New Insider’s Edge Updates: Issues 153-155

The Insider’s Edge newsletter is produced by the Maryland Department of Health and Mental Hygiene.

In the issues, “Medicaid Marge” discusses Medicaid eligibility and enrollment policy.

You can also visit DHMH’s Medicaid Marge main page to search by issue number or keyword, or email questions to dhmh.medicaidmarge@maryland.gov.

Here is a summary of issues 153-155 of Insider’s Edge:

Issue 153: Newborns and Medicaid Coverage

This issue reviews tips on enrolling eligible newborns in Medicaid:

  • If the mother is enrolled in Medicaid
  • If the mother is not enrolled in Medicaid, including:
    • If the mother doesn’t have active Medicaid and appears eligible
    • If the mother does not appear to be Medicaid-eligible but the child does

Issue 154: Case Comments

Please create detailed case comments. Case comments are critical to include in every application. They can help explain special situations, detail the consumer’s concerns, what was done to resolve the issue, and give more context for future workers who look at a consumer’s application.

This issue includes steps to create case comments, including helpful screenshots from the application.

Issue 155: Top 5 Tips for Verification Checklist Items

  1. Citizenship/Lawful Presence Status does not need to be verified for a household member not applying for coverage (leave pending).
  2. A Social Security Number (SSN) does not need to be verified for a household member not applying for coverage (though if this is the tax filer or income earner, it will inevitably trigger an income VCL). SSN VCLs for household members not applying for coverage should be marked as “N/A.”
  3. The application may not be unilaterally modified in a way that will change the consumer’s program eligibility without the consumer’s acknowledgement. This is especially relevant for Income VCL processing, which should not be unilaterally changed (de minimus changes such as spelling correction or address changes are OK) without first contacting the primary member. If the worker is unable to contact the consumer, then the appropriate next step is to fail the VCL item, not to change the application.
  4. Read case comments before proceeding to VCL work items to check for special circumstances. Update case comments with your own actions and the rationale you used for VCL determination. (Read more about case comments in INSIDER’S EDGE: Issue 154.)
  5. Once a document is provided to satisfy a VCL, you should not compare the document with MABS and then use the MABS information to fail the VCL. Once the document is provided, it should be compared to the attestation, not an electronic resource. The expectation is that workers will check all systems for potential verification before failing a VCL. They should be checked against the attestation, not a provided document. Documents that are current and complete trump all electronic services.

About “The Classroom”

“The Classroom” is Maryland Health Connection’s blog for its consumer assistance community, including navigators, authorized brokers, certified application counselors, caseworkers and call center staff. Check here for updates on training, website releases, new tools, and other helpful information as you help get Marylanders covered through the health insurance marketplace.

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For questions on this topic or to suggest additional topics for The Classroom, email mhc.trainingsupport@maryland.gov.