Obsolete 0914 - 721 Eligibility Renewals

Effective Date: January 1, 2014 - August 31, 2014

IN 2014, all reviews will require client participation, similar to mandatory reviews. This process will change in the future. Until then, use the guidelines listed below and in Section 721-1 to complete reviews

· All clients must complete scheduled reviews for all Medicaid programs. Paper, electronic, in-person or phone reviews will be accepted.

· Signature requirement will be waived.

· Clients will have the standard 30 days to complete a review.

· Allow ‘due process’ to extend eligibility when appropriate.

· If the case closes for not completing the review or providing requested verification, allow 3 months for the client to contact DWS without having to complete an application.

· No Simplified reviews beginning in January, 2014.

SPECIAL RULES FOR REVIEWS IN JANUARY – MARCH, 2014:

· For MAGI programs, use MAGI rules to determine eligibility.

· If individuals are still eligible, re-certify the program for 12 months.

· If the individuals fail eligibility under MAGI rules, use 2013 rules to determine eligibility. If the individual passes using 2013 rules, continue eligibility through March, 2014. Re-determine eligibility for April 1, 2014 using MAGI rules.

· If the individual fails using 2013 rules, close the case. Refer to the Federally Facilitated Marketplace (FFM).

CHANGE REPORTS IN 2014 (Section 815)

· Use 2013 rules for any change report received before a scheduled review in 2014.

· If there is no change in eligibility, continue benefits to the scheduled review date.

· If the change results in the client no longer being eligible, close the program.

· Consider eligibility for other programs, including the new mandatory MAGI-based programs using the new rules.

· Request needed verification to determine eligibility using MAGI methodology.

· If the client is eligible, start a new 12 month certification period.

TARGETED LOW-INCOME CHILDREN (DURING 2014 ONLY) eligible on Dec 31, 2013

· When completing reviews in 2014, children eligible for Medicaid on Dec. 31, 2013, who no longer qualify for Medicaid but have income under 200% of FPL are eligible for CHIP.

o If the child would not qualify for CHIP because they have other health insurance the agency shall make them eligible for CHIP for one year with the following exceptions:

§ Children who have access to coverage through a public employee health insurance plan.

§ Children who are inmates of a public institution.

§ Children who are patients in an institution for mental disease (IMD).