157.03 Required Verification for Redeterminations SR 15-03, 01/15 (MAM-A)

For all categories of medical assistance (MA) that use the modified adjusted gross income (MAGI) method in the eligibility determination process, the individual is notified of any verifications that may be needed to renew eligibility via the New HEIGHTS-generated CS0006, MAGI-Only Rede Letter, or the CS0030, MAGI Online Rede Letter.

For categories of MA that do not use MAGI in the eligibility determination process, the individual is notified of any verifications that are needed at redetermination via the New HEIGHTS-generated:

. CS0001, Rede Interview, if he or she has a face-to-face redetermination;

. CS0005, Mail-In Rede Letter, if he or she is completing a mail-in redetermination; or

. CS0027, Online Rede Letter, if he or she is completing an online redetermination.

When verification is not sufficient or not provided in the online or mail-in redetermination process, notify the individual in writing of any required information or verification needed to complete the redetermination and the time frame for returning the verifications. Use New HEIGHTS-generated AE0026, Verification Checklist, which explains what information or verification is needed and the date the information or verification is due. The AE0026 is automatically generated anytime something is entered onto the Application Entry screen, marked "Not Yet Verified," and eligibility is run. If New HEIGHTS is unavailable, use the paper backup DFA Form 808, Proof Needed to Determine Your Assistance.

For all categories of medical assistance, the individual must provide verification of all eligibility factors and circumstances*, if requested.

The individual must provide the required verifications no later than:

. if receiving a category of MA that uses MAGI in the eligibility determination process, by the due date in the CS0006/CS0030;

. if an interview is required, 10 working days after the personal interview;

. if participating in a mail-in redetermination, no later than 10 business days after the required return date for DFA Form 771A, Nursing Facility Care Renewal, *or DFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and Food Stamp Benefits; or

. if participating in an online redetermination, by the due date in the CS0027.

Terminate assistance if the individual refuses or fails to provide the required verifications within time frames.

Exceptions:

. When a third party has not responded to a request for verification within timeframes, send a follow-up request to the third party and to the individual. Allow an additional 10 working days for a response. If the verification is not provided within the second waiting period, terminate assistance unless the individual provides other acceptable verification.

. If assistance is being terminated due to lack of required verification and the individual provides the required verification within the advance notice period, stop the termination action and reinstate assistance.

. For all categories of MA that use MAGI in the eligibility determination process, if assistance was terminated due to failure to provide requested verification listed on the New HEIGHTS-generated CS0006/CS0030 and the casehead subsequently provides all requested verification within 90 days of the date of the termination of his or her coverage, reinstate medical assistance back to the date of termination by the 30th business day following the date the last piece of verification was provided.

. For categories of MA that do not use MAGI in the eligibility determination process, if assistance was terminated due to failure to provide requested verification and the individual provides all the required verification within the 10 days following the end of the advance notice period:

- have the individual fill out DFA Form 800, Application for Assistance, or DFA Form 800MA, Application for Health Coverage & Help Paying Costs, if the case is Medicaid-only, with their name, address, and signature;

- ensure that no other changes have occurred in the case that would affect eligibility and that no new program services have been requested on DFA Form 800 other than those which were originally terminated;

- if the individual meets all program eligibility requirements, reinstate assistance based on the new application date, with no new interview required; and

- generate medical benefits in accordance with PART 121, INITIATION OF MEDICAL ASSISTANCE, assuming the individual has requested retroactive medical coverage back to the date of closing, if applicable.

*

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)