Obsolete 0221 COVID 19 Questions and Answers

Effective Date: December 16, 2020 - January 31, 2021

On March 18, 2020, Public Law 116-127 passed. November 2, 2020, CMS published a new interim rule that affects how cases are treated. These laws provide an increase in the federal funds a state may receive during the COVID-19 Public Health Emergency (PHE). To receive these funds, states must keep Medicaid recipients enrolled in coverage during the emergency period.

The following Q & As are designed to help the Medicaid Eligibility Agency assure eligible individuals receive continued coverage during the emergency period.

*Policy References*	461-2, 462-2, 703-1, 715 & 721

*General*	Follow all normal eligibility policies, unless making any change makes the person ineligible. See resource below. Apply changes prospectively allowing for proper 10 day notice.

*Question 1*	During the COVID-19 Public Health Emergency (PHE), can Medicaid eligibility end?
*Answer*	In most cases, no. There are a few exceptions when the agency may end Medicaid with proper notice: If a client dies Moves out of the state permanently Asks the agency to end their Medicaid coverage If the case was approved in error or due to fraud, See #2.
*Question 2*	What action do you take if a case was approved in error or fraud?
*Answer*	1. When the agency finds a case was granted eligibility due to agency error the agency must close the case with proper notice, if currently ineligible. (For example, if the agency failed to count the correct income.) A case found to have been granted eligibility due to an agency error must still have all other programs addressed prior to closure. 2. If the agency determines the client had willfully withheld information as part of the previous eligibility determination, the agency may refer the case for investigation. If the investigation finds the client willfully withheld information, the agency may close the case and provide proper notice and fair hearing rights. 3. If the previous eligibility determination was a result of fraud, and the client is convicted of fraud, close the case. If a case is found to have remained open during the PHE due to willful withholding or a fraud conviction, no overpayments should be collected from March 2020 until the end of the PHE See Policy section #825
*Question 3*	How should the eligibility agency handle changes in circumstances that impact ongoing eligibility?
*Answer*	The Eligibility Agency may now make case changes and allow movement between most programs. Medicaid coverage must still continue through the PHE when the recipient becomes ineligible. Some program movement is not permitted. See chart below. If the change would result in an increase to the spenddown, MWI premium, or the contribution to the cost-of-care for long-term care, the agency must act on the change. For Spenddown payment, see Question #13. If you have a client who becomes eligible for Medicare, see Question #7.
*Question 4*	What if someone’s time-limited Medicaid would end during the emergency? For example: a child turns age 19, 12-month TR would end, TAM etc.
*Answer*	The agency must continue Medicaid coverage until the end of the month in which the emergency ends. However, if a child turns 19 and meets the criteria for another program, such as the Adult Expansion program, the agency needs to move the child to Adult Expansion. This applies to someone whose 12-month TR or TAM ends, and who meets criteria for another program (like PCR or Adult Expansion.) If the person no longer qualifies for another program with essentially the same benefits, the agency cannot end Medicaid, and should continue coverage based on the chart below. See policy 721-4 for a list of time limited programs.
*Question 5*	If a child turns age 6 and household income is higher than the income limit, do we continue coverage for that child?
*Answer*	Yes. The child’s coverage under Medicaid must continue until the end of the emergency.
*Question 6*	Do we continue coverage for a lawfully present child during the emergency?
*Answer*	Yes. However, coverage will depend on their status. At age 19, validate the individual’s citizen/alien status. If the individual turning age 19 has become a citizen or meets a qualified alien status, determine eligibility for other Medicaid programs. See Question 4. If the individual is not a citizen or have a qualified alien status, they can only receive emergency services See question #4.
*Question 7*	What can we do when a client becomes eligible for Medicare (e.g. turns 65)?
	People usually become eligible for Medicare when they turn age 65. A person who is disabled usually becomes eligible for Medicare when they have received 24 months of Social Security disability payments. If a client is on a program, such as Adult Expansion, BCC, TAM or PCR when they become eligible for Medicare, determine eligibility for Aged or Disabled 100% FPL Medicaid (as applicable.) If they meet all the criteria for the 100% FPL group, move them to that group. Also add the QMB program. If income exceeds 100% FPL, determine eligibility for SLMB or QI; if eligible close the Medicaid program and open SLMB or QI. If they are not eligible for SLMB or QI, then force 100% FPL Aged or Disabled Medicaid.
*Question 8*	Can a client be moved to Disability Medicaid from another Medicaid program?
*Answer*	Yes, but only if the individual qualifies without a spenddown. If the client’s income will exceed 100% of the FPL under the Disabled Medicaid rules, and the client would owe a spenddown, the agency must continue coverage under the program they are on until the end of the emergency period. The exception to this is if they are eligible for Medicare and a Medicare Cost Sharing program. See Question #7.
