157.01 Timely Notice (MAM)

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Inform each individual that on a regularly scheduled basis, his or her eligibility for continued medical assistance (MA) is reviewed.

Based on household circumstances and the category of medical assistance received, notify individuals that at those regularly scheduled reviews, some MA cases may:

•         have their eligibility automatically renewed; or

•         be required to complete an online or mail-in redetermination/renewal as a condition of continued eligibility.

MA Renewals

Automatic Renewals (Passive Renewal)

For the categories of medical assistance (MA) that use modified adjusted gross income (MAGI) in the eligibility determination process, and for non-MAGI cases that do not report having a trust or annuity, the regularly scheduled renewal period is automatically advanced 12 months if all eligibility factors for the MA case can be verified by electronic crossmatching at that regularly scheduled renewal. This is referred to as a “passive renewal.” For passive renewals:

•        Notification of the new renewal date, via New HEIGHTS-generated CS0006, MA Mail-In Rede Letter, or New HEIGHTS-generated CS0030, MA Online Rede Letter, is generated to the casehead by the 15th of the month prior to the month of the scheduled renewal along with the case information that DHHS used to renew eligibility.

•        The CS0006/CS0030 includes a request that the casehead contact DHHS to report any corrections that need to be made to the information that DHHS used to renew eligibility, but this information is assumed to be correct and it is not expected that corrections will be returned. The return of this information is not required in the passive renewal process.

Online or Mail-In Renewals (Non-Passive Renewal)

If all MA eligibility factors for the case cannot be verified by electronic crossmatching, the case's regularly scheduled renewal period is not automatically advanced 12 months. This is referred to as a “non-passive renewal.” For non-passive renewals:

•        Eligibility factors for the MA case that cannot be verified by DHHS through electronic cross-matching include such situations as:

- when reported wages or unearned income are not able to be electronically verified by DHHS (there is no electronic crossmatch available; no response is received in the electronic crossmatch process; or the response from the crossmatch is not within the 10% income threshold);

- the case includes self-employment income;

- a non-MAGI case has liquid resources and the electronic crossmatch shows those resources to be over the resource limit; and/or

- a non-MAGI MA case includes a trust or annuity or another resource that cannot be verified by the Asset Verification System (AVS).

• Notification that eligibility could not be automatically renewed is generated to the casehead via the CS0006 or CS0027, Online Rede Letter, along with the following: 1) a list of proofs that the case must provide for DHHS to determine continued eligibility and the date when these proofs are due, and 2) case information that DHHS used in the determination that the automatic (passive) renewal could not occur.

       The casehead is notified in the CS0006/CS0027 that the list of required proofs must be provided to DHHS by the 15th day of the month following the date on the CS0006/CS0027. Failure to provide the proofs requested within timeframes results in termination of MA. Exception: For MAGI MA only, if medical assistance is terminated due to failure to provide the verification requested in the CS0006/CS0027 within the original timeframes, and the casehead subsequently provides all requested verification within 90 days of the date of the termination of his or her coverage, eligibility must be reinstated back to the date of termination by the 30th business day following the date the last piece of verification was provided.

The CS0006/CS0027 renewal package generated includes:

•         BFA Form 811R, Application: Your Rights and Responsibilities; and

•         a postage-paid business reply envelope.

MA cases eligible to participate in the automatic renewal, online, or mail-in redetermination process are not required to participate in a face-to-face interview. However, an interview must be granted if one is requested.

When verification is not sufficient or not provided in the online or mail-in redetermination process, send New HEIGHTS-generated AE0055, Proof Needed to Determine Your Assistance. If New HEIGHTS is unavailable, use paper backup BFA Form 808, Proof Needed to Determine Your Assistance.

References: He-W 606.01; He-W 606.100-606.101; He-W 844.01; He-W 883.01; He-W 884.01-.02; RSA 161:4-a, X(a) & (g); 42 CFR 435.914(a); 42 CFR 435.916; 45 CFR 206.10(a)(9)