Page 2

Community Engagement - ACA Adult Expansion: (ACA Adult Medicaid and ACA Adult) If a discrepancy is discovered or the auto-renewal process cannot run at redetermination, a pre-populated redetermination form is mailed to the household, allowing 30 days for the form to be returned. The client is required to respond and provide necessary information; they must either return the signed redetermination form, complete the redetermination online, via the PAHL, or in person. The Medicaid participant must meet community engagement requirements or have an exception in any 3 months since the last redetermination; or qualify for an exclusion in the eligibility month. The 3 months do not have to be consecutive. Ongoing community engagement requirements can be met by participating in at least 80 hours per month of qualifying activities or earning the equivalent of 80 hours at the federal minimum wage per month. A combination of these activities can also meet this requirement. Available queries will be run as a part of the review. If the recipient/household reports a change at redetermination that may be verified by use of an available query or matches current information available in the case file, no further verification is requested from the client. Information related to community engagement requirements, exceptions, or exclusions may need further verification. See Community Engagement and Exclusion Policy Client’s self-attested income is required to be electronically verified at redetermination. If the electronic interface returns information with a reasonable compatibility, no further verification is required. If it is not reasonably compatible or the information is not matching, verification is required. A CSC may call and attempt to get a reasonable explanation of a discovered discrepancy. If the attempt to obtain a reasonable explanation is unsuccessful or the reported change can’t be verified, hard copy verification of the change is required. When verification is not submitted with the reported change, a request for information will be sent. If the requested information is not submitted, benefits will be terminated. If the reported change could result in a negative action, as a courtesy, send a request for information if timely notice of adverse action would still be possible by the due date on the notice. If timely notice would not be possible by the due date of the request for information notice, benefits will be closed