*Question 9*	What do we do if a pregnant woman’s post-partum period ends during the emergency period?
*Answer*	When the post-partum period ends, redetermine the woman’s eligibility for another Medicaid program. For example, she might qualify for PCR or Adult Expansion. If she meets that criteria, move her to the other Medicaid program. Her Medicaid eligibility must then continue through the end of the emergency period. However if she does not qualify on another program, continue her on Adult Expansion until the emergency ends.
*Question 10*	What happens if someone has a review due during the emergency period?
*Answer*	Follow normal review policy in section 721. If the agency can renew eligibility through an ex-parte review for the same program, complete the review. If the person does not qualify for the existing group, decide if the person qualifies for another Medicaid program. For example, someone on PCR might qualify for the Adult Expansion. If so, they can be moved to that program. If changes would cause the person to lose their Medicaid eligibility, do not act on those changes. Continue their coverage on the existing program. If a pre-populated review needs to be sent out but the client does not provide all required verification, then the agency will need to add a due process month until the review is completed or until the emergency ends. If a review is due for a different program, like SNAP, and verification is requested, the Medicaid program cannot end due to failure to provide the verification, or due to changes that affect the other program (like a change in income.)
*Question 11*	Can Medicaid for Emergency Only services be closed?
*Answer*	No. If the client was eligible on March 18^th, or becomes eligible during the emergency period, keep the case open for emergency only services. They still only qualify for emergency services, which may include certain COVID related services. If an individual’s status were to change, though, say their 5-year bar ends and they are now a qualified alien, they should be moved to a regular Medicaid group.
*Question 12*	What happens if a client enters a public institution?
*Answer*	Suspend benefits for the client following policy in 604. Reinstate benefits if they are released and continue to reside in Utah.
*Question 13*	What happens if a client who is supposed to pay a Spenddown, an MWI premium or a Waiver Cost-of-Care contribution does not pay it?
*Answer*	A spenddown or MWI recipient that has made a payment during the PHE, which began March 2020, will have their Medicaid eligibility continue through the end of the emergency period. From the month eligibility is met the client’s eligibility will continue through the end of the emergency period. Individuals who owe a cost-of-care contribution for waiver or nursing home services must continue to make their payments. If a change would result in an increase to the spenddown, MWI premium, or the contribution to the cost-of-care for long-term care, the agency must act on the change.
*Question 14*	Will I receive a refund if I have paid more than one month of Spenddowns or MWI premiums during the PHE?
*Answer*	No. Refunds will be handled according to current policy.
*Question 15*	Do Presumptively Eligible clients receive continuous coverage during the emergency period?
*Answer*	No. If the only coverage someone qualifies for is Presumptive Eligibility, coverage will end at the end of the PE period. However, if the agency makes a full eligibility decision and finds the person is eligible for a Medicaid program, they receive the protection of continuous coverage through the end of the emergency.
*Question 16*	What do we do if a client is receiving Continued Benefits pending the outcome of a Fair Hearing?
*Answer*	If the client was enrolled correctly in Medicaid on March 18, 2020 and is receiving continued benefits pending a Fair Hearing, the agency cannot close their case until the emergency period ends. The fair hearing should proceed as usual. If the hearing decision determines that there was an error in the decision (an initial or redetermination decision made before 3/18/2020), then follow the guidance in #2 above. If the Fair Hearing decision would result in case closure, but the prior eligibility decision was not due to an error, that decision cannot be carried out until after the emergency period ends. The client’s eligibility is protected through the end of the emergency period. No overpayment will accrue for such dates, either. After the emergency ends, the agency needs to reevaluate the situation to determine whether the client is ineligible. Medicaid may be closed if the client is no longer eligible at that time.
Question 17	If a case is closed because the agency determines the prior eligibility decision was made in error, does the client have the right to a fair hearing?
Answer	Yes. The client can request a fair hearing if the agency ends eligibility because the agency believes the prior decision was made in error. If the hearing upholds the closure, the client also has the right to request a Superior Agency Review. If the hearing overturns the agency decision, reinstate the client’s eligibility.
*Question 18*	Will overpayments be assessed if the agency later finds that someone enrolled on March 18, 2020, or who becomes enrolled during the emergency period, really was not eligible?
*Answer*	No. However, if there is suspected fraud, the agency may refer the case for criminal investigation. If the agency suspects client abuse, refer the case for investigation. If the agency determines the client received eligibility due to client abuse, close the case. The decision does not affect eligibility for the previous months during the PHE.
