Policy Reference Case Maintenance Activities
• Notify Third Party Liability (TPL) Unit when CommonHealth Basic or Plus is approved. – Send copies of both sides of the enrollment form to TPL.
• Issue temporary CommonHealth card if requested for medical needs during period before client receives MassHealth card for CommonHealth Basic.
• Client receives MassHealth card.
• If ineligible because of income, PACES sends CommonHealth denial letter. – If ineligible individual is disabled, determine eligibility for CommonHealth as a disabled adult.
• Complete SMARTS Transmittal sheet for key entry. CommonHealth Policy Manual Welfare to Work Citation 513.000 – 513.600 Issue temporary CommonHealth Basic card when necessary for clients who are not currently enroDed in HMO’s. Review family income, availability of employer or other third-party insurance.
– One year after enrollment; – When changes are reported; or – When waiting period ends for employer health insurance. Review availability of and participation in employer’s health insurance plan Kaiser Calculator every six months for CommonHealth Assist cases.
– Complete PACES Worksheet to:
• adjust Department’s contribution toward employer-offered premium (if appropriate); and send notice advising client of new amount.
• If employer-offered health insurance becomes available to a CommonHealth Basic or Plus enrollee:
– Complete PACES Worksheet and TD. PACES will:
• determine eligibility for CommonHealth Assist:
• determine amount of Department’s contribution: and
• send approval letter informing client of amount of Department’s contribution. If client wishes to disenroll from HMO and chooses CommonHealth Basic, notify HMO representative to complete disenrollment paperwork.
Complete PACES TD and/or Worksheet to close case. PACES sends closing letter giving either advance notice or adequate notice depending upon the closing reason (see PACES User’s Guide)
. If client reports a change in income: – Verify income of all family members. – Complete PACES Worksheet. PACES will:
• determine if income is below 185% of federal poverty level; and
• adjust Department’s contribution to employeroffered health insurance. If client reports a change in household composition:
– Add or remove family member on PACES TD.
– PACES sends appropriate notification letter. If client moves:
– Complete PACES TD to change address and. if necessary, transfer case.
– Review HMO’s accessibility to client.
– PACES sends notice to client when case transfers.
– Tell client to contact worker in new office.
Replacing a Check Send referral to HMO marketing representative when: – Client moves;
– Case closes; or
– Household composition changes.
If client reports CommonHealth Assist check is lost, stolen, or not received;
• Confirm that the check was mailed and issued to correct address.
• See if the check has been returned to office and remail.
• Complete FCB-1 with your client.
• Give the FCB-1 to Data Entry Operator:
– immediately when your client received the check and it was lost or stolen then; or
– after waiting 2 days beyond check date
– when the check was delayed in the mail and your client confirms non-receipt.
• Meet with your client if FCB-2 is received from Finance to review signature on cashed check.
• Help your client complete FCB-3 when requested by Finance because the original check was cashed and signature on check is not your client’s signature:
• Check the Local Office Recipient Replacement Check Register and send NFL-9 to your client when replacement check has been issued.
Policy Reference Reminders AFDC policy Manual Stolen and Lost Checks Citation 306.500 – 306.520
• CommonHealth Basic clients shall receive a MassHealth card.
– TPL closes case on CommonHealth Basic and opens on CommonHealth Plus when client is enrolled in HMO.
– Client receives HMO card (MassHealth card will no longer be valid).
• CommonHealth Assist clients will not receive a card. They will receive a monthly check as a contribution toward the cost of their employer-offered health insurance.