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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL If information is not provided within the time period given, deny the application or terminate assistance allowing adverse action. Do not deny individuals if the pending information is not used in that individual’s eligibility determination. Example: Household consists of grandma, adult child and grandchild. Grandma claims all members on her taxes. Household fails to provide grandmother’s income verifications. The grandchild would not be denied because the grandmother’s income is not used in her eligibility determination. If information is provided prior to the denial/termination action being taken, process the case using the verifications. Note: When proof of pregnancy ending/birth of child is requested but not provided, and no information is available through collateral contact or approved electronic data source, the ongoing eligibility of the pregnant woman must be re-evaluated for all other Medicaid coverage groups (without the unborn member) prior to termination. The unborn member record(s) and pregnancy information should be updated to reflect the unborn as no longer present in the household (see MAM D-520 Questionable Information and/or Unreported Changes). D-155.1 Future Actions If staff has information about anticipated changes in circumstances that may affect ongoing eligibility of a case, they must re-evaluate eligibility at the appropriate time based on such changes. Create a future action for the date of the anticipated change to affect the change timely. Example: Critical age changes, birth of a child(ren), seasonal employment. D-160 CERTIFICATION PERIOD Medical assistance is approved ongoing from the first (1st) month of eligibility. Individuals remain eligible for Medicaid until information is received indicating they no longer meet eligibility criteria. A redetermination of eligibility must be completed at least every 12 months. D-160.1 Nevada Check Up NCU is approved effective the month following the month of approval. If processed after cut-off the effective date is the second (2nd) month after the month of approval. Approve NCU for 12 months from the enrollment date. Child(ren) are entitled to 12 months continuous eligibility. An enrollee’s 12-month continuous eligibility may be terminated for the following federally recognized exceptions: • The child attains the age 19; • The child or child’s representative requests a voluntary disenrollment; • The child is no longer a resident of the State; D-155 MAGI APPLICATION PROCESSING Division of Social Services Medical Assistance Manual 25 July MTL 07/25 PENDING INFORMATION