Current through Register Vol. 47, No. 5, March 10, 2024
140.1
"Redetermination of eligibility" means a case review and necessary verification
to determine whether the member continues to be eligible to receive Medical
Assistance. "Reconsideration period" means the 90-day period following
termination of eligibility. Eligibility shall be redetermined at least every
twelve (12) months since the last eligibility determination. An Eligibility
site may redetermine eligibility through telephone, mail, or online
electronically.
A. Ex Parte Review: A
redetermination form will not be sent to the member if all current eligibility
requirements can be verified by reviewing information from another assistance
program or if this information can be verified through an electronic data
source - this process is referenced as Ex Parte Review. The use of telephonic
or electronic redeterminations shall be noted in the case record. When
applicable, the eligibility site shall redetermine eligibility based solely on
information already available. If verification or information is available for
any of the six months prior to the redetermination month, and all other
eligibility requirements are met, then an approval notice will be sent for all
eligible members of the household who are requesting assistance. This approval
notice shall include directions on how to view the information used to
determine eligibility.
B. If all
required information is not available and/or the information received does not
support a finding of eligibility, a redetermination form will be issued to the
household at least 30 days prior to the end of the eligibility period. The
redetermination form shall be prepopulated with the current information on file
and sent to the household at least 30 days prior to the redetermination period
ending. As part of the ex parte review, the member will be informed of any
verification needed to determine eligibility.
The redetermination form shall direct members to verify that
the information provided is accurate or to report any changes to the
information. Members must complete and return the redetermination form with
necessary verifications and the signature form. If a member fails to sign the
signature form or comply with any failure to complete the redetermination
process.
C. Members who
return properly completed redetermination forms and requested information
during the reconsideration period shall not be required to submit a new
application of eligibility. If redetermination forms and requested information
are not returned within 90 days after the termination, the member must submit a
new application to obtain enrollment in the program. For individuals who are
determined to be eligible for Medical Assistance within the reconsideration
period, the effective date of coverage will be the first day of the month in
which the redetermination form was returned. If the member has a gap in
coverage due to submitting the redetermination within the reconsideration
period, the member can request up to three months in retro coverage.
D. Due to the Coronavirus COVID-19 Public
Health Emergency, required through the Federal CARES Act for the Maintenance of
Effort (MOE), the Department will continue eligibility for all Medical
Assistance categories regardless of changes made for a redetermination or
additional documentation for current CHP+ enrollee and allow them to continue
eligibility through the emergency declaration. Once the emergency declaration
has concluded, the Department will process the redetermination and /or changes
for all members whose eligibility was maintained during the emergency
declaration. Effective May 11, 2023 the coronavirus COVID-19 pandemic federal
emergency has been declared to end. To ensure the Department Maintains access
to State and Federal funding provided by the Federal 'Families First
Coronavirus Response Act" Pub.L. 116-127, and the Federal
"Consolidated Appropriations Act, 2023", the Department will process
eligibility redeterminations and take appropriate action for all members whose
eligibility was maintained during the emergency declaration. By May 2024 all
members whose eligibility has been maintained due to the Public Health
Emergency will have completed the renewal process. A member's eligibility may
no longer be maintained after May 31, 2023 if they have completed the renewal
process and/or a change is reported, and they are found ineligible. Members
whose eligibility has been maintained during the Public Health Emergency and
whose renewal is not due yet will remain in their current category until their
renewal due month, regardless if there is a change reported that makes them
ineligible.