157.05 Processing Redeterminations (MAM-A)

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*To prevent delays in the redetermination/renewal process, the medical assistance (MA) case must do the following by the 15th day of the last month of the redetermination/renewal period:

·         Categories of MA that use the modified adjusted gross income (MAGI) method in the eligibility determination process that are subject to a non-passive MAGI renewal must:

-         provide all requested proofs as listed in the CS0006/CS0027; and

-         correct the information in the CS0006/CS0027 that DHHS used to review continued eligibility for MAGI MA, sign and date the information, and return or electronically submit this information to DHHS.

·         Non-MAGI categories of MA must:

-         complete DFA Form 800, Application for Assistance, DFA Form 800MA, Application for Health Coverage & Help Paying Costs, or Form 800HR, New HEIGHTS-generated Application for Assistance, provide all needed proofs, if required, and participate in a face-to-face interview, if the redetermination method is face-to-face;

-         return the completed DFA Form 771A, Nursing Facility Care Renewal, or DFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and Food Stamp Benefits, and provide all needed proofs, if the redetermination method is mail-in. No interview is necessary if participating in the mail-in redetermination process; or

-         complete the online Redetermination Application and provide all needed proofs, if the redetermination method is online. No interview is necessary if participating in the online redetermination process.

When verification is not sufficient or not provided in the online or mail-in redetermination process for non-MAGI MA cases or in the non-passive MAGI MA renewal process:

·         send New HEIGHTS-generated AE0055, Proof Needed to Determine your Assistance. Or, if New HEIGHTS is unavailable, use paper backup DFA Form 808, Proof Needed to Determine Your Assistance. For non-passive MAGI MA renewals, ensure the due date in the AE0055 reflects the 90-day grace period allowed in the MAGI MA renewal process; and

·         allow individuals 10 additional days to provide the needed verification.

Require face-to-face interviews for non-MAGI MA cases that do not fully complete either DFA Form 800R, or the online Redetermination Application, but at a minimum provide their name, address, and sign the form.

Contact the non-MAGI MA case to ensure information has not changed since the redetermination appointment if the case is not being processed within one month of the appointment date.

Process redeterminations within 30 days of the redetermination due date if the non-MAGI MA case has not participated in an interview or provided required verification by the end of the redetermination period.

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)