Conducting a Special Case Review

Conducting a Special Case Review A. A special case review is completed when changes occur between regular reviews which may result in adjustments to eligibility or benefit level. B. A special case review is not a full review. 1. The special case or an individual is evaluated to consider the impact of the changed information. 2. Factors unrelated to the change are not re-verified as part of a special case review. C. A special case review of eligibility is required when: 1. The beneficiary reports a change in circumstances which could affect eligibility and benefit level, 2. Information is received from any other source which could affect eligibility and benefit level, and/or 3. Potential changes in eligibility are indicated by information available to the Division of Medicaid. D. The special case review process may result in termination of benefits, benefit reduction or adjustments to Medicaid income. It may also involve procedural changes, including, but not limited to, updating or correcting case information with no impact on eligibility or benefits.