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Title 8: Medicaid Page 17 Iowa Department of Health and Human Services Employees’ Manual Chapter G: Case Maintenance Automatic Redetermination Revised November 4, 2022

Automatic Redetermination Legal reference: 42 CFR 435.916(f)(1), 435.930(b), 441 IAC 76.17(249A) Whenever a member no longer meets the eligibility requirements of the current coverage group, an automatic redetermination of eligibility for other Medicaid coverage groups will be made. EXCEPTION: An automatic redetermination will not be made if the reason the client is ineligible under the current coverage group relates to a condition of eligibility that applies to all coverage groups. Examples include refusal to provide verification and failure to assign a third-party benefit. For MAGI-related and Non-MAGI-related cases, the redetermination process is built in the ELIAS hierarchy when Eligibility Determination and Benefit Calculation (EDBC) is completed. However, when the person is an SSI recipient, you will first need to gather additional verification of income and resources before the redetermination process can be completed. If a non-MAGI-related person is no longer disabled, look for eligibility under MAGI-related Medicaid. If a MAGI-related person loses eligibility, check to see if the person is disabled for non-MAGI-related Medicaid. “Disabled for non-MAGI-related Medicaid” means that the person: ▪ Is currently receiving social security disability payments; or ▪ Has previously been determined disabled by the Department; or ▪ Is a child who lost SSI due to reevaluation of disability but who remains eligible for non-MAGI-related Medicaid under the Balanced Budget Act of 1997. The effective date of cancellation from the current coverage depends upon when you receive information that causes ineligibility.

Information Received: Time Frames to Complete Automatic Redetermination Effective Date of Cancellation By the tenth of the month Complete the redetermination by the end of month. First day of the month following the month the information was received. Issue timely notice. After the tenth of the month Complete the redetermination no later than the end of the following month. No earlier than the first day of the first month following the month the information was received, but no later than the second month following the month the information was received. Issue timely notice. During the redetermination period, provide Medicaid only to people who were receiving Medicaid in the eligible group when eligibility under the initial coverage group ceased. This applies only to situations where the information causing ineligibility was received after the tenth of the month. When an SSI recipient loses SSI and additional verification is needed, send form 470-3152 or 470-3152(S), Notice of Cancellation/Redetermination, and request the verification. Allow the client ten calendar days from the date of notification to return the requested verification.