All Medicaid Programs |
Obsolete Policy |
Review Requirements
A review must be completed every 12 months.
Send a pre-populated review form, including the 116M form, to the client. (See 1008-2 for details of the review process)
The review form must include the most current electronic information available and a list of verification needed to complete the review.
The client must submit a new form 116M or verify the current health insurance coverage or plan information.
The client has 30 days from the date the form is mailed to respond.
The review form must be signed to be considered complete.
If the case closes because the client does not complete the review request, there is a three month reconsideration period after the review month for the client to contact the eligibility agency to complete the review.
The benefit effective date is the first day of the month in which the client responds.
No interview or application form is required.
Waive the ‘already insured rule’.
If the client does not complete the review within the three month reconsideration period, the client must re-apply during the next open enrollment period.
All eligibility factors apply, including enrollment in employer-sponsored health insurance.
An UPP review requires client participation. An ex parte review cannot be completed.
Referrals for the Advanced Premium Tax Credit.
The electronic client information will be transferred to the FFM when UPP is closed.