Medicaid Policy
Medicaid Policy
A. Review Requirements
1. A review must be completed every 12 months.
2. The agency must attempt an ex parte review before requiring participation. (see 721-1)
3. Send a pre-populated review form, including the 116M form, to the member. (See 1008-2 for details of the review process)
a. The review form must include the most current electronic information available and a list of verification needed to complete the review.
b. The member must submit a new form 116M or verify the current health insurance coverage or plan information.
4. The member has 30 days from the date the form is mailed to respond.
5. The review form must be signed to be considered complete. Signatures are required on reviews that require member participation and follow the same rules as application signatures found in section 703-1.
6. If the case closed for failure to complete the review, the member has three months following the closure date to contact the eligibility agency to complete the review.
a. The benefit effective date is the first day of the month in which the member responds.
b. An interview or application form is not required.
c. Waive the ‘already insured rule’.
d. If the member provided updated TPL information during the failed review period, do not request it again to complete the review.
7. If the member does not complete the review within the three month review period, the member must re-apply during the next open enrollment period.
§ All eligibility factors apply, including enrollment in employer-sponsored health insurance.
B. Referrals for the Advanced Premium Tax Credit.
The electronic member information will be transferred to the FFM when UPP is closed.