Section 477-3-007 - RENEWALSA redetermination of eligibility for continued Medicaid benefits must be completed every 12 months.
007.01RENEWAL OF ELIGIBILITY FOR MODIFIED ADJUSTED GROSS INCOME (MAGI) PROGRAMS. A renewal of modified adjusted gross income (MAGI)-based eligibility shall be completed on the basis of information available to the Department without requiring information from the individual. Information will only be required from the individual when not available through other sources. If information is not available to complete a renewal, a prepopulated renewal form shall be sent by the Department to the applicant or authorized representative. The completed renewal form and necessary verifications shall be returned within 30 days of the date the renewal form was sent.007.02RENEWAL OF ELIGIBILITY FOR NON-MODIFIED ADJUSTED GROSS INCOME (non-MAGI) PROGRAMS. A prepopulated renewal form shall be required every 12 months for non-modified adjusted gross income (non-MAGI) based eligibility renewals.007.03RENEWAL FOR SUPPLEMENTAL SECURITY INCOME (SSI) RECIPIENTS. A renewal form is not required at the time of renewal for clients who are receiving Supplemental Security Income (SSI).007.03(A)RENEWAL DURING NON-PAY SUPPLEMENTAL SECURITY INCOME (SSI) STATUS. A renewal is not required for periodic non-pay status due to an extra pay period in a month.007.03(B)SUPPLEMENTAL SECURITY INCOME (SSI) CLIENTS ELIGIBLE UNDER 1619(b). Supplemental Security Income (SSI) clients who are determined eligible for Medicaid by the Social Security Administration (SSA) under the provisions of 1619(b) are not required to complete a renewal form, and resources do not need to be verified.007.04INCOME REVIEW FOR AGED, BLIND, AND DISABLED (ABD) CLIENTS. For eligibility purposes, a review of income must be completed every 12 months. An income review is completed by the Social Security Administration (SSA) for Supplemental Security Income (SSI) clients, including those placed in 1619(b) status.007.05DISABILITY REVIEW FOR AGED, BLIND, AND DISABLED (ABD) CLIENTS. For clients whose disability status is approved by the State Review Team (SRT), a periodic review of the disability determination is required. Reviews of the disability determination are conducted consistent with the relevant portions of the Supplemental Security Income program and 20 Code of Federal Regulations (CFR) Part 416 Subpart I.007.05(A)REQUIRED DISABILITY REVIEWS. A review of a beneficiary's disability status will occur in the following circumstances: (i) The previous determination period has ended;(ii) The beneficiary was determined disabled as a child, and is now turning age 18;(iii) The beneficiary begins, or returns, to work, and the income earned is greater than the Substantial Gainful Activity (SGA) amount published by the Social Security Administration (SSA);(iv) The Department receives credible evidence or reports that the beneficiary is no longer disabled; or(v) The beneficiary reports that the disability has ended.007.05(B)REQUIRED DOCUMENTATION. The State Review Team (SRT) requires contemporaneous documentation of a beneficiary's health condition in order to determine whether the beneficiary meets the disability criteria. The medical documentation must be dated no more than 12 months prior to the date for which a disability determination is requested. The medical documentation must include an examination by a physician or another appropriate provider for the condition or conditions related to the disability determination dated no more than 12 months prior to the date for which a disability determination is requested. A failure to provide all necessary documentation will result in a denial of disability status.007.05(C)DURATION OF DISABILITY DETERMINATION. The length of time during which a beneficiary is considered to be disabled is dependent on the beneficiary's medical condition. A shorter time period is assigned if the medical evidence indicates that the beneficiary's medical condition may improve in order to ensure that the beneficiary continues to meet the disability criteria. The beneficiary's condition, and length of the disability review period, is re-determined at each review. The review schedule is determined as follows:(i) A disability review will be conducted every 12 months when the disability may reasonably be expected to improve;(ii) A disability review will be conducted every three years if the disability is not permanent, but the possibility for medical improvement cannot be accurately predicted; or (iii) A disability review will be conducted every five years if it is unlikely that the medical condition will improve.477 Neb. Admin. Code, ch. 3, § 007
Amended effective 7/29/2020Amended effective 9/17/2024