CSM 122 KCHIP and Closure of Child Only Medical Cases

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					                                 COMMONWEALTH OF KENTUCKY
                                 Cabinet for Health and Family Services
                                    Department for Income Support
                                      Child Support Enforcement

TO:           All IV-D Agents and Staff                                                    CSM No. 122
              Child Support Enforcement Staff

FROM:         Steven P. Veno
              Deputy Commissioner

DATE:         September 2, 2009

SUBJECT:      Kentucky Children’s Health Insurance and Closure of Child-Only Medical Cases

Child Support Memorandum No. 110, issued 12/09/2008, provided changes to the Kentucky Children’s
Health Insurance Program (KCHIP) and questions and answers related to case closure. The KCHIP
information remains unchanged and has been added to this memorandum. The case closure information
has been revised to reflect changes in the federal case closure criteria.

Effective November 1, 2008, changes were made to the Kentucky Automated Management and
Eligibility System (KAMES), which affect how the IV-A office will process KCHIP and "I" Medical
Assistance cases. KCHIP case members will only be a child(ren) whose family meets a certain income
levels. An "I" medical case contains a child(ren), but can also contain an adult member under certain
conditions.

Family Support staff are no longer referring all "I" cases for Medical Support Enforcement, only cases
where the parent/specified relative wishes to pursue medical support enforcement are referred. When
Child Support Enforcement (CSE) staff receive a case pending approval (PNDA case) for an "I" MA
child only, the case is worked as usual. CSE staff will schedule an appointment to have the client sign
the complaint. The case should not be closed just because it is an "I" medical case.

In addition, Family Support staff will no longer refer cases with a deemed eligible newborn child. If the
mother is receiving Medicaid when the child is born and the child continues to live with the birth
mother, the child is eligible for Medicaid without regard to technical or financial eligibility factors,
including CSE/MSE, from the birth month through the 12th month. During that first year, the client
does not have to cooperate and complete a child support referral in order for the child to receive MA. If
he or she wants child support enforcement services, he or she would need to contact the IV-A office and
ask to complete the child support referral.

A recent change in the federal regulation relating to case closure now allows states to close child only
medical cases if the custodial parent is not cooperative. The change in the federal regulation still does
not allow states to close child only medical cases based on the custodial parent's request.

Office of Child Support Enforcement (OCSE) Action Transmittal 08-08 issued the final rule, which
provides the following changes to CFR 303.11:

       Section 303.11—Case Closure Criteria - Under § 303.11(b)(11), In a non-IV-A case receiving
        services under § 302.33(a)(1) (i) or (iii), or under § 302.33(a)(1)(ii) when cooperation with the
CSM No. 122
September 2, 2009
Page Two


        IV–D agency is not required of the recipient of services, the IV-D agency documents the
        circumstances of the recipient of services’s noncooperation and an action by the recipient of
        services is essential for the next step in providing IV-D services.

       Section 303.11(b)(10) was revised in response to comments with language similar to paragraph
        (b)(11) to read as follows: ‘‘In order to be eligible for closure, the case must meet at least one of
        the following criteria in a non-IV–A case receiving services under § 302.33(a)(1)(i) or (iii), or
        under § 302.33(a)(1)(ii) when cooperation with the IV–D agency is not required of the recipient
        of services, the IV–D agency is unable to contact the recipient of services within a 60 calendar
        day period despite an attempt of at least one letter sent by first class mail to the last known
        address.’’

Therefore, when a MA referral is received from IV-A and the only active participant in the IV-A case is
the child, if the custodial parent fails to cooperate with the child support office, a notice is sent to the IV-
A office advising of the custodial parent’s noncooperation. After the IV-A office is notified, case
closure can be initiated, using CNON - Client Not Cooperative. A Custodial Parent Notice of Intent to
Discontinue IV-D Services (Form CS-137) must be sent and 60 days after the CS-137 is sent, the case
can be closed on KASES. Child support staff must document the noncooperation in the KASES system
prior to initiating case closure.

When a MA referral is received from IV-A and both the custodial parent and the child are receiving
medical assistance, if the custodial parent fails to cooperate with the child support office, a notice must
be sent to IV-A to sanction the custodial parent. Once IV-A has sanctioned the custodial parent and
he/she is removed as an active member in the MA case, case closure can be initiated, using CNON -
Client Not Cooperative. A Custodial Parent Notice of Intent to Discontinue IV-D Services (Form CS-
137) must be sent and 60 days after the CS-137 is sent, the case can be closed on KASES. Child support
staff must document the noncooperation in the KASES system prior to initiating case closure. If IV-A
fails to sanction the custodial parent and he/she continues to receive medical assistance, then case
closure cannot be initiated.

It is extremely important for child support staff to notify the IV-A agency of the custodial parent’s
noncooperation. Staff must document the noncooperation and the imposed sanction on KASES, prior to
initiating case closure. These changes apply to all cases currently on KASES, as well as any that are
received in the future.

Obsolete

CSM No. 110, Kentucky Children Health Insurance Program (KCHIP) and “I” Medical Case Changes,
12/19/08

				
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