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1)  Question:  What dates should be captured in the “Eligibility Start Date” and “Eligibility End Date” fields?

 

Answer:  Start and end dates are used by other PARIS states as a filtering tool for the Interstate match.  It is very important to enter both a start and an end date for each program and only submit records that are currently open for a program in your state.  In order to create consistency across states, it is recommended that states use one of the following options to determine program eligibility state and end dates:  

 

  • For the start date use the most recent actual program start date or the program start date of the current certification period.  For the end date use the end date of the current certification period. 
    • Example 1:  A case is open for Food Stamps and TANF.  The Food Stamp program was opened October 12, 2007 and the TANF program was opened May 24, 2008.  The next re-certification must be completed by September 30, 2008.  For Food Stamps use the start date 20071012 (CCYYMMDD).  For the TANF program use the start date 20080524.  For both programs use the end date 20080930.
    • Example 2:  A case is open for Food Stamps and TANF.  The Food Stamp program was opened October 12, 2007 and the TANF program was opened May 24, 2008.  The last certification was completed in June 2008 and benefits were continued starting July 1, 2008.  The next certification must be completed by December 31, 2008.  For Food Stamps use the start date 20080701.  For the TANF program use the start date 20080701.  For both programs use the end date 20081231.
    • Example 3:  A case is open for Food Stamps and TANF.  The Food Stamp program was opened October 12, 2007 and the TANF program was opened May 24, 2008.  The certification periods are not the same for both programs.  The current Food Stamp certification ends August 31, 2008.  The current TANF certification period ends November 30, 2008.  Use either methodology in examples 1 & 2 to determine the start date.  Use the last date of the certification period for each program for the end date, 20080831 for Food Stamps and 20081130 for TANF. 

 

  • For the start date use the most recent actual program start date or the program start date of the most recent re-certification (same as first option).  For the end date use 99999999 to indicate that the program is still open. 
    • Example 1:  A case is open for Medicaid and Child Care.  The Medicaid program was opened November 18, 2007.  The Child Care program was opened March 4, 2008.  Both programs are still open at the time the PARIS file is submitted.  Use 20071118 for the Medicaid start date and 20080304 for the Child Care start date.  Use 99999999 for the end date for both programs. 
    • A case is open for Medicaid and Child Care.  The Medicaid program was opened November 18, 2007.  The Child Care program was opened March 4, 2008.  The last certification was completed April 30, 2008 and benefits were continued as of May 1, 2008.  Both programs are still open at the time the PARIS file is submitted.  Use 20080501 as the start date for both programs and 99999999 as the end date. 

 

2)  Question:  How do you locate the group of PARIS Federal file matches that possibly lead to potential TRICARE Third Party Liability (TPL) identification?

Answer:  The group that comprises virtually all of the persons eligible for TRICARE may be identified by isolating the ‘Record Type’ (position 130 & 131 on Federal output file) identified as ‘MR’ or ‘MA’ clients. These, including all of the dependents listed in each of their state assistance units (spouse, children etc) are likely TRICARE eligible and already entered in the Federal DEERS (Defense Enrollment Eligibility Reporting System) system. By comparing this group with those already known by your state’s Third Party COB (Coordination of Benefits), you will be left with new TRICARE related third party enrollments. These should be sent to the COB office for necessary action. Your state and PARIS related savings may be attributed to and based upon the resulting pre and post Medicaid payments. Keep in mind that your state is entitled to retroactively (up to one year) bill TRICARE for any services that Medicaid paid.   

3)  Question:  What is the process used to identify veterans that are between 70-100% disabled? I heard they were entitled to full VA care and for the most part, shouldn’t require Medicaid coverage.

Answer:  Veterans that receive disability percent payments may be found in the ‘Entitlement Code’ field (positions 419 & 420 on the VA output file). The second position of this 2-position data field will or should reflect a ‘1’ (compensation). An example of one that you may see in this data field is ‘71’.  The first position ‘7’ identifies this to be a Vietnam era veteran. The second position ‘1’ reflects receiving compensation (disability percent related) related benefits. Thus you have a Vietnam veteran that is receiving a monthly disability percent based monthly benefit.  Arranging the second position ‘1’ by their gross dollar benefit and beginning with those with the highest monthly benefit, you will be starting with those that are undoubtedly 100% disabled. Click here for a table that lists the usual monthly amounts associated with the respective % of disability. As veterans receive extra dollar amounts associated with loss of limbs etc, the amount listed in the gross may be higher than the base amount found on the table.  The VA table should be utilized as a guide. 

 

4)  Question:  When it is determined that a recipient has received benefits in more than one state in the same month which state pursues the overpayment and/or disqualification? 

 

 

Answer:  The following answer is very general.  States should follow up with their own policy specialists and possibly the federal agency that administers the program for which the possible overpayment is alleged for specific clarification.  The question has come about mostly because of Food Stamp Simplified Reporting and therefore the information below is based mostly on Food Stamp regulations and clarifications.  Also, the question of whether or not an IPV of any type should be pursued for any matter depends on the particulars of each case. 

 

In general it depends on the reporting requirements of the state, specifically if the recipient is required to report if they move (including if they move to another state).  When a client applies for benefits in a state and fails to report that they were currently participating in the program in another state, as required by your application, you may pursue an Intentional Program Violation (IPV) because the application was falsified.  The claim resides with your state.  If the recipient was required to report the move to the state they moved from and did not, that state may also have a potential overpayment and IPV.  Thus, if a recipient moves out of your state and is required to report the move timely but does not, your state may also consider pursing an overpayment and IPV because the client failed to report. 

 

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