101.15.07 TIMELY AUTHORIZATION

The approval of a Medicaid redetermination is timely if it is authorized by the last day of the month in which the review is due. If Medicaid or CHIP benefits are terminated, the action must be authorized no later than the adverse action deadline in the review month to be effective the following month. When a redetermination closure is not authorized by the adverse action deadline in the review month, the case or individual is out of certification. However, an improper payment report is not required for the untimely closure. Ineligibility must exist for another reason for an improper payment report to be prepared. Adverse Action Deadlines The adverse action deadline is the 15th of the month in order to allow 10-days advance notice plus 5 days mailing time. Action must be taken by the adverse action deadline in the review month if coverage is to be terminated at the end of the review month. If Medicaid or CHIP termination action is authorized by the 15th of the month in which the review is due, the termination is effective at the end of the review month. An exception is February when the adverse action deadline is the 13th. NOTE: Non pregnant adults are not guaranteed 12 months of coverage. If termination is appropriate, the specialist will take action to terminate an adult’s eligibility for the earliest possible month. However, coverage must be terminated no later than the adverse action deadline in the last month of the review period for the redetermination closure to be timely.