Option 2

Under the second option we define at § 435.558(b)(2)(ii), a State is unable to verify an applicable individual's compliance with the community engagement requirement only after providing the pre-populated renewal form in accordance with § 435.916(a)(3) to a beneficiary whose eligibility cannot be renewed based on reliable information in accordance with § 435.916(a)(2). Specifically, a State would consider that it is “unable to verify” an individual's compliance if either: (1) the returned renewal form does not provide sufficient information to demonstrate the beneficiary's compliance with or exception from the community engagement requirement, or to demonstrate that the requirement does not apply; or (2) the beneficiary does not return their renewal form when the only information needed to redetermine eligibility is related to demonstrating compliance with the community engagement requirement. The State is then considered unable to verify compliance with the community engagement requirement and must provide the beneficiary the notice of noncompliance under § 435.558(c). ( printed page 33412)

This option differs from option 1 because the State would send the notice of noncompliance to the beneficiary after the time allotted by the State under § 435.916(a)(3) to return the renewal form or, if earlier, after the individual has returned their renewal form without sufficient information to verify that the individual demonstrated community engagement, met an exception, or is excluded from the requirement.

We note that under this second option, the State is only required to send the notice of noncompliance if compliance with the community engagement requirement is the only factor of eligibility that remains to be verified after the time allotted for the beneficiary to return the renewal form has elapsed. A State does not need to send the noncompliance notice in instances where the State must request information on the pre-populated renewal form related to multiple factors of eligibility, and the individual does not return their form or returns their form without all the necessary information for eligibility criteria other than community engagement. In this case, the State must provide notice and fair hearing rights consistent with § 435.917(b) and part 431 Subpart E before disenrolling the individual for procedural reasons. States should also inform such individuals that, if they later return their renewal form, during the reconsideration period under § 435.916(a)(3)(iii), their eligibility may be reconsidered and how the individual may demonstrate community engagement during the reconsideration period.

We outline two scenarios under Option 2 when an individual does not return the renewal form to illustrate when the State needs to send the notice of noncompliance.

Option 2—Scenario 1: After checking reliable information available to the State during the ex parte process, the State has reliable information available to verify continued eligibility for all factors of eligibility for an applicable individual except community engagement. The State sends the applicable individual a pre-populated renewal form that requests information related to community engagement. If the applicable individual does not return their renewal form requesting information related to community engagement, the State must follow the community engagement noncompliance procedures at § 435.558(a), beginning with sending the noncompliance notice.

Option 2—Scenario 2: After checking reliable information available to the State during the ex parte process, the State does not have sufficient reliable information to complete the renewal for State residency or community engagement and sends the applicable individual a pre-populated renewal form that requests information needed to complete the renewal. If the applicable individual does not return the renewal form with requested information on residency, the community engagement noncompliance procedures at § 435.558(a) do not apply in this scenario because the State does not have sufficient information to determine the individual's continued eligibility for Medicaid. The State must provide notice and fair hearing rights consistent with § 435.917(b) and Part 431 Subpart E and disenroll the individual from coverage for procedural reasons at the end of the individual's eligibility period.

The second option could result in the State needing to send the notice of noncompliance to fewer individuals, as States are expected to collect the information needed to renew eligibility on the renewal form, including information related to community engagement. However, a State selecting this option would need to account for the additional time it would take to complete renewals, because the State is providing two separate periods of at least 30-calendar days for the individual to provide information with the pre-populated renewal form and the noncompliance notice. States must complete the entire renewal process, including the noncompliance procedures, by the end of the beneficiary's eligibility period.

We believe that providing States with these two options allows them the ability to operationalize the noncompliance procedures within the context of the existing renewal process, without creating unnecessary confusion for the beneficiary or disruptions to State operations, in the manner the State determines most appropriate for its circumstances.

If a State receives a completed renewal form and any requested information or documentation after the timeframe provided by the State, but prior to the end of an individual's eligibility period, the State must act on this information by promptly redetermining eligibility and must have a mechanism in place to ensure that eligibility and coverage continue, consistent with § 435.930(b), until the information received is evaluated and a final redetermination is made. [ 105 ]