All Medicaid Programs |
Obsolete Policy |
The eligibility agency may use various methods to conduct the review.
Use all available resources to determine continued eligibility.
Determine if any individual would be eligible for Medicaid before re-determining UPP eligibility.
Consider only those factors of eligibility relevant to the UPP program to complete the review for each household member.
An UPP review requires client participation. An ex parte review cannot be completed.
Completion of the Review
Send the client a review form that is pre-populated with the most current information from electronic records. The review form is provided to the household early enough to allow the recipient time to provide the updated information to complete the review during the review month.
The review form will explain what the client is required to do to complete the review process and the due date for responding.
If the client responds by the due date, or sometime during the review month, request needed verification from the client.
The agency must send a written request and give the client 10 days to provide the verification.
If the client does not return all requested verification by the due date, eligibility ends at the end of the month for which the eligibility agency can give 10-day notice.
The client has three months after the effective closure date to complete the review without having to re-apply. (See B.)
If the agency cannot give 10-day notice before deciding eligibility for a new certification period, extend benefits to the following month. This is called the “due process month”. (See 811 for exceptions to 10-day advanced notice.)
Benefits cannot be extended during the eligibility review for an UPP eligible child who turns age 19 or an UPP eligible adult who turns age 65 in the review month.
If the client provides all the requested verifications by the verification due date, the eligibility agency proceeds with the eligibility decision.
The agency continues eligibility into the following month (the “due process month”) if needed while it makes a decision.
Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give a 10-day notice.
If the client provides all requested verification after the due date and before the end of the review month, proceed with the eligibility decision.
The agency continues eligibility into the following month (the “due process month”), if needed, while it makes a decision.
Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give 10-day notice.
If eligibility is continued into the “due process month”, the client must provide verification by the verification due date.
If the client provides verification by the due date, complete the review and send the notice of the eligibility decision.
Waive the ‘already has insurance’ rule.
If the client remains UPP eligible, begin the new certification period the first day of the next month.
Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give 10-day notice.
If the action is in the client's favor make the change for the month immediately following the change report month. This may require a change to be made in the due process month.
Example: The client has a June review for July benefits. They provide their review on June 25th and report a decrease in income. The worker issues a due process month for July. The client returns all requested verifications on July 7th, prior to the verification due date. The client is eligible for an increase in the UPP premium. Because the change was reported in June and verified timely, the worker makes the income change effective for July.
If the client fails to provide verification by the due date, close the case and send notice.
If an overpayment investigation determines individuals were not eligible in the review month and a due process month was established, the referral must include the due process month.
Client fails to complete review process
If the case closes because the client fails to complete the review, eligibility ends at the end of the month in which proper notice can be sent. The client has three months from the date of case closure to complete the review without submitting a new application. (If eligibility is extended to the month after the review month, the three month period begins after the second month.)
The benefit effective date is the first day of the month in which the recipient contacts the agency.
There is no retroactive benefit.
No interview or application form is required.
Eligibility does not continue while the agency makes a decision.
Application processing time applies.
If the client fails to respond within three months after the case closes for failure to complete the review, require a new application.