140 REDETERMINATION

140.1 “Redetermination of eligibility” is a case review and/or the request for necessary verification to determine whether a member enrolled in a Medical Assistance Program continues to be eligible. Eligibility shall be redetermined at least every twelve months since the last eligibility determination. Eligibility may be redetermined through telephone, mail, or online electronic means. Prior to making a determination of ineligibility, the eligibility site must review on all bases of Medical Assistance eligibility for a member. A. “Ex Parte Review” is a redetermination of eligibility for a member without requesting verification by utilizing available information from the member’s account, electronic sources and other assistance programs. 1. If verified information is available for any of the six months prior to the redetermination month, and the member meets all other eligibility requirements, then an approval notice will be sent to eligible members of the household who are requesting assistance. This approval notice shall include directions on how to view the information used to determine eligibility. 2. If all required information is not available and/or the information on file does not support a finding of eligibility, a redetermination form,as described in Section 140.1.A.3, and/or a verification form will be issued to the household at least 30 days before the end of the eligibility period. The household will be sent a prepopulated redetermination form with the current information on file and a notice of required verifications to determine eligibility at least 30 days prior to the end of the eligibility period. 3. The redetermination form shall direct members to verify that the information provided is accurate or to report any changes to the information. Members must complete and return the redetermination form with the necessary verifications and the signature form. If a member fails to sign the signature form or comply with any of these requirements, the member will be terminated from the program for failure to complete the redetermination process. 4. If the member submits the redetermination form and/or verification information before the end of the eligibility period, the member must maintain coverage until the eligibility site can make a final determination. i. The eligibility site has 30 calendar days from the date the documents are received to make a final determination. 5. If the member submits the redetermination form and/or verification information after the end of the eligibility period, the member will not maintain coverage. 6. If incomplete information is submitted or a member reports new changes, the eligibility site must contact the member by telephone or in writing to provide required documents or requested verifications. i. If requested verifications are needed, the eligibility site must send a form with a letter specifying the items that require completion. The member shall return the completed request form to the eligibility site no later than ten working days; ii. The eligibility site will have fifteen working days from the date the documents are received to make a final determination. B. “Reconsideration period” is the 90-day time period allowed after a member's eligibility is terminated due to failure to return the redetermination with the necessary verifications and the signature. The member’s eligibility must be reconsidered if the member submits the requested information within 90 days following termination of eligibility. 1. Members who return properly completed redetermination forms and requested information during the reconsideration period will not be required to submit a new application for eligibility. If redetermination forms and requested information are not returned within 90 days after the termination, the member must submit a new application for enrollment in the program. 2. For members who are determined to be eligible for Medical Assistance within the reconsideration period, the effective date of coverage will be the first day of the month in which the redetermination form was returned. If the member has a gap in coverage due to submitting the redetermination within the reconsideration period, the member can request up to three months in retro coverage.