157.05 Processing Redeterminations SR 15-03, 01/15 (MAM-A)

For categories of medical assistance (MA) that use the modified adjusted gross income (MAGI) method in the eligibility determination process, individuals who must provide required verification as indicated on the New HEIGHTS-generated CS0006, MAGI-Only Rede Letter, or CS0030, MAGI Online Rede Letter, must provide that verification by the 15th day of the last month of the renewal period to prevent delays in the renewal process.

For categories of MA that do not use MAGI in the eligibility determination process, to prevent delays in the redetermination process, the individual must do the following by the 15th day of the last month of the redetermination period:

. 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:

. 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; and

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

Require face-to-face interviews with individuals who 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 individual 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 application date if the individual has not participated in an interview or provided required verification by the end of the certification 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)