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Eligibility Reporting Requirements

Eligibility Reporting Requirements

Someone who is eligible for Medicaid or CHIP must report changes that could affect eligibility. Changes to report include:

Income: A change in the amount of income the beneficiary’s household receives. This can be an increase or decrease in income from wages, self-employment or any type of income received such as retirement benefits, contributions, state or federal benefits or other income received within the household. A change in the source and/or amount of income for a household member must be reported within 10 days of the change.

Address or living arrangement: A change in address or a change in someone’s living arrangement must be reported. A Medicaid or CHIP recipient who moves in or out of the household or enters or leaves a nursing or medical facility must be reported within 10 days of the change.

Family size: A change in family size. A marriage, divorce, death or a child moving into or out of a household must be reported.

Resources: For individuals eligible on the basis of age, blindness or disability, any change in what a household member owns must be reported.  If a Medicaid recipient buys, sells or gives away anything of value that he/she owns, the change must be reported within 10 days of the change. Resources include property someone owns or has an interest in including home property, money in the bank or on hand, stocks, bonds or any item of value.

Improvements in disability: For individuals eligible on the basis of age, blindness or disability, any improvements in disability, especially improvements that affect Medicare entitlement or disability benefits must be reported.

How to Report Eligibility Changes or Updates

Changes affecting Medicaid or CHIP eligibility may be reported in a variety of ways:

Attention Nursing Home Recipients
If deductions are claimed from the amount paid to the facility in the form of “Medicaid Income” for a health insurance premium or other allowable medical expense, any changes in the amount of these deductions must be reported. If a premium amount changes or if an insurance policy is canceled, it must be reported.

Attention Beneficiaries Who Have Other Insurance Coverage
Any change in other health insurance coverage must be reported. If someone on Medicaid or CHIP gains coverage through other health insurance or if a Medicaid recipient loses coverage through other health insurance, report this event within 10 days of the change. Report third party insurance coverage.