MEDICAL SUPPORT

CS 484P Gather and Disseminate Medical Insurance Information

01/90 Revised 06/29/18 Training Completed 07/13/18

45 CFR 303.30, 303.31; R527-010 and R527-201-9(9); 42 U.S.C. 652(f)

 

 

Statutory Authority

 

Federal regulations found at 45 CFR 303.30 state:

“(a)  If the IV-A or IV-E agency does not provide the information specified in this paragraph to the Medicaid agency and if the information is available or can be obtained in a IV-D case for which an assignment as defined under Sec. 301.1 of this chapter is in effect, the IV-D agency shall obtain the following information on the case:

    (1)  Title IV-A case number, Title IV-E foster care case number, Medicaid number or the individual's social security number;

    (2) Name of noncustodial parent;
    (3) Social security number of noncustodial parent;
    (4) Name and social security number of child(ren);
    (5) Home address of noncustodial parent;
    (6) Name and address of noncustodial parent's place of employment;
    (7) Whether the noncustodial parent has a health insurance policy and, if so, the policy name(s) and number(s) and name(s) of person(s) covered.
    (b) The IV-D agency shall provide the information obtained under paragraph (a) of this section to the Medicaid agency in a timely manner by the most efficient and cost-effective means available, using manual or automated systems.”

 

In addition 45 CFR 303.31 requires CSS to:

 

1.                   Petition the court to include private health insurance that is accessible to the child(ren) and the parent providing the medical support and is reasonable in cost;

“1) Petition the court or administrativeauthority 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;”

 

2.                   Communicate with the Medicaid agency to determine lapses in medical insurance coverage on all Medicaid recipients; and,

“(b)(5) Periodically communicate with the Medicaid agency to determine if there have been lapses in health insurance coverage for Medicaid applicants and recipients.”

 

 

Sources for Insurance Information

 

You may use any of the sources listed below to obtain the necessary medical insurance information.

 

1.                   Insurance information listed in the Application for Child Support Services Packet form.

 

2.                   The case file:  Check:

a.                   Content Manager for:

i.                     An old Financial Statement for Review/ Adjustment, Section 2: Medical Insurance section; and,

ii.                   Letters from the CP or NCP or others.

b.                  ORSIS narratives; etc.

 

3.                   The employer, union, and/or insurance company.  Call or send the Employer Request form.

 

4.                   The Bureau of Medical Collections (BMC). 

 

5.                   The CP:  Call or contact the CP for insurance information.

 

6.                   The NCP:  Call or contact the NCP for insurance information. 

 

 

State Child’s Health Insurance Program (CHIP)

 

The State Child’s Health Insurance Program (CHIP) is an alternative health insurance program administered by the Department of Health (DOH).  The CHIP program provides health insurance coverage to previously uninsured, low-income children who do not qualify for Medicaid, and have no other insurance available. The CHIP program is not a Medicaid program, and ends as soon as the child becomes Medicaid eligible or is covered by a commercial insurance policy. 

 

 

Providing Insurance Information to the Custodial Parent

 

CSS must disseminate the gathered insurance information to the appropriate CP or other state on an incoming intergovernmental case per federal regulations found at 45 CFR 303.30.  After insurance information is added to the appropriate medical screens, ORSIS automatically generates one of the following letters to the appropriate CP per case, per day, per insurance company:

 

1.                   Insurance Notification to the Non-IV-A Obligee.

 

2.                   Insurance Notification on an Incoming Interstate Case.

 

ORSIS does not generate an insurance notification letter to a IV-A or Non-IV-A Medicaid CP.  Each month the IV-A or Non-IV-A Medicaid CP receives a new Medicaid Card.  The card lists the most current medical insurance information and all of the participants covered. 

 

IV-A or Non-IV-A Medicaid CP’s receive a plastic Medicaid Member Card from the Medicaid agency.  In addition to the card, IV-A or Non-IV-A Medicaid CP’s will receive a Benefit Letter in the mail.  The letter has eligibility and plan information.  When there are changes, the Medicaid agency will send a new Benefit Letter.  

 

 

Insurance Lapse Notification

 

Federal regulations found at 45 CFR 303.30 and 303.31 require CSS to identify lapses in medical insurance coverage, periodically communicate all lapses in medical insurance coverage on IV-A and Non-IV-A Medicaid CPs to the Medicaid agency, and request employers and other groups offering medical insurance coverage to notify CSS of any lapses in coverage.

 

1.                   Non-custodial Parent Notification:  A NCP who owes past-due support and meets the notice criteria will receive the “Annual Notice of Past-Due Child Support” annually.  A NCP who does not owe past-due support will receive the “Initial Contact Notice” at the time the case is opened.  These forms instruct the NCP to notify CSS of any changes in the child(ren)s medical insurance coverage.

 

2.                   Custodial Parent Notification:  The CP receives the insurance notification letter each time CSS adds insurance information to the medical screens.  This letter also requests that the CP keep CSS advised of any lapses in insurance coverage.  This information is also included in the “Notice of Services” that all IV-A and Non-IV-A applicants receive at the time they apply for IV-A assistance or CSS services.

 

3.                   Medicaid Agency:  ORSIS electronically transfers insurance information to the Medicaid agency when BMC verifies insurance information and updates the medical screens on ORSIS.

 

4.                   Employer Notification:  The Employer Request letter and National Medical Support Notice notifies employers and other groups offering medical insurance to advise CSS of any lapses in coverage.

 

In accordance with R527-201-9(9), employers are required to notify CSS when the obligated parents terminates employment.

“In accordance with Subsection 62A-11-406(9), the employer shall promptly notify ORS\CSS when the obligated parent’s employment is terminated.”