CASE MANAGEMENT

CS 059P-3 Non-IV-A Medicaid-only Applicant/Recipient Cooperation Requirements

10/87 Revised 03/29/18 Training Completed 04/27/18

45 CFR 303.31; R527-039; UCA 62A-11-304.2(1)(h) and 307.2, 63G-4-201(3)

 

 

Definitions

 

1.                   Non-IV-A Medicaid-only case – A case where the custodial parent (CP) is not receiving IV-A cash assistance but s/he and the child(ren) are receiving Medicaid.  In these cases, the CP is required to cooperate with the Office of Recovery Services/Child Support Services (ORS/CSS).

 

2.                   Non-IV-A Non-Medicaid case – A case where the CP is not receiving IV-A cash assistance or Medicaid, or only the child(ren) is receiving Medicaid.  In these cases, the CP is not required to cooperate with CSS. 

 

 

Non-IV-A Medicaid-only Applicant/Recipient Cooperation with CSS

 

A Non-IV-A Medicaid-only applicant/recipient of Medicaid for himself/herself along with a child(ren) must comply with the Office of Recovery Services/Child Support Services (ORS/CSS) cooperation requirements in establishing paternity on the child, if necessary, and in establishing a child and medical support order when there is not a current order for child and medical support

 

As long as the applicant/recipient is eligible for and receiving Medicaid along with the children, s/he must:

 

1.            Cooperate in good faith with CSS in obtaining and enforcing an order for medical support; and,

 

2.            Turn over to CSS any medical support paid by the obligor, unless CSS has determined that the applicant/recipient is not able to meet the cooperation requirements and is cooperating in good faith, or good cause or another exception has been determined by the Department of Workforce Services (DWS) or the Department of Health (DOH), the Medicaid agency in Utah.  

 

Examples of a Non-IV-A Medicaid-only Case:

 

·                     Mother and the child are on the LIFC (Low Income Families with Children) program.

·                     Mother is on the ABD (Aged, Blind and Disabled) program and the child is on newborn program.

 

Most medical programs also require the applicant/recipient to provide information about any possible third party insurance coverage by having the applicant/ recipient complete a Medicaid Application form or a Third Party and Insurance Information Form.  This information is sent to the ORS Bureau of Medical Collections (BMC) team who will attempt to offset Medicaid costs by billing third party insurance carriers who may be responsible for the medical expenses.  

 

 

Non-IV-A Non-Medicaid Cases

 

If the Non-IV-A applicant/recipient applies for Medicaid for a child(ren) only (i.e. s/he does not apply for Medicaid for herself/himself), there is no Federal requirement to meet the CSS cooperation requirements in establishing paternity and/or child and medical support orders.  If you receive a referral for a Non-IV-A Non-Medicaid applicant/recipient, you may assume s/he wants to cooperate.  If the applicant/recipient fails to cooperate with CSS in establishing paternity, if necessary, and/or in establishing a child and medical support order, you may close the case “CNC” (Client Not Cooperating).  Or, if the applicant/recipient requests that the case be closed, you may close the case “RNP” (request of the Non-IV-A applicant/ recipient or initiating state).     

 

Examples of a Non-IV-A Non-Medicaid Case

 

·                     Mother is the CP; she is not on Medicaid and the child is on the Child program.

·                     Mother is the CP; she is not on Medicaid and the child is on the CHIP  Children’s Health Insurance Program.

·                     Grandmother is the CP; she is not on Medicaid and the child is on LIFC (Low Income Family with Children) program.

 

 

Child Support Order – No Medical Order

 

Federal regulations found at 45 CFR 303.31(b) state:

“The State IV-D agency must:

(1) Petition the court or administrative authority to -

(i) Include health care coverage that is accessible to the child(ren), as defined by the State, and is available to the parent responsible for providing medical support and can be obtained for the child at reasonable cost, as defined under paragraph (a)(3) of this section, in new or modified court or administrative orders for support; and

(ii) Allocate the cost of coverage between the parents.

(2) If health care coverage described in paragraph (b)(1) of this section is not available at the time the order is entered or modified, petition to include cash medical support in new or modified orders until such time as health care coverage, that is accessible and reasonable in cost as defined under paragraph (a)(3) of this section, becomes available. In appropriate cases, as defined by the State, cash medical support may be sought in addition to health care coverage.

 

When the Non-IV-A applicant/recipient is on Medicaid along with the child(ren) and there is a child support order but not a medical support order, the Non-IV-A applicant/recipient must cooperate with CSS in establishing a medical support order that must also contain a cash medical support provision.   

