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All Medicaid Programs |
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Obsolete Policy |
Review Requirements – All Programs
Reviews are required for all Medicaid programs. A review is used to determine an individual’s eligibility for the next certification period. Complete the review based on whether or not a client is required to participate in the review process (See 721-1). Use current electronic data sources and case information.
Do not require signatures.
End eligibility for individuals who fail to complete a review effective the end of the month in which the agency can send proper notice.
If the agency cannot make an eligibility determination before 10-day notice or the agency makes an adverse decision but does not have time to send 10-day notice, extend benefits to the following month. This is called a due process month.
A new certification period can be set for other medical programs with future review dates if all factors of eligibility have been reviewed.
See section 435 for budgeting of income.
See section 815 for changes during the certification period.
MAGI Programs
Do not require a review more than once every 12 months. (Workers can update as part of the ex parte and set review out 12 more months.)
A child who loses eligibility for Medicaid at their 2014 review and is otherwise eligible for CHIP, except for having other health insurance, is eligible for CHIP for one year if:
The child was eligible for Medicaid on December 31, 2013; and
The health insurance is not through a public employee health insurance plan.
Non-MAGI Programs
Do not require a review for Medicare cost-sharing programs more than once every 12 months. (Workers can update as part of the ex parte and set review out 12 more months.)
For all non-cost-sharing programs, complete the review at least every 12 months.
Reviews for non-cost sharing programs can be scheduled for less than 12 months when:
A recipient has fluctuating income;
The agency has information about anticipated changes in the household's circumstances that may affect eligibility; or
Changes are needed to meet workload demands.