*Question 19*	Will someone receiving UPP remain eligible during the emergency period?
*Answer*	Yes. Keep the UPP program open. If they still have health insurance, we will keep sending their payment. If they lose health insurance, we will send a zero payment.
*Question 20*	Will someone who remains eligible for Adult Expansion due to the public health emergency be eligible for an ESI reimbursement?
*Answer*	Yes, if one of the following situations apply 1. If the client is on Adult Expansion and their income increases and puts them over the Adult Expansion income limit, but is still within the UPP income level, continue Adult Expansion with ESI as long as they have access to and are enrolled in health insurance that meets QHP. Subsequent income changes during the PHE will not stop the ESI payment. 2. If a client is on Adult Expansion with ESI and they have an income change that puts them over the UPP income limit, continue coverage on Adult Expansion with the ESI payments. No, if one of the following situations apply 1. The client is on Adult Expansion without ESI. They report a change in both income and access to ESI. However, the new income is over the UPP income level. We will not give the option of ESI. We will continue them on Adult Expansion during the emergency period with no ESI option. 2. The client is on Adult Expansion without ESI and no longer meeting the requirement to cover their children with Minimum Essential Coverage or has an ORS sanction due to duty of support requirements, we will not offer an ESI reimbursement.
*Question 21*	Will Adult Expansion have the Community Engagement requirement?
*Answer*	No. All Adult Expansion clients that have the community engagement participation requirement, will get good cause according to policy 348-2.
*Question 22*	Do we continue eligibility for an otherwise eligible client who needs to provide evidence of citizenship or satisfactory immigration status if they do not provide such evidence by the end of the 90 day reasonable opportunity period?
*Answer*	Yes. Otherwise eligible individuals for whom the agency is unable to receive electronic verification of citizenship or satisfactory immigration status will continue to receive medical assistance through the end of the emergency period. After the emergency period ends, if the client has received the full reasonable opportunity period, the agency will terminate coverage. Do not end benefits during the emergency period. However, if the agency receives verification that proves the individual is neither a citizen nor a qualified immigrant, the agency will change eligibility to the emergency services Medicaid program for the duration of the emergency period.
*Question 23*	Is there a program available to cover COVID-19 Testing?
*Answer*	Yes. Uninsured individuals may qualify to receive coverage for COVID-19 testing. To qualify, an individual must meet residency, citizenship/alien status requirements, and must meet the definition of an uninsured individual. An uninsured individual is an individual who is not enrolled in Medicaid, any health care program funded by the federal government, or any group health plan or health insurance coverage offered by a health insurance issuer. There are no income, asset or age limits. Eligibility is determined by current HPE providers and designated UDOH/DWS staff. Decisions are based on client’s self-attestation, including self-attestation of citizenship or alien residency. Benefits include COVID-19 testing and additional, limited testing related services.
*Question 24*	Can I accept a ‘testing site’ location as a ‘signature’ for Medicaid?
*Answer*	Starting on June 22, 2020, COVID-19 testing sites will sign applications for Medicaid and the COVID-19 testing group with verbal consent from the client. The testing site will be acting as an authorized representative with limited scope to sign on behalf of the applicant for this coverage only during the PHE. The testing site must be noted in the case record. Once approved, a form 40 and a 61Med will be generated. DWS receives and follows established process (enters/ongoing application). When the emergency period ends, a signature must be obtained by the client to maintain ongoing Medicaid coverage.
*Question 25*	When a client is unable to sign an application (paper/online/in person), what options do they have?
*Answer*	There are two ways. See policy 703-1. 1. Complete a telephone application with a telephonic signature. 2. The authorized representative will complete an application and form 114COVID. The form 114COVID allows a limited role for an authorized representative to sign and complete an application on the client’s behalf. This option will only be available during the PHE period.
*Question 26*	Does eligibility continue for a household member on Medicaid that leaves the home and remains in Utah during the emergency period?
*Answer*	Yes with an exception for adoption. Exception for Adoption: ∙ The birth mother has given up parental control (adopted), close the child’s case as customer request. Examples of when a spouse, non-relative or child on Medicaid leaves the home that require opening a new case: ∙ If a spouse, non-relative or child on Medicaid leaves the home with a known address, open the client on their own case with the updated address. ∙ If a spouse, non-relative or child on Medicaid leaves the home for any domestic violence issues, open the client on their own case with an address of general delivery.
*Question 27*	Do we apply a transfer of asset penalty for Nursing Home and Waiver benefits?
*Answer*	Yes. Apply a transfer of assets penalties according to policy 575.

