)
3. Contact the household to request needed information or verification as soon as possible.
4. Complete an Asset Verification Solution (AVS) request if the change involves a bank account that must be verified.
5. Changes are effective the month following the month of the change, given timely and adequate notice requirements. In addition, the following apply:
   1. Working Healthy - Changes which would increase the amount of countable income shall not be acted upon until the scheduled 6-months review or full review, see 2664.5(3).
   2. Medically Needy - For changes in income, use the converted or actual income amounts currently established through the month in which the change is reported, or following month to allow for timely and adequate notice. If income continues, establish a new converted monthly amount based on anticipated income beginning the month following the month the change is reported through the end of the base period. For changes involving assistance planning, including instances where one or more members of the plan lose categorical eligibility, the change is effective the month following the month the change is reported. If this results in an increased spenddown, timely and adequate notice is required for budgeting the change. However, the new spenddown amount is effective immediately. When a met spenddown is increased, the spenddown status is protected through the end of the month, or following month, given timely and adequate notice requirements. If the change was not timely reported based on when it became known to the household, overstated eligibility may result.
   3. Patient Liability/Client Obligation/Recipient Obligation Changes - Changes are generally effective the month following the month of change; 8172.3, 8270.3, and 8340.
6. If an automated system action occurred on the case prior to a worker becoming aware of the change, the worker must evaluate the effect of the change to determine if any incorrect payment occurred as result. 

9121.2 Notices to Households Subject to Change Reporting

The agency must provide the household with a notice of action that meets the definition of timely and adequate notice, as defined in 1432, if the household's benefits are being reduced or terminated. If benefits are being increased, only adequate notice, as defined in 1432, is required.

9122

Reserved

9123 Failure to Report

If the agency discovers that the household has failed to report a change, as required in 9121, and as a result, received benefits to which it was not entitled, a claim shall be filed against the household. The household is entitled to a timely and adequate notice of adverse action if the household's benefits are reduced.

A household shall not be held liable for a claim because of a change in household circumstances which it is not required to report in accordance with 9121. Individuals shall not be disqualified for failing to report a change unless disqualified in accordance with fraud disqualification procedures.

9124 Whereabouts of Recipient Unknown

In instances when the agency does not know the whereabouts of a recipient, typically due to receiving returned mail with no forwarding address, the agency should attempt to confirm the consumers’ whereabouts through available methods of research, including (as best practice) contact with the consumer via phone.  If updated information is not located, coverage is discontinued for all non-pregnant adults on the case allowing adequate notice only. The Notice of Action is to be sent to the last known address. See 1432(6)).

The above does not apply if the application for review returns with no forwarding address. That is because assistance will terminate automatically for failure to return those forms.

Coverage shall not be terminated for persons eligible under the continuous eligibility provision (see KFMAM 2300). If the agency becomes aware that residency requirements of 2150 are no longer met coverage shall be terminated.

If at any time prior to the consumer’s next renewal (12-months review period) their whereabouts become known, eligibility must be reinstated.  This means that if a consumer contacts the agency after being discontinued due to whereabouts being unknown and they provide an updated in-state address, eligibility must be reinstated back to the date of discontinuance if the consumer is still within the original review period.  An exception to this policy exists when a consumer had a change in circumstance during that timeframe that would have caused loss of eligibility such as moving out of state (assuming it was not a temporary absence).  It is not required that staff clarify possible changes in circumstance prior to reinstating coverage.  

9125 Mass Changes in Social Security or SSI Benefits

Households are not responsible for reporting mass changes to Social Security or SSI benefits. The agency through use of BENDEX and SDX information, shall ascertain the amount of the increase in these benefits and shall reflect the changes no later than the second benefit issued after the month in which the change becomes effective. These changes are processed as a mass change each year in the preceding November and December effective for January. Any cases not updated in the mass process must be updated no later than the March benefit month.