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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 4 The agency will consider all categories of eligibility prior to a termination of eligibility as described in DSSM 14100.5 - Determination of Eligibility. 9 DE Reg. 774 (11/01/05) 17 DE Reg. 731 (01/01/14) 28 DE Reg. 387 (11/01/24) 14100.7 Fair Hearings A fair hearing is an administrative hearing held in accordance with the principles of due process. An opportunity for a fair hearing will be provided, subject to the provisions in policy at DSSM Fair Hearing Section. Any individual who is dissatisfied with a decision of the Division of Social Services may request a fair hearing. See DSSM Fair Hearing Section for policies covering fair hearings. 14100.8 Coordination of Eligibility and Enrollment with Other Insurance Affordability Programs The following words and terms, when used in the context of these policies, will have the following meaning unless the context clearly indicates otherwise. “Coordinated content” means information included in an eligibility notice regarding the transfer of the individual’s or households’ electronic account to the Federally Facilitated Marketplace (FFM) for a determination of eligibility for another insurance affordability program. “Electronic account” means an electronic file that includes all information collected and generated by the agency regarding each individual’s Medicaid eligibility and enrollment including any information collected or generated as part of the agency fair hearing process or the FFM appeals process. “Insurance affordability program” means a program that is one of the following: 1) Medicaid 2) Delaware Healthy Children Program 3) a State basic health program established under section 1331 of the Affordable Care Act 4) a program that makes available coverage in a qualified health plan through the FFM with advance payments of the premium tax credit established under section 36B of the Internal Revenue Code available to qualified individuals 5) a program that makes available coverage in a qualified health plan through the FFM with cost-sharing reductions established under section 1402 of the Affordable Care Act. “Secure electronic interface” means an interface which allows for the exchange of data between Medicaid and other insurance affordability programs and adheres to the requirements in 42 CFR Part 433 subpart C. 17 DE Reg. 503 (11/01/13) 14100.8.1 Transfer from Other Insurance Affordability Programs to the State Agency For individuals who have been assessed by the FFM (including as a result of a decision made by the FFM appeals entity) as potentially Medicaid eligible the agency must: • accept, via secure electronic interface, the electronic account for the individual and notify the FFM of the receipt of the electronic account; • not request information or documentation from the individual provided in the individual’s electronic account; • promptly and without undue delay, determine the Medicaid eligibility of the individual without • requiring submission of another application; and • notify the FFM of the final determination of the individual’s eligibility or ineligibility for Medicaid. 17 DE Reg. 503 (11/01/13) 14100.8.2 Evaluation of Eligibility for Other Insurance Affordability Programs For individuals who submit an application; return a renewal form; or whose eligibility is being redetermined due to a change in circumstances; and who are found ineligible for Medicaid, the agency will: • promptly and without undue delay, determine potential eligibility for, and as appropriate, transfer via a secure electronic interface the individual’s electronic account to the FFM, and • include coordinated content in the notice of denial or termination of Medicaid eligibility. 17 DE Reg. 503 (11/01/13)