When an MA recipient reports that he or she is temporarily absent from the county of residence, the CAO must take action depending on why the individual is away. The CAO must find out: 55 Pa. Code § 148.12
The type of absence (out of the county, out of the state, or out of the United States).
Why the individual is away.
How long the individual will be away.
The individual’s new address.
An individual is still eligible for benefits during a temporary absence from his or her county of residence if he or she:
Is staying in another Pennsylvania county.
Plans to return when the purpose for the absence is completed.
Continues to meet all other eligibility rules.
If the recipient reports a temporary change of address to another Pennsylvania county and continues to meet all eligibility rules, the CAO must continue benefits at the new address in the other county.
During a temporary absence, the CAO must redetermine an individual’s eligibility using normal renewal procedures.
When an individual reports that he or she is temporarily living in another county, the CAO must take the following actions:
Determine whether the applicant/recipient group is still eligible for MA.
Make the address change, and issue a medical replacement card if one is needed.
Send a confirming notice to the new address, and make sure that the individual receives the MA card at that address.
Note the change of address in the case record or the e-CIS case comments.
If a new review of eligibility is needed due to a change in circumstances while a recipient is temporarily living in another county, the CAO must take the following actions: 55 Pa. Code § 148.12
Write to the recipient letting him or her know what information is needed to establish continued eligibility and when the information is due in the CAO.
NOTE: MA is continued as long as facts presented by the individual are consistent and reasonable. The CAO must set up a plan for the individual to give proof within 30 days from when the information about the change is received.
Contact the CAO in the county of temporary residence if more information or an individual interview is needed.
Make any required changes.
Send the individual notice of a change in eligibility.
If a partial renewal for MNO is due while an individual is temporarily absent, the CAO must take the following actions: 55 Pa. Code § 148.12
Send a PA 600R for him or her to fill out, with instructions and a due date for when the completed, signed form is due in the CAO.
Make any required changes to the budget or discontinue MA if the applicant/recipient group no longer meets eligibility requirements or fails to return the PA 600R.
Send the individual appropriate notice of a change in eligibility.
If a complete renewal is due while the individual is temporarily absent, the CAO must take the following actions:
Provide the individual with a renewal packet.
Review the factors that make the individual eligible.
Make any required changes or discontinue MA if the applicant/recipient group no longer meets eligibility requirements or fails to complete the renewal process. Send the individual an advance notice telling when and why benefits will be stopped
If the individual asks for a transfer of his or her case to the CAO in the county of temporary residence, or if the CAO determines that the absence is permanent, the CAO must follow the steps for an intercounty transfer.
An individual who continues to meet eligibility requirements during a temporary absence from the state and plans to return to Pennsylvania can keep getting benefits. The CAO must continue to provide MA to a recipient while he or she is in another state when: 55 Pa. Code § 148.13
Emergency medical care is needed while the individual is temporarily away from his or her home.
The individual's health would be at risk if the service was put off until he or she returns home.
Medical services are needed and the individual's health would be in danger if he or she were required to travel to Pennsylvania.
The CAO determines, on the basis of medical advice, that the needed medical services or resources are more readily available in the other state.
It is common practice for individuals in a certain location to use medical services in a neighboring state.
The CAO should discontinue MA, with advance notice, if: 55 Pa. Code § 148.13
The CAO finds out that the reason for the temporary absence is done and that the recipient has still not returned to Pennsylvania.
Another state has decided that the individual is a resident there for MA purposes.
If a recipient reports a temporary move from Pennsylvania, the CAO must take the following actions:
Find out why and how long the individual will be absent, and determine whether the applicant/recipient group is still eligible.
If the individual asks for his or her address to be changed temporarily, put the original Pennsylvania address in the alternate address field and narrate that it is a temporary absence.
Send the individual a PA/FS 162-C to confirm the address. Let the individual know that if he or she is gone longer than expected, he or she must contact the CAO.
Create an alert for the expected date of return to Pennsylvania
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If the individual does not contact the CAO by the expected date of return:
Contact the individual by phone or mail to find out why he or she is still absent.
Create a new alert if the temporary absence will continue.
Continue to monitor the period of absence.
If the CAO determines that the applicant/recipient group no longer meets MA eligibility requirements, has abandoned its Pennsylvania residency or is trying to establish residency in another state to receive MA from that state, discontinue MA and send an advance notice telling when and why benefits will be stopped.
If a partial or complete renewal is due during the temporary absence: 55 Pa. Code § 148.13
Send the individual a PA 600R and instructions for completing the PA 600R.
Review the factors that make an individual eligible
Make any required changes to the budget or discontinue MA if the applicant/recipient group is no longer eligible or does not complete the renewal process.
Send the individual an advance notice telling when and why benefits will be stopped.
Narrate all changes, plans and actions in the case record or CIS case comments.
A recipient's move to another county in Pennsylvania is considered permanent if the individual does not plan to return to the county where he or she used to live.
In order to ensure uninterrupted MA coverage and that CAOs are in compliance with Federal requirements for MA inter-county transfers, the following procedures are used.
