B-8420 Notification of Changes as a Result of Redetermination

Revision 25-2; Effective June 1, 2025

If a redetermination results in one of the following situations, dispose the case and provide the appropriate notice:

Decrease of co-payment - If the recipient's co-payment is decreasing, dispose the case action and send Form TF0001, Notice of Case Action, and Form TF0001P, Provider Notice, to notify the recipient and the facility. To correct the co-payment for a prior period, complete Form H1259, Correction of Applied Income . Note: Complete Form H1259 manually if a co-payment adjustment involves averaged income or incurred medical expenses. If all amounts are lower in the reconciliation shown on Form H1259, adverse action is not required. If Form TF0001 and Form TF0001P are not automatically generated, ensure a manual Form TF0001, Form TF0001P or both are sent.

Increase of co-payment - If the recipient's co-payment is increasing, dispose the case action and send Form TF0001 and Form TF0001P to notify the recipient and the facility. If the recipient does not request an appeal by the end of the 12-day notification period, the increased co-payment remains.

Denial of benefits - If a redetermination results in the termination of benefits, send Form TF0001 to notify the recipient. Send Form TF0001P to notify the facility, if applicable. If the recipient does not request an appeal by the end of the 12-day notification period, the benefits remain terminated.

For redeterminations, if the information provided indicates the person no longer qualifies for the current type of Medicaid, explore eligibility for all other types of Medicaid and the Medicare Savings Programs.