Beneficiary Eligibility Impacts for June 2018

PROVIDER ALERT

The Code of Federal Regulations (42 CFR 435.916) requires the state Medicaid agency to implement streamlined annual renewal processes for Medicaid beneficiaries under new modified adjusted gross income (MAGI) rules. These changes, designed to decrease the amount of paperwork received by beneficiaries and increase the use of automation, were first implemented in South Carolina in 2014. As with the traditional annual renewal process, individual beneficiaries that do not return the evidence necessary to maintain Medicaid eligibility exit the program after due notice. 

Due to an above average number of individuals who received but did not return annual review forms mailed in April 2018, the number of individuals exiting the Medicaid program on June 1 was also above average.

This Medicaid Alert is to remind providers that under federal rules, individuals who lose Medicaid coverage for failing to return renewal forms on a timely basis may have their coverage restored - provided that they continue to meet other Medicaid eligibility rules - by submitting a renewal form within 90 days of their coverage loss. In this case, South Carolina Department of Health and Human Services (SCDHHS) will deem the individual's coverage to have been continuous, as if there had never been a break in coverage. Providers serving Medicaid beneficiaries that have recently lost coverage should encourage them to return annual review forms (Form #WKR002, attached) to SCDHHS so that services rendered may continue to be reimbursed by the agency. One-third of the individuals who lost coverage on June 1 have already regained it through this process.

If there are questions about a patient's eligibility or enrollment in a managed care plan, providers can check their status using the provider web tool, portal.scmedicaid.com. Beneficiaries who have questions regarding their Medicaid coverage should call the Healthy Connections Member Contact Center at (888) 549-0820.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

Tags: 
Report Fraud