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This page last updated in Release Number: 26-02 Release Date: 04/15/2026 Effective Date: 02/23/2026 3.3 Redeterminations for Changes When a member no longer meets the eligibility requirements of their current health care program due to a change, their existing coverage must be maintained while eligibility for all other health care programs is being determined. Example 1 Anders is enrolled in SSI-Related Medicaid and QMB. On July 13, he reports an income increase, bringing his countable income to 115% FPL, which is over the income limit for both SSI-Related Medicaid and QMB. While the income verification is requested and his eligibility for other benefits is being determined, Anders’s existing benefits are maintained. On July 22, Anders is determined eligible for an unmet Medicaid deductible and SLMB. Anders’ SSI-Related Medicaid and QMB end August 31, and the Medicaid deductible and SLMB begin September 1. Example 2 Ella is enrolled in MAPP. Outside of CWW, she is also enrolled in IRIS. On November 2, she reports that she received an inheritance that puts her over the $15,000 asset limit for MAPP. Because she is enrolled in IRIS, eligibility must be determined for other health care, including Waiver Medicaid. Ella is married and spousal impoverishment policies apply to the Waiver Medicaid determination. Verification is requested for the additional financial information (and spousal signature) needed to determine if Ella is eligible for Waiver Medicaid under spousal impoverishment rules. Ella’s MAPP coverage is maintained for December while eligibility for Waiver Medicaid is determined. On November 23, Ella is determined eligible for Waiver Medicaid. Ella’s MAPP coverage ends December 31, and Waiver Medicaid begins January 1. 3.3.1 Changes in Circumstance Health care eligibility must be promptly redetermined between regular renewals whenever information is received about a change in a member’s circumstances that may affect their eligibility. Requests for information or verification must be limited to information related to the change. During redeterminations of eligibility due to a change in circumstances, the member must remain enrolled in their prior health care assistance group without disruption until enough information is available to determine all health care eligibility.

When an individual is enrolled in a new health care certification period on a case, new 12-month certification periods will be established for all eligible health care members in the household, with some exceptions.

New certification periods will be established for existing eligible members when an individual is enrolled in health care following a change in circumstances, person-add, new program request, or renewal. For example, new certification periods can be established when a person joins the household and is enrolled in health care, changes health care categories, or a previously ineligible person becomes eligible due to a change (for example, a reduction in income puts them under the program limit). New certification periods will not be established for an existing member when: • A newly added person is found ineligible. • A new assistance group is pending. • The member is open for time-limited benefits.