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:
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:
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:
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:
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:
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
.
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:
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 SNAP or cash assistance budget.
When an individual reports an address change to another county within the commonwealth, CAOs will process an Intercounty Transfer (ICT). The CAO that receives the report of the address change will update the address, assess all impacts to MA benefits, and reopen the case in the gaining CAO if all required information is available.
For all active MA cases, CAOs must follow these steps for address changes that involve a move to a different PA county:
1. The office that receives the report of the address change will update the address
2. The office that receives the report of the address change will complete all pending Work Items due within the timeframe of the closure date if the information is available.
3. If a renewal or SAR is overdue or due within the timeframe of the system ICT advance closure date(s) or if there is an application pending, the office that receives the report of the address change will complete the renewal, SAR or application.
4. If a renewal or SAR is due within two months of the closure, and the correct date cannot be entered when case is opened, the CAO that receives the report of the address change will enter the earliest date possible, narrate the date entered with the reason, and send a renewal or SAR identifying the correct due date and the gaining CAO’s address. Once the renewal or SAR is processed in the CAO, enter and narrate the correct renewal or SAR date.
5. The county office that receives the report of the address change should make sure citizenship and identity verifications, as well as the last 2 renewals, SARs, and/or applications for benefits (if available), are in imaging.
6. Change address
a. To identify the gaining county, use the County/Zip Locator:
https://tools.usps.com/go/ZipLookupAction!input.action
b. If moving to a districted county, use the tools below to determine the district:
i. Allegheny CAO – Allegheny Zip Codes by Area
Allegheny Zip Codes by District
ii. Delaware CAO – Delaware Zip Code List
iii. Luzerne CAO – Luzerne Zip Code List
iv. Philadelphia CAO – Philadelphia CAO Address List
v. Westmoreland CAO – always assign new case to Greensburg District
7. Review the individual/budget group's new address, household composition, employment of each budget group member and income types and amounts available to each budget group member and compare this to what is recorded in eCIS.
8. If the individual reports a change in household composition, income or resources, review the case and request any necessary verification.
9. Narrate all changes: address, phone number, household composition, etc.
10. If the case information is unchanged and a renewal is not due in the month of the reported address change, the caseworker will discontinue Medicaid effective the day before the third cash assistance payment date after the move is reported using Reason Code 099 (NOTE: The caseworker will only have to enter the information for the new county address and phone number.)
11. Inform the individual to contact Health Choices at 800-440-3989 to select an MCO if needed.
12. Send a notice advising the individual that the address change has been processed. The notice must provide them with the address of the CAO in the new county of residence.
13. Narrate the actions taken and the circumstances surrounding the change.
14. The county that receives the report of the address change should close the current case and reopen the case in the gaining county’s record number. Assign to caseload 4545 in the new county.
15. Complete the ICT Template and e-mail it to the gaining CAO general mailbox with a cc to the losing CAO general mailbox. Flag for any concerns. This step is not needed if the gaining CAO completed the ICT.
NOTE: Any appeal will be heard in the new county of residence.
323.631 Forced Closing for Immediate Medical Need for New Managed Care
If there is an immediate medical need to have case closed before ICT closure date, follow the steps below ONLY AFTER an 099 closing has been completed and if an immediate opening is needed.
1. On the Case Summary Screen, select ‘Maintenance’. Make any necessary changes to the case.
2. Enter the closure action and Reason Code 052.
3. On the “Execute Eligibility” screen, the budget is will be set to close in the future. Select “Apply Adverse Action so the system presents the next possible close date.
4. After running eligibility, the close date should be the earliest close date possible.
5. Suppress the notice, submit the case, and clearly narrate the actions taken and why the notices were suppressed.
6. Assign to caseload 4545.
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 not 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.
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.
Reviewed May 3, 2024, Replacing February15, 2023