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All Medicaid Programs |
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Obsolete Policy |
Effective Date: May 1, 2015 - October 31, 2017
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.
Signatures are required on reviews that involve client participation.
End eligibility for individuals who fail to complete a review, when client participation is required, 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, with the following exceptions.
A time limited program which is set to end before the next review (See 721-4);
A CHIP program; or
Situations where an ex parte review cannot be completed because client participation is required (See 721-1).
Do not require a review for MAGI based programs more than once every 12 months.
For non-MAGI programs, the following apply.
Do not require a review for Medicare cost-sharing programs more than once every 12 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
Change are needed to meet workload demands.
See section 435 for budgeting of income.
See section 815 for changes during the certification period.