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CAF SSP Medical Program Renewal Process Overview

CAF SSP Medical Program Renewal Process Overview. CAF SSP Medical Program Clients. CAF SSP medical program clients have cases in OHA, CAF SSP offices and SPD/AAA offices

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CAF SSP Medical Program Renewal Process Overview

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  1. CAF SSP Medical Program Renewal Process Overview

  2. CAF SSP Medical Program Clients • CAF SSP medical program clients have cases in OHA, CAF SSP offices and SPD/AAA offices • This presentation applies to CAF SSP medical program clients in OHA’s Statewide Processing Center (branch 5503) and CAF SSP branch offices

  3. CAF SSP Medical Renewal (Redetermination) Mailings CAF SSP medical program clients in OHA branch 5503 and CAF SSP offices are mailed one of the following when it’s time for their medical to be renewed: • OHP 7210 reapplication packet; or • DHS 415F packet (the DHS 6623); or • DHS 945 medical pend notice

  4. CAF SSP Renewal Mailings • OHP 7210 is mailed when a child is aging out of a program as an adult, such as a CHIP child turning age 19 or an MAA child turning age 19 • DHS 6623 is mailed when the medical end date and the SNAP recertification end dates are in alignment • DHS 945 is mailed to all other CAF SSP medical program clients in OHA/SSP offices

  5. OP6 and OPP Clients • Families with an OP6 child are mailed either a DHS 945 or DHS 6623 the month before the OP6 child turns age 6 • OPP clients are mailed either a DHS 945 or DHS 6623 the month after the DUE date month

  6. Excluded from the Mailings Some CAF SSP medical program clients are excluded from the mailings: • MAA/MAF clients on TANF cases are automatically renewed and are not sent any medical renewal paperwork • SAC and BCCM clients are not mailed renewal paperwork. SAC and BCCM cases are carried at OHA branch 5503, which is responsible for the medical program renewals

  7. Note about HKC Cases • HKC cases are mailed a DHS 945 renewal pend notice, but the timing is different than the other DHS 945 mailings • HKC renewals are completed by OHA branch 5503 • This overview does not include the HKC DHS 945 renewal process

  8. SPD Medical Program Cases are Excluded, Too • SPD medical program clients in OHA/SSP offices are not mailed an OHP 7210, DHS 6623 or DHS 945. For example, OSIPM and QMB clients are excluded from the mailings • Eligibility workers at OHA branch 5503 and CAF SSP offices are responsible for reviewing SPD medical program companion cases

  9. Changes to Renewal Mailing Process • Effective July 2011, CAF SSP medical program clients mailed the DHS 6623 have a DOR and BED code added to their CM case • The change means both DHS 945 and DHS 6623 medical program clients have a DOR and BED code added

  10. To Pend or Not to Pend • The DHS 945 is a pend notice. Send an additional pend notice only if necessary to supplement the DHS 945 • The DHS 6623 is a multiple program application packet. It is not a pend notice and will require an initial pend notice be sent to the client

  11. Mailing Counts Most clients are sent the DHS 945. For example, in July, 2011: approximately 14,600 DHS 945 medical pend notices will be mailed; 6,000 DHS 6623 application packets will be mailed; and 1,000 OHP 7210 application packets mailed

  12. Example of 945/6623 Renewal Timeline:

  13. Explanation of 945/6623 Renewal Timeline Example In the timeline example, the last month of the eligibility period is April: • DHS establishes a DOR of 03/15/11 • The 45th day after the DOR is 04/29/11 • The 945/6623 is mailed in March between the 16th and the 23rd • A BED code is automatically added for the month of May • The BED code generates a “BED close notice” (77B) in mid-May

  14. 945/6623 Timeline & Budgeting The last month of the eligibility period will usually be the initial budget month, but there are exceptions. For example: If the client reports a change occurred in month 11 of a 12 month eligibility period, consider if the change requires a redetermination If it requires a redetermination, use month 11 as the initial budget month If there are no reported changes affecting eligibility during the 11th month, go to the 12th month as the budget month for recertification

  15. 945/6623 Timeline & Budgeting, cont. Examples of changes in month 11 that require a redetermination using month 11 as the budget month: • An MAA client reports an increase in income affecting eligibility • An OHP client reports a new filing group member and requests medical for the new filing group member • An OHP client reports loss of income and becomes MAA or MAF eligible

  16. Basic Scenarios There are 3 basic scenarios that will most commonly occur: 1) The client does not respond to the DHS 945 or DHS 6623 2) The client responds to the DHS 945 or the DHS 6623 within 45 days from the DOR 3) The client responds after 45 days and doesn’t have good cause to be late

  17. Basic Scenario #1: The client does not respond at all If the client does not complete the 945 or DHS 6623 renewal process: A BED (77B) close notice is automatically sent by the CM system. The worker is NOT required to send a closure notice The CM system will automatically end benefits

  18. Scenario #1 timeline

  19. Basic Scenario #2: The client responds within 45 days from the DOR If the client responds to the renewal paperwork (either the DHS 945 or the DHS 6623) by phone call, written note or by completing the paperwork: Look to see if there is a change reported in the month prior to the last month of the eligibility period that must be acted on. If there is a change that must be acted on, use the DOR month as the initial budget month Otherwise, the last (usually 12th) month of the eligibility period becomes the initial budget month

  20. Basic Scenario #2: Example of when the client responds within 45 days of the DOR

  21. Basic Scenario #2: What if the client responds within 45 days, but isn’t eligible? If the client responds timely (within 45 days of the DOR) but is not eligible for medical: The date the client responds establishes a new DOR The new DOR establishes a new 45 day application period The client has already had one 45 day period to respond. Do not “BED on a BED”

  22. Basic Scenario #2: Example of New DOR The initial DOR is 03/15/11. A new DOR was established 4/25/11. If the client is not eligible using the 3/15/11 DOR, use 04/25/11. The new 45 days ends 06/09/11 Let the CM case close, and reopenthe case if eligibility is found – with a medical start date of the 1st of the month following the BED month

  23. Basic Scenario #3: The client responds after 45 days If the client responds after the 45th day, consider good cause for the late response. If no good cause: Use the new DOR and redetermine Because the new DOR was established after the original 45th day, the new medical eligibility period begins the 1st of the month after the DOR Note: If a Standard applicant establishes a DOR before the last day of the BED month, there is no gap in coverage, and the client is potentially eligible for medical

  24. Basic Scenario #3: The client responds to after the original 45 days

  25. Don’t Forget to Determine Good Cause If the client responds late, determine if there is good cause. If there is good cause: Keep the original DOR in place Extend the BED end date if necessary (it’s not “BEDding on a BED” if it’s the same DOR) NOTE: Consider if there could be an ADA accommodation. More information is in the FSM Multiple Program Worker Guide MP-13.

  26. Additional Resources For questions, please contact SSP-Policy, Medical or contact a CAF SSP Medical Program Policy Analyst: • Michelle Mack (503) 947-5129 • Joyce Clarkson (503) 945-6106 • Carol Berg (503) 945-6072 • Vonda Daniels (503) 945-6088 • Jewel Kallstrom (503) 947-2316 • Audray Hunter (503) 947-5519

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