Page 12

such consent is provided, the State may retrieve and review such information when conducting all subsequent annual renewals. 2. Duty to Report -- Medicaid members are required to report changes in eligibility factors to the Medicaid agency within ten (10) days from the date the change takes effect. Self-reports are permitted through the eligibility system on-line portal. Medicaid members also may report such changes in person, via fax, by mail, or telephone with the assistance of HSRI, DHS agency representative, or Navigator. Failure to report in a timely manner, as noted above, may result in the discontinuation of Medicaid eligibility. 3. Cooperation – Medicaid members must provide any documentation that otherwise cannot be obtained related to any eligibility factors subject to change when requested by the State. The information must be provided within the timeframe specified by the State in the notice to the Medicaid member stating the basis for making the agency’s request. 4. Voluntary Termination – A Medicaid member may request to be disenrolled from a Medicaid health plan or to terminate Medicaid eligibility at any time. Disenrollment results in the termination of Medicaid eligibility. 5. Reliable Information – Medicaid members must sign under the penalty of perjury that all information provided to the Medicaid agency at the time of application and any annual renewals thereafter is accurate and truthful. 3.3 Information 3.3.1 For Further Information or to Obtain Assistance A. Applications for affordable coverage are available online on the following websites: 1. www.eohhs.ri.gov 2. www.dhs.ri.gov 3. www.HealthSourceRI.com B. Applicants may also apply in person at one of the DHS offices or by U.S. Mail. Request an application by calling 1-855-840-4774 or TTY 1-888-657-3173. C. For assistance finding a place to apply or for assistance completing the application, please call: 1-855-840-HSRI (4774). 3.4 Severability A. If any provisions of these Regulations or the application thereof to any person or circumstance shall be held invalid, such invalidity shall not affect the provisions