157 REDETERMINATION (MAM-A)

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Medical assistance (MA) 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 MA cases at regularly scheduled intervals. Schedule redeterminations at least every 12 months.

Review MA cases 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 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 In and Out MA cases 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.

Category of Assistance	Eligibility Period	Redetermination Method
Categories of MA that do not use MAGI in the eligibility process	12 mo	Online/Mail-In
Categories of MA that use MAGI in the eligibility determination process	12 mo	Automatically renewed for 12 months with no action needed by the recipient if all MAGI eligibility factors can be verified by electronic crossmatching (called a “passive MAGI renewal”) Onlline/Mail-in if all MAGI eligibility factors cannot be verified (called a “non-passive MAGI renewal”)
QMB, QDWI, SLMB/SLMB135	12 mo	Online/Mail-In
LTC Services, including HCBC	12 mo	Online/Mail-In
CM, CSD, HC-CSD	12 mo	Online/Mail-In
MCPW	60 days post-partum**	Online/Mail-In
Newborn	12 mo from date of birth**	Online/Mail-In
Refugee MA	8 mo from date of entry	Face-to-Face
All In and Out MA	1 mo or 6 mo	Online/Mail-In
Extended MA	4 mo or 12 mo	Online/Mail-In

** In accordance with policy at MAM 225.01, Continuation of Medical Assistance Following Pregnancy.

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)