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Issue Alert - 04-02-02

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Date:

Feb 09, 2004

Issue Summary:

Termination of Medicaid when Healthy Kids Medicaid eligibility ends, without any pre-termination effort to redetermine eligibility under other categories, appears to violate federal law.

Persons Affected:

Women and children who become ineligible for Medicaid under one of the Healthy Kids Medicaid categories after receiving Healthy Kids Medicaid based on a “short form” MIChild/Healthy Kids application (DCH 0373).


Background

Medicaid - Healthy Kids

What's Happening?

If a recipient who qualified for Medicaid under a Healthy Kids category based on a DCH 0373 short form application becomes ineligible for Medicaid under Healthy Kids categories, the Family Independence Agency (FIA) will terminate the individual’s Medicaid without first requesting information needed to determine whether the recipient remains eligible for Medicaid under other, non-Healthy Kids categories. See FIA PEM 105. Common situations in which individuals become ineligible for Healthy Kids Medicaid are:
  1. A woman who had Healthy Kids for Pregnant Women is more than 2 months post partum and either(a) is age 19 or older or(b) is under age 19 but has income over 150% of FPL;
  2. An infant turns 1 and has income over 150% of FPL;
  3. A teen reached his or her 19th birthday and is not pregnant;
  4. The recipient’s group’s income exceeds the applicable limit (185% of FPL for pregnant women and children under age 1, 150% FPL for children age 1 through 18) at the end of their 12 month eligibility period.
Recipients in these situations will receive a notice informing them that their Medicaid is ending. No effort is made to redetermine the recipients’ eligibility under other, non-Healthy Kids Medicaid categories before the decision is made to terminate their Medicaid eligibility. The Center for Civil Justice has asked FIA to review their policy in light of the federal requirements discussed in “Background”, above, which require an effort to determine whether or not the individual is ineligible under ALL Medicaid categories before Medicaid is terminated, regardless of the type of application that was used to file for Medicaid. In order to receive Medicaid under the non-Healthy Kids categories, recipients will have to file an FIA 1171 application. However, FIA does not provide the application form and allow the Healthy Kids recipients an opportunity to submit the form and any necessary verification prior to termination of their Medicaid. In similar circumstances, the courts have held that the state agency was violating federal law. The Crippen v. Kheder case that was brought against the Michigan Medicaid agency was based on the agency’s failure to review recipients’ eligibility under other categories when the recipients became ineligible for Supplemental Security Income (SSI) disability benefits. SSI recipients, like Healthy Kids recipients, need not file a complete FIA 1171 “long form” Medicaid application in order to qualify for Medicaid. See PEM 150. SSI recipients automatically qualify for Medicaid. However, in Crippen the court ordered the state agency to fully review possible eligibility under other, non-SSI categories when the recipient’s SSI eligibility ends. As a result, when Michigan Medicaid recipients lose their SSI eligibility, FIA sends them an FIA 1171 Medicaid application and requests that they provide the necessary information to determine their eligibility under other Medicaid categories. See PEM 150.It appears that FIA's failure to redetermine eligibility under other, non-Healthy Kids categories prior to termination of Medicaid violates federal law.

What Should Advocates Do?

Share this information with agencies that work with low income pregnant women. Share this information with pregnant women and parents of children who may be affected by this policy. Refer clients for legal advice if they lose Medicaid eligibility because of FIA's practice of not redetermining Medicaid eligibility for other categories before Healthy Kids Medicaid is terminated. See below for information on where to find legal help. Individuals or advocates who have questions about the federal law may contact the Center for Civil Justice (see contact information at the top of this alert).

What Should Clients Do?

Seek legal advice if you recive a notice that your Medicaid is being terminated. If you request a hearing within 11 days of the date on the notice, your Medicaid will continue pending the outcome of your hearing. FIA must receive an original, signed hearing request within the 11 day period. Seek legal advice if you are receiving Medicaid based on pregnancy and you no longer are pregnant. Seek legal advice if you have been receiving Medicaid as a child under age 19 and you are about to turn 19. Seek legal advice if your child has been receiving Medicaid and is about to have his or her first birthday, if you think that your income may be over 150% of the federal poverty level, or are not sure if it is above that level.

Finding Help

Most legal aid and legal services office handle these type of cases, and they do not charge a fee. You can locate the "free" legal services or legal aid office that serves your county on the Michigan LawHelp website (www.MI.LawHelp.org,) or look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.