Section 210-RICR-30-00-5.13 - Post-Eligibility Verification (PEV) by the Integrated Eligibility System (IES)A. The IES will conduct post-eligibility verification of the beneficiary's information. The IES runs post-eligibility verifications on the following beneficiary information:
1. Factors reviewed: a. Incarceration status (Rhode Island Department of Corrections data)b. Death data (Department of Health Vital Records data)c. Current Income - Wages (Department of Labor and Training - SWICA)d. Current Income - Unemployment Income (UI) (Department of Labor and Training)2. Timelines: a. Post-eligibility verification for incarceration, death data, and current unemployment insurance information will be checked monthly.b. Post-eligibility verification for current income/wages runs approximately every ninety (90) days (such as February, May, August, and November).3. PEV Results - The State may take the following action or actions based upon the PEV process: a. All information is current and accurate and the difference between the total attested income supplied by the beneficiary and the information supplied by an external data source(s) is within the state's established reasonable compatibility standard, no action on the part of the State or the beneficiary is required. The beneficiary continues to receive benefits without interruption.b. During the post-eligibility verification process, if the income from electronic data sources is above the applicable Medicaid eligibility threshold, and the difference between the electronic data source and the total attested income is more than ten percent (10%), the IES will check each line of income and send out a notice to the beneficiary(ies) indicating the source of income that cannot be verified and requesting that it be reviewed and verification documentation related to current income be provided.(1) The beneficiary will have ten (10) days to respond to such a notice. The ten (10) day period begins on the fifth day after the notice was mailed by the State. The beneficiary may either log onto the automated account (www.healthyrhode.ri.gov) and change information, send via U.S. mail, or bring the documentation to a local DHS office. Upon receipt of the verification documentation, the State will redetermine eligibility.(2) After the time period to provide documentation has elapsed, if the person has not provided documentation or reported a change, the State will redetermine eligibility using the data from external sources.(3) If any member of the beneficiary's household has died or if there is a change in the household composition, the State will seek further information from the beneficiary before terminating coverage. If terminated, the beneficiary will then have to re-apply (i.e., log onto the automated account (www.healthyrhode.ri.gov); send via U.S. mail; or bring the documentation to a local DHS office).(4) A notice of the beneficiary's new eligibility status will be sent, along with a Medicaid termination notice with appeal rights (Part 10-05-2 of this Title, as applicable).B. A beneficiary will not be terminated by the State based on a change in income without first considering other possible categories of eligibility based on factors including age, disability status, and level-of-care needs.C. All children found eligible for CHIP or Medicaid will be granted one (1) year of continuous eligibility (CE) from the date they are found eligible. During their CE period, children will not be disenrolled due to changes in circumstances. The following are the only exceptions to the CE provision:1. The child attains age 19;2. The child or child's representative requests a voluntary termination of eligibility;3. The child ceases to be a resident of the state;4. The agency determines that eligibility was erroneously granted at the most recent determination, redetermination, or renewal of eligibility because of agency error or fraud, abuse, or perjury attributed to the child or the child's representative; or5. The child is deceased.6. The child is found eligible for Medicaid (applies only to those initially eligible via CHIP).210 R.I. Code R. 210-RICR-30-00-5.13
Adopted effective 10/1/2024