Iowa Admin. Code r. 441-76.17

Current through Register Vol. 47, No. 11, December 11, 2024

Rule 441-76.17 - Automatic redetermination of eligibility

Whenever a Medicaid member no longer meets the eligibility requirements of the current coverage group, an automatic redetermination of eligibility for other Medicaid coverage groups shall be made. If the reason for ineligibility under the initial coverage group pertained to a condition of eligibility which applies to all coverage groups, such as failure to cooperate, no further redetermination shall be required. When the redetermination is completed, the member shall be notified of the decision in writing. The redetermination process shall be completed as follows:

(1)Information received by the tenth of the month. If information that creates ineligibility under the current coverage group is received in the department by the tenth of the month, the redetermination process shall be completed by the end of that month unless the provisions of rule 441-76.14 (249A) apply. The effective date of cancellation for the current coverage group shall be the first day of the month following the month in which the information is received.

(2)Information received after the tenth of the month. If information that creates ineligibility under the current coverage group is received in the department after the tenth of the month, the redetermination process shall be completed by the end of the following month unless the provisions of rule 441-76.14 (249A) apply. The effective date of cancellation for the current coverage group shall be the first day of the second month following the month in which the information is received.

(3)Change in federal law. If a change in federal law affects the eligibility of large numbers of Medicaid members and the Secretary of Health and Human Services has extended the redetermination time limits, in accordance with 42 CFR § 435.1003 as amended to January 13,1997, the redetermination process shall be completed within the extended time limit and the effective date of cancellation for the current coverage group shall be no later than the first day of the month following the month in which the extended time limit expires.

Iowa Admin. Code r. 441-76.17

ARC 1069C, IAB 10/2/2013, effective 10/1/2013