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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |500 Effective Month: December 2016 101.15 THE REDETERMINATION OR RENEWAL PROCESS Redetermination is the process of verifying whether a recipient continues to meet the eligibility requirements of a particular program. Redeterminations are classified as either regular or special reviews. A regular review is an annual review of all eligibility factors that are subject to change. A special review is completed when a portion of the case must be re- worked or case information must be updated because of a change. This chapter addresses the redetermination process.
101.15.01 REGULAR REDETERMINATIONS OR RENEWALS – MAGI & ABD Federal regulations require that the eligibility of every Medicaid and CHIP recipient be reviewed at least every 12 months. Mississippi state law also requires annual reviews. During the regular redetermination process, the recipient’s circumstances are reviewed and each eligibility factor that is subject to change, such as income and/or resources, is re-evaluated. Recipients are not asked to provide information that is not relevant to ongoing eligibility or that already been provided and is not subject to change.
101.15.01A FREQUENCY OF REVIEWS A full review must be conducted for all eligible household members (MAGI and ABD) at the earliest 12-month review when case members have different review due dates. When a redetermination is currently due for some but not all case members, a redetermination contact will be set on everyone to attempt to align redetermination dates for the following year and assure one annual review for case members:
• Adults in the case can have their 12-month review period shortened by a change in circumstances that affects adult(s) in the case. The exception is a pregnant adult who is eligible in COE-088.
• Children that are not due for review require special handling to ensure protection of their 12-months of continuous eligibility, as described in 101.16.01B and 101.16.01C below.