Fail To Pay Evidence

MHN transmits information regarding participants who fail to pay their CHIP premiums to MEDES. This will create a piece of evidence called CHIP Failure to Pay. This could affect the participant’s eligibility for continued coverage. MEDES will reexamine the case and complete the Auto Finalize Process. This will also affect the Application Details.

All notices regarding adverse actions will be suppressed as MHD will send out notification of case closure due to non-payment of premiums.

NOTE: While this evidence is Active, participant can still be determined eligible for all other eligibility ME codes other than CHIP 73, 74 and 75. If the participant reports a CiC and is qualified for higher LOC they will be eligible upon that report, even if the CHIP Failure to Pay evidence is active and open dated.

 

Fail To Pay Evidence

CHIP Failure to Pay – Initial Payment Not Received

    1. From the Integrated Case > Evidence sub-tab > Dashboard folder > Review the Chip Fail to Pay evidence
    2. Verify the Participant Name
    3. Set End date (as applicable per policy)

NOTE: If the participant reapplies for CHIP, the End Date value on the participant Chip Fail to Pay evidence will have to be manually entered so that the participant can be eligible for CHIP 73, CHIP 74 or CHIP 75 after the end date.

CHIP Failure to Pay – Failure to Pay Recurring Premium

NOTE: Since the End Date is set to 90 days from the date the evidence is created, the participant will be ineligible for CHIP 75 for 90 calendar days. Since the system calculates the eligibility until the certification period, the participant may be eligible for CHIP 75 from the 91st day depending on the evidences on the case.

    1. From the Integrated Case > Evidence sub-tab > Dashboard folder > Review the Chip Fail to Pay evidence
    2. Verify the Participant Name
    3. Set End date = (as applicable per policy)

NOTE: The system will auto end date the Sanction End Date for individuals once determined eligible for another benefit other than CHIP 75. As part of the HCR finalization strategy, the system compares the proposed determination with the previous determination and if the system identifies the individual is eligible for a benefit other than CHIP75 and has active Fail to Pay evidence for Recurring payments, system end dates the “Sanction End Date” and “End Date” to current date.

Reinstatement of Benefits

    1. MEDES allows for retroactive reinstatement of eligibility
    2. Eligibility Reinstate Reasons cannot be used unless an approval notice has been received from MHD.

NOTE: Either the Ineligibility Reason or Eligibility Reinstate Reason fields must be populated. The trigger for this validation check will be to click Save on the evidence.