AFS Special Procedures: Medicaid Guidance During COVID-19

Please be advised that as we are beginning implementation of our unwinding plan. The following information is to aid you with determinations moving forward:

  • All closure determinations at review are to resume effective immediately.
  • Start applying negative actions (closures) if the household is no longer eligible or fails to complete the review process.  (These include anyone over resource, over income, unable to locate, etc.)
  • SMS (text) messages and email reminders are being sent.  A team is being set up to make cold calls to assist the households with getting their reviews turned in, so that we can make this transition back to pre-Pandemic handling as smooth as possible.
  • We redistributed cases and delinquent reviews to balance them out over the remaining course of the unwind.  You may have noticed that some D10 dates have been moved around.
  • Flexibility was granted to utilize strategies that allows to passively renew some medical cases.  If you see the following case note: “MEDICAL Auto Renewed: Ex Parte process used based on e14 waiver strategy outlined in the CMS unwinding efforts”, please know that the case has already been reviewed.
  • Doing a thorough case review before taking action could prevent someone from unnecessarily losing coverage when they should have been eligible.  The households could be out of practice; therefore, be sure to review the systems, such as previous Case Notes, BENDX, SDX, ACES, AVS, OnBase & WorkFlow, which could prevent rework and loss of coverage.
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