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2200.00.00 CONTINUING CASE PROCESSING

This chapter contains policy regarding continuing case processing, including:

• Redeterminations (Section 2205) • Changes (Section 2215) • Processing Changes (Section 2220) • Adding an Individual to the AG (Section 2225) • Timely Notice of Adverse Action (Section 2232) • Changes in Category of Assistance (Clevidence Ruling) (Section 2235) • Reduction in Scope of Medicaid Coverage (Section 2236) • Suspension of Medicaid Benefits (Section 2237) • Discontinuance (Section 2238) • Correction of Spend-down and Liability (Section 2239) • AG Address Change (Section 2240) • Voluntary Withdrawal from Assistance (Section 2250).

2205.00.00 REDETERMINATIONS

Periodic reviews of eligibility must be made on assistance cases to ensure that benefits are computed correctly. A redetermination is the process in which the caseworker gathers information on the circumstances of the case members and verifies all changeable elements to establish continuing eligibility. For changes in circumstances which happen after initial approval but outside of the annual renewal timeframe, please see 2215.00.00 (and following) further in this chapter.

The requirements for redetermination of eligibility at annual renewal are discussed in this section. Annual renewals will be conducted for both MAGI and non-MAGI individuals once a year.

The only groups which typically do not complete annual renewals are those for whom a determination of income or resources is not required: ongoing pregnancy/postpartum (12 months after pregnancy ends) members, foster children and those receiving Adoption Assistance, former foster children who aged out of foster care at age 18 and have not yet turned 26, and SSI recipients. Any changes in address or other household factors should be followed up on for these members when the change happens.

Ex-Parte (Automatic) Renewals When it is time for annual renewal, the eligibility system will first attempt to gather electronic data to determine whether we have recent and reliable information which shows the member remains eligible. Common data sources which are checked are The Work Number and, for non- MAGI individuals, the Asset Verification System. If electronic data is returned showing the individual is still eligible for Medicaid, they qualify for an ex-parte renewal.