Iowa Admin. Code r. 441-76.15

Current through Register Vol. 47, No. 11, December 11, 2024

Rule 441-76.15 - Report of changes

As a condition of enrollment and continued enrollment for medical assistance, applicants and members shall report changes in circumstances as required in this rule.

(1)Report of changes for eligibility prior to January 1, 2014.

a. In coverage groups for which Medicaid eligibility is determined using the family medical assistance program (FMAP) income and resource policies, members shall report changes as follows:

(1) At the annual review or upon the addition of an individual to the eligible group, members shall report any change in the following:

1. Income from all sources, including any change in care expenses.

2. Resources.

3. Members of the household.

4. School attendance.

5. A stepparent's recovery from an incapacity.

6. Mailing or living address.

7. Payment of child support.

8. Receipt of a social security number.

9. Payment for child support, alimony, or dependents as defined in 441-paragraph 75.57(8)"b. "

10. Health insurance premiums or coverage.

(2) Applicants and members shall report any change in the following within ten calendar days of the change:

1. Members of the household.

2. Mailing or living address.

3. Sources of income.

4. Health insurance premiums or coverage.

(3) Members described at 441-subrule 75.1(35) shall also report any change in income from any source and any change in care expenses within ten calendar days of the change.

b. In coverage groups for which Medicaid eligibility is determined using income and resource policies related to the supplemental security income (SSI) program, members shall report any change in the following to the department within ten calendar days of the change. EXCEPTION: Persons actually receiving SSI benefits are exempted from these reporting requirements unless the persons have a trust or are applying for or are receiving home- and community-based waiver services.

(1) Income from all sources.

(2) Resources.

(3) Members of the household.

(4) Recovery from disability.

(5) Mailing or living address.

(6) Health insurance premiums or coverage.

(7) Medicare premiums or coverage.

(8) Receipt of social security number.

(9) Gross income of the community spouse or of the dependent children, parents or siblings of the institutionalized or community spouse living with a community spouse when a diversion is made to the community spouse or family. (See definitions in rule 441-75.25 (249A).)

(10) Income and resources of parents and spouses when income and resources are used in determining Medicaid eligibility, client participation or spenddown.

(11) Residence in a medical institution for other than respite care for more than 15 days for home-and community-based waiver services recipients.

c. Individuals in the breast and cervical cancer coverage group are required to report when health insurance coverage begins, or when their living or mailing address changes, within ten calendar days.

(2)Report of changes for eligibility on or after January 1, 2014. A change in circumstance that may affect the eligibility of applicants and members must be reported within ten days of the date the change occurred. Changes required to be reported are described in this subrule.

a. In coverage groups for which Medicaid eligibility is determined using the modified adjusted gross income methodology, any change in the following must be reported:

(1) Income from all sources.

(2) Members of the household.

(3) School attendance.

(4) Mailing or living address.

(5) Receipt of a social security number.

(6) Health insurance premiums or coverage.

(7) Alien or citizenship status.

b. In coverage groups for which Medicaid eligibility is not determined using the modified adjusted gross income methodology, any change in the following must be reported. EXCEPTION: Persons actually receiving SSI benefits are exempted from these reporting requirements unless the persons have a trust or are applying for or are receiving home- and community-based waiver services.

(1) Income from all sources.

(2) Resources.

(3) Members of the household.

(4) Recovery from disability.

(5) Mailing or living address.

(6) Health insurance premiums or coverage.

(7) Medicare premiums or coverage.

(8) Receipt of social security number.

(9) Gross income of the community spouse or of the dependent children, parents, or siblings of the institutionalized or community spouse who are living with a community spouse when a diversion is made to the community spouse or family. (See definitions in rule 441-75.25 (249A).)

(10) Income and resources of parents and spouses when income and resources are used in determining Medicaid eligibility, client participation or spenddown.

(11) Residence in a medical institution for other than respite care for more than 15 days for home-and community-based waiver services recipients.

c. Individuals in the breast and cervical cancer coverage group are required to report changes in their health insurance coverage and changes in their living or mailing address.

d. Individuals receiving Medicaid based on the receipt of Title IV-E-funded foster care or based on an adoption assistance agreement are required to report changes in health insurance coverage, when their living or mailing address changes, receipt of a social security number, and termination of the adoption assistance agreement.

e. Individuals receiving state-only funded Medicaid are required to report any change in the following:

(1) Income from all sources.

(2) Mailing or living address.

(3) Receipt of a social security number.

(4) Health insurance coverage.

(5) Alien or citizenship status.

(3)Failure to report. When a change is not reported as required by this rule, any Medicaid expenditures for care or services provided when the member was not eligible shall be considered an overpayment and subject to recovery from the member.

Iowa Admin. Code r. 441-76.15

ARC 1069C, IAB 10/2/2013, effective 10/1/2013