157 REDETERMINATION SR 14-09, 01/14 (MAM-A)

Medical assistance is determined for a specific period of time called the eligibility period. At the end of the eligibility period, medical assistance benefits continue automatically until action is taken to terminate assistance.

Redetermine eligibility for all individuals at regularly scheduled intervals. Schedule redeterminations at least every 12 months.

Review individuals more frequently than indicated below when either of the following occurs:

• there is a change in case circumstances that affects other eligibility factors; or

• there is conflicting information regarding eligibility.

Review and verify all eligibility factors and criteria subject to change. Update eligibility and benefit levels, as necessary. See the rest of this PART for additional information

12-Month Redetermination

The following cases are redetermined via the online or mail-in redetermination process at 12-month intervals:

• all categories of Medicaid, including CM, CSD, and HC-CSD;

• QMB, QDWI, SLMB, and SLMB135; and

• Long-Term Care (LTC) services.

*

In and Out Medical Assistance

In and Out Medical Assistance is redetermined via the online or mail-in redetermination process at the end of the estimated end-date of eligibility.

Review individuals more frequently when either of the following occurs:

• there is a change in case circumstances that affects other eligibility factors; or

• there is conflicting information regarding eligibility.

Review and prove all eligibility factors and criteria that are subject to change. Update eligibility as necessary. See the rest of this PART for additional information.

Policy about redeterminations will change under the Affordable Care Act (ACA). This policy will be updated to incorporate these changes at that time.

** In accordance with policy at FAM 221.03, Continuation of Medical Assistance Following Pregnancy.

Policy about redeterminations and verification required at redeterminations will change under the Affordable Care Act (ACA). This policy will be updated to incorporate these changes at that time.

References: He-W 606.01, He-W 606.100-.101, He-W 636.01, He-W 644.01, He-W 684.01-.02, RSA 167:79,III(j), RSA 167:83,II(d), 42 CFR 435.916, 45 CFR 206.10, 42 USC 1397bb