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Issue Alert - 04-07-17

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Jul 15, 2004

Issue Summary:

Family Independence Agency policies have been clarified to protect recipient's rights to have eligibility under other categories reviewed when eligibility based on age or pregnancy ends, but problems remain for individuals who receive Medicaid in some other categories

Persons Affected:

Medicaid recipients who become ineligible under the criteria for the particular category of Medicaid that they have been receiving

For More Information:

Michigan Poverty Law Program 611 Church Street, Suite 4A Ann Arbor, MI 48104-3000(734) 998-6100(734) 998-9125 Fax



What's Happening?

Effective July 1, 2004, FIA has specifically included instructions in PEM 125 policy on Healthy Kids for Pregnant Women, instructing caseworkers to pursue eligibility under other categories when pregancy-based Medicaid is ending, and advising them to request that the recipient complete the FIA 1171 (long form application) when it is needed to determine eligibility for other Medicaid categories.FIA also has revised PEM 132 policy on Group 2 Persons Under Age 21 to specifically instruct caseworkers to consider eligibility under all other Medicaid categories when they receive notice that the recipient is turning 21. This same language is contained in PEM 131 policy on Other Healthy Kids (age 1 through 18) who turn 19, but specific instructions requiring the caseworker to ask for any information necessary to evaluate eligibility for non-Healthy Kids categories (such as information on the FIA 1171 long form)are not included.Caseworkers are likely to continue to inappropriately terminate Medicaid for women who no longer are pregnant and for Healthy Kids recipients turning 19, without requesting information needed to evaluate eligibility under other categories, as long as PEM 105 tells caseworkers that they do not have to consider eligibility under non-Healthy Kids categories for recipients who applied using the short form. In addition, caseworkers are likely to erroneously terminate Medicaid without an appropriate review because neither PEM 105 nor PAM 210, which contains FIA policy on Redeterminations of eligibility, clearly set forth the obligation to conduct ex-parte, pre-termination reviews of Medicaid eligibility -- and to provide an opportunity for the recipient to provide any missing information --before concluding that the recipient is not eligible under other categories.

What Should Advocates Do?

Carefully examine cases in which recipients have been terminated from Medicaid, to determine whether their eligibility has been considered under all potential Medicaid eligibility categories. Carefully examine cases in which recipients have been terminated from Medicaid, to determine whether the recipients are eligible under another category, or at least are eligible to receive Medicaid if they meet a spenddown. (Some FIA workers do not notify recipients about possible spenddown eligibility if the spenddown is large.)Be sure clients understand their right to a Medicaid hearing if Medicaid is erroneously terminated, as well as their right to have Medicaid continued if FIA receives their hearing request (with an original signature) within 11 days of the date on the notice of termination. The notice of termination should tell the recipient the deadline for requesting a hearing in time to continue receiving Medicaid pending the outcome of the hearing. Contact the Center for Civil Justice if it appears that FIA has not conducted an appropriate pre-termination review.

What Should Clients Do?

Seek legal advice if your Medicaid is terminated and you are not sure if FIA considered your eligibility under all potential categories.Request a hearing immediately if you believe that FIA was wrong or made a mistake in deciding to terminate your Medicaid. The notice of termination will tell you how to request a hearing. Be sure to keep a copy of the hearing request for your records, and note the date that you mail or take the hearing request to your local FIA office. Remember that FIA must receive the original, signed request before the deadline date.

Finding Help

Most legal aid and legal services offices handle these types 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 web site ( or look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.