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Reporting Requirements For Medicaid Beneficiaries


When a person accepts a Medicaid card, that person (or his or her representative) must report all changes in either income or resources that could affect his or her eligibility.  These changes should be reported to the Medicaid regional office that serves his or her home county. These changes may be made by calling, writing or visiting the Medicaid regional office. All changes MUST be reported within 10 days after the change happens (or within 10 days after the beneficiary realizes the change has taken place.)  Failure to report a change may result in the beneficiary receiving the wrong Medicaid benefits.

 

Changes to report include:

Income Changes - any increase or decrease in the amount of money or change in the source of money that a beneficiary or his or her  spouse receives must be reported.  (Income includes all earned or unearned income, gifts, or any type of money that belongs to the beneficiary.) If a beneficiary applies and is approved for benefits for which he or she is entitled he or she must report this change within 10 days.


Resource Changes
-
Any change in what a person owns must be reported. this means that the beneficiary buys, sells, gives away, or receives any asset (thing of value) or any part of an asset he or she must report the change to the Medicaid regional office.  (Resources or  assets include any property property the recipient owns or has interest in, money in banks, credit unions, etc., stocks, bonds, life insurance policies or any other item of value.)


Living Arrangements or Change of Address
- Any change in where a beneficiary or his or her spouse lives and/or gets mail must be reported. (This includes if the beneficiary moves in or out of someone's household, enters a hospital or nursing home,  leaves a hospital or nursing home or moves from one medical facility to another.)


Family Size -
Any change in the family size must be reported.  (This includes the death of a beneficiary, the death of a spouse, if a beneficiary's children under the age of 18 move in or out of the beneficiary's household.)


Change in Blindness or Disability -
Any change in a beneficiary's disability which affects his or her Medicaid eligibility must be  reported.


Recipients Who Have
Third Party (other insurance) Coverage(s)

Persons who apply for, as well as those who already have Medicaid must report any and all types of third party coverage policies. "Third party" includes any type of policy which would pay for medical services such as: health insurance, indemnity policies, major medical policies, CHAMPUS, and lawsuit settlements.

State law also requires as a condition of eligibility that a Medicaid beneficiary sign over all third party rights to the Division of Medicaid.

Medicaid beneficiaries should identify all third party policies in addition to Medicaid coverage whenever any medical service is provided. This will allow the provider to file and obtain those benefits before filing the Medicaid claim.

Medicaid beneficiaries must report changes in third party policy information to the Division of Medicaid.  Contact the Regional Medicaid office which serves your area to report changes in third party policy information or click here to report to the Division of Medicaid any health insurance information which may have changed since your last report of this information.

ATTENTION NURSING HOME BENEFICIARIES

Deductions which a nursing home beneficiary may claim from his or her Medicaid income due to health insurance premiums which are paid out of the beneficiary's own funds must be checked during  each premium period.  If the premium amount changes or the insurance policy is canceled, it must be reported.

Deductions which a nursing home beneficiary may claim from his or her Medicaid income for drug, physician, and/or hospital expenses which have been billed to the beneficiary because of  limitations put on these types of services, must be reported to the Medicaid regional office every three (3) months. These expenses will not be allowed as deductions unless they have been reported to your caseworker.


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