Resource

During the national public health emergency period, clients who were enrolled in Medicaid on March 18, 2020, and those who become eligible during the emergency, may not have their eligibility or coverage end.

In all cases where the member dies, loses residency, was approved due to agency error or requests to have their case closed, the eligibility should end.

We have three tiers of programs. Changes may occur that would normally cause a client to move to a different Medicaid program, any movement between same tier programs is allowed.

A client may request that their case be changed from a higher (Tier 1 or Tier 2) to a lower tier (Tier 2 or Tier 3).

Note - For situations not mentioned in this document, consult with a policy specialist from the Department of Health for guidance.

This is in alphabetical order. Not in hierarchical order.

Tier 1 Programs
Program	Program to force when not eligible for any other Tier 1
Adult Expansion	Force Adult expansion with or w/o kids as proper. If the client has Medicare and not eligible for MCSP, then force Aged, or Disabled 100% FPL.
Aged, Blind or Disabled with no spenddown	Force Aged or Disabled 100% FPL
Breast or Cervical Cancer (BCC)	Force Aged or Disabled 100% FPL
Child 6-18	Force Child 6-18. When the client turns 19, force Adult Expansion.
Child 0-5	Force Child 0-5. When the client turns 6, force 6-18.
Child 1yr	When the client turns 1, force 0-5.
Lawfully Present Medicaid child	Force Child Medical. When client turns 19, force Adult Expansion emergency. Move to Tier 3.
Former Foster Care (age 26)	When the client turns 26, force Adult Expansion.
Foster Care	Force Foster Care
Foster Care Independent Living	Force Foster Care Independent Living Client turns age 21 - force Adult Expansion.
Home and Community Based Waivers	Force Aged or Disabled 100% FPL.
Medicaid Work Incentive (MWI)	Force MWI if they still have earnings. Force Aged or Disabled 100% FPL if they do not have earnings.
Medicare Cost Sharing Program only (MCSP) - QMB	Force QMB, SLMB or QI
MCSP only - SLMB or QI	Force SLMB or QI
Nursing Home	Force NH, sanctions do apply (Question came up about forcing ABD)
PCR	Force Adult Expansion
Pregnant Woman	Force Adult expansion when the post partum period ends
Refugee (not Medicaid)	If not eligible for another program, close Refugee.
Sub Adopt	Force SA for the remainder of the emergency. DCFS will extend the adoption agreement end date on the program evidence for SA IV-E Medicaid. If the Sub-adopt agreement cannot be extended then force Child Medicaid. (coordinate with DCFS) FEAR evidence must be added for the SA Non IV-E Medicaid, to extend coverage beyond age 18.
TAM	Force Adult Expansion If the client has Medicare and not eligible for MCSP, then force Aged or Disabled 100% FPL.
4 Month Extended	Force Adult Expansion
12 month TR	Force Adult expansion
Tier 2 Programs Note - Tier 1 clients may request to be moved to this tier.
Spenddown (Medically Needy (MN)) or MWI with premium	Force MN or MWI with premium.
Tier 3 Programs Note - Tier 1 and Tier 2 clients may request to be moved to this tier.
COVID-19	Force COVID-19
Emergency Programs	Force emergency
Presumptive Eligibility	Close at end of PE period, or Medicaid decision
Tuberculosis	Force TB
UPP	Keep open with $0 payment.
Other programs
CHIP	May move to Medicaid. May not decrease CHIP benefits (Plan B to Plan C.). May not move from Medicaid to CHIP.

Tier quick reference guide
Tier 1	Tier 2	Tier 3
Adult Expansion	Medically Needy Programs	Covid 19
Aged, Blind, Disabled		Emergency Programs
Breast and Cervical Cancer		Presumptive Eligibility (HPE & BYB)
Child Programs		Tuberculosis
Former Foster Care		UPP
Foster Care
Foster Care Independent Living
HCB Waivers
Medicaid Work Incentive
Medicare Cost Sharing
Nursing Home
PCR
Pregnant Woman
Refugee
Sub-Adopt
TAM
4 month extended
12 month TR

Temporary COVID-19 Verification Changes

Follow policy 731-3, if verification is required from the client per policy, the following temporary exceptions are allowed during the National Health emergency COVID-19 period. The intent is to help people in quarantine or self isolation as information may be difficult to obtain during the emergency period.

Type	Preferred	Allowable
Citizenship & ID	Electronic	Client Statement (CS) if electronic verification is not available and the reasonable time period has expired. (Good faith)
Income (termination)	Electronic verif, Collateral contact	CS if employer is not available or client is in quarantine or self isolation.
Income (new employment)	Electronic verif, collateral contact	CS if employer is not available or client is in quarantine or self isolation.
Income (change)	Electronic verif, pay stubs, employer statement, collateral contact	CS if employer is not available or client is in quarantine or self isolation.
116M	Limit the use of the 116M form to those situations where the health insurance information is required. (Example - Do not send the 116M for health insurance termination.)	∙ CS if the individual is losing insurance. ∙ CS on access to health insurance (5% test) for UPP and CHIP. ∙ CS is not allowed if the individual is gaining access to health insurance ∙ CS is not allowed to verify the ESI or UPP payment amount.
Medical bills	Recent copies of billing statements, printouts from medical provider, collateral contact with provider	Collateral Contact (CC) is acceptable.
Applications	Allowable application modalities from policy 703-1	COVID-19 testing sites signed applications for Medicaid and the COVID-19 testing group with verbal consent from the client.