NOTE: The MA intercounty transfer process applies to all MA budgets, whether or not they exist with a food stamp or cash assistance budget.
NOTE: If a cash case is closed for a reason that does not affect MA eligibility, MA must be opened in the correct category for the remainder of the MA certification period.
The CAO in the county that the household is moving from must take the following actions after finding out that a household is moving to a new county:
Get the individual or budget group’s new address.
Find out who is in the household, the employment status of each budget group member and each budget group member’s income.
Determine whether the individual or budget group is eligible for MA in the new county.
If the individual or budget group is not eligible, the caseworker must send an advance notice to discontinue benefits and should not send case information to the new CAO.
NOTE: Any appeal will be heard in the new county of residence.
If the individual or budget group is eligible, the caseworker must change the case address to the new address and discontinue MA effective on the day before the third cash assistance payment date after the move is reported. The CAO must forward the case record to the new CAO.
Send the individual or household that remains eligible a confirming notice, using reason code 099, option A.
Complete a renewal before the transfer if the renewal due date is in the calendar month of the transfer.
Send a CAO to CAO e-mail message with all the budget group’s information to the new CAO within five work days of the transfer. Include all information provided by the recipient and any relevant case/budget information, including the renewal due date.
NOTE: The caseworker must enter the following information:
Current county name.
New county name.
Date benefits are to close.
New county open date.
Renewal date.
New address.
New phone number.
The CAO in the county that the household is moving to must take the following actions:
Enter the case into application processing (AP) when notified of the case transfer.
Open all budget group members who moved for the remainder of the eligibility period as originally established in the losing CAO. To open the budget earlier ask the former county to close its budget immediately. The new open date will be the day after the closing date in the former CAO. There will be no lapse in benefits.
NOTE: Open the budget(s) without waiting for the physical transfer of the MA records, as long as the former CAO has investigated the budget group’s change and determined the budget group remains eligible for MA.
NOTE: A new application for MA is not required.
Request any additional information that may affect eligibility that the individual did not give to the former CAO.
If the budget group is still eligible, continue MA until the end of the eligibility period set by the former CAO before the transfer.
If the budget group is no longer eligible or if the budget group does not provide the required information, send an advance notice to close using the appropriate time period.
NOTE: If a cash budget closes in an intercounty transfer, the budget group must complete an application and interview for cash assistance. However, if the individual does not reapply for cash, the new CAO should open PC/PU 27 for the rest of the MA eligibility period for families with children.
A recipient who makes a permanent move to another state or country is not eligible for continued MA benefits.
Exception: An individual who moves from Pennsylvania to an institution in another state may still be considered a Pennsylvania resident. See Section 323.23, Individuals Living in an Institution, and Section 323.24, Individuals Placed by the State in an Out-of-State Institution.
When the CAO finds out that an individual has moved permanently out of Pennsylvania, it must take the following actions:
Discontinue MA.
Send the individual a notice telling him or her when and why benefits were stopped:
If the individual has submitted a signed, written request to close MA, an Advance Notice must be sent to the individual.
If the individual has submitted a signed PA1829 or written notice, send a Confirming Notice to the individual.
Note the reasons for the action in the case record or CIS case comments.
A recipient who moves permanently to another country is not eligible for continued MA benefits. 55 Pa. Code § 148.15
If a recipient reports a temporary absence from the United States, the CAO must continue MA for 30 days.
NOTE: The following are considered part of the U.S.: the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands and Swain's Island.
On the 30th day, the CAO must assume that the recipient has made a permanent move outside the country unless all of the following apply:
The individual is ill or has other good cause why he or she cannot return to Pennsylvania at the end of 30 calendar days.
The individual has not taken steps to establish residence outside the United States.
The individual continues to meet all other eligibility conditions.
The individual provides written proof of why he or she is unable to return.
As long as the recipient continues to meet all of the above conditions, the CAO must continue MA benefits.
A recipient who is temporarily out of the U.S. must comply with renewal requirements.
If the CAO decides that the individual (a) no longer meets eligibility requirements or (b) has not returned to the United States and has not shown that he or she continues to live in Pennsylvania, then the CAO must discontinue MA.
If an individual reports that he or she will be temporarily out of the U.S. for less than 30 days, the CAO must take the following actions:
Tell the individual to let the CAO worker know immediately when he or she returns.
Create an alert for the expected date of return.
If the individual does not contact the CAO within 30 days after he or she leaves the United States:
Discontinue MA.
Send the individual an advance notice telling when and why benefits were stopped.
If the individual reports that he or she will be unable to return to the United States within the 30-day period:
Determine whether the applicant/recipient group meets all requirements for continued MA.
Create an alert for the expected date of return.
If a partial or complete renewal is due during the temporary absence:
Send the individual a PA 600R.
Review the factors that make an individual eligible.
Make any required changes to the budget, or discontinue MA if the applicant/recipient group no longer meets eligibility requirements or does not complete the renewal process.
Send the individual an advance notice telling when and why benefits will be stopped.
Discontinue MA at any time that the applicant/recipient group no longer meets requirements.
Note the reasons for all actions in the record.
Updated April 23, 2018, Replacing February 14, 2012