 

If a medical support order was previously established, or once the medical support order is established, the Non-IV-A Medicaid only applicant/recipient may decline child support services.   This means that CSS will only enforce the medical support obligation, not the child support obligation.

 

 

Continuing Services

 

When the Non-IV-A Medicaid-only recipient goes off Medicaid, ORSIS will automatically generate the Continuing Services Notice to the recipient.  At this point, CSS will continue to provide medical-only services unless the recipient responds to the notice and requests full services (child support and medical support services), or requests the case be closed.  This means that once the CP closes off of Medicaid and the notice is generated, it does not matter what option(s) the CP selected in Section XI:  Request for Services on the Application for Services, the case must  remain open unless the CP requests case closure or until it meets one of the federal closure criteria.  CSS only provides medical-only services on a continuing services medical-only case.  CSS does not provide medical support only services on a new application for a Non-IV-A case. 

 

 

Cooperation Not Required with CSS 

 

If the applicant/recipient is on or applying to be on one of the medical programs listed below, s/he is not required to complete a Duty of Support referral or cooperate with CSS in establishing or enforcing a child or medical support order.  If you receive a referral on a CP that is on any of the programs listed below, you may assume that s/he wants to cooperate.  Work the case as you would any other Non-IV-A Non-Medicaid case.  If later the CP fails to cooperate, you may close the case “CNC” (Client Not Cooperating).  Do not initiate non-cooperation proceedings against the CP.    

 

1.                   Prenatal/Pregnant Woman.  A Medicaid program covering the mother from application to 60 days after the birth of the child.  DWS (Department of Workforce Services) eligibility workers will explain the advantages of working with CSS to establish paternity and an order for child and medical support once the child is born.

 

2.                   Postnatal/Children under 1.  A Medicaid program covering the child from birth to twelve months and the mother for 60 days after the birth. DWS eligibility workers will explain the advantages of working with CSS to establish paternity and an order for child and medical support. 

 

NOTE:  If after the 60 day post-partum period the mother is deemed eligible under another Medicaid program, a Duty of Support and cooperation with CSS is required. 

 

3.                   Transitional Family Medicaid/LIFC with 12 Month Transitional.  A Medicaid program that extends medical benefits for recipients whose IV-A cases were closed due to an increase in income, causing the recipient to go over the household income limit.  The recipient remains eligible for a Medicaid card for an allotted time depending on the reason the financial benefits were lost.  Open a Non-IV-A continuing services debt and continue to work the case unless the CP chooses not to cooperate.  Should that occur, close the Non-IV-A debt.

 

4.                   Transitional Family Medicaid/LIFC 4 Month.   Similar to LIFC with 12 Month Transitional above, a Medicaid program that extends medical benefits for recipients whose IV-A cases were closed due to an increase in child support income.  Open a Non-IV-A continuing services debt and continue to work the case unless the CP chooses not to cooperate.  Should that occur, close the Non-IV-A debt.

 

                NOTE: LIFC 4 Month and LIFC with 12 Month Transitional are the only State Family Medicaid (LIFC) programs that do NOT require cooperation with CSS.

 

5.                   Children’s Health Insurance Program (CHIP).  This is not a Medicaid program but an alternative health insurance program for those who do not qualify for Medicaid.  This program does not require a Duty of Support or cooperation with CSS, although a CHIP recipient may choose to open a Non-IV-A case. 

 

6.                   Refugee Medical Assistance.  This is a Medicaid program that is available to refugees for several months once they enter the U.S.  This program does not require a Duty of Support or cooperation with CSS.

 

NOTE:  Duty of Support is also not required for RF (Refugee Cash Assistance) programs.

 

 

Non-Cooperation Procedures

 

If the Non-IV-A Medicaid-only applicant/recipient does not meet cooperation requirements and/or you believe the applicant/recipient is not cooperating in good faith, notify DWS or the Medicaid agency of the non-cooperation determination.  The DWS or the Medicaid agency’s conciliation process includes a “Refusal to Cooperate Sanction” that will result in the removal of the applicant/recipient from the medical card.  The Medicaid-only applicant/recipient may request a non-UAPA review, request a UAPA review, or take the matter to court.

 

If the Non-IV-A Non-Medicaid applicant/recipient does not cooperate and you are unable to take the next step on the case, close the case “CNC” (client not cooperating).  Do not initiate non-cooperation procedures.