Section 210-RICR-40-00-2.7 - Renewal of Eligibility for IHCC Groups2.7.1Scope and PurposeA. One of the principal requirements of Medicaid is that continuing eligibility must be re-evaluated at least once a year. For the IHCC groups, this annual review was called a "redetermination" and, accordingly, often required beneficiaries to reapply for coverage. Current federal regulations [ 42 CFR 435.916(b)] governing the IHCC groups now require that these annual reviews consider only those eligibility factors that are subject to change. Accordingly, the continuing eligibility of the IHCC group beneficiaries receiving Community and LTSS Medicaid is now conducted by requiring them to review their account information on key eligibility factors, as updated by internal and external data sources, and report any inaccuracies or changes in the manner described in this section. B. The factors subject to change include income, resources, household composition (e.g., as a result of births, deaths, divorce, etc.), disability or clinical factors, access to third-party coverage, and changes in family size (e.g., due to death, marital status, birth or adoption of child), and/or immigration status. LTSS beneficiaries may be required to provide additional information related to change in care settings. Note: The provisions in this section do not apply to beneficiaries who are deemed eligible due to participation in other programs (e.g., SSI recipients), or that are determined eligible by the SSA. Special MPPP renewal provisions also apply.2.7.2Agency ResponsibilitiesA. IHCC group renewals are conducted in accordance with the following: 1. Frequency - The Medicaid renewal process occurs at least once every twelve (12) months and no more frequently unless as result of a change in eligibility factors.2. Types of Information - The eligibility renewal is based on information already available to the full extent feasible. Such information may be derived from reliable sources including, but not limited to, the beneficiary's automated eligibility account, current paper records, or databases that may be accessed through the IES. Information about eligibility factors that are not subject to change or matters that are not relevant to continuation of Medicaid eligibility are not requested or used at the time of renewal. Factors that are not subject to change include, but are not limited to, U.S. citizenship, date of birth, and Social Security Number.3. Notice - Timely notice must be provided of: a. Renewal Date. A notice of the date of the annual renewal is sent at least thirty days (30) days prior to the renewal date. The beneficiary is also provided with a pre-populated form containing information from the Integrated Eligibility System and other sources on each relevant eligibility factor. In instances in which the Medicaid beneficiary is required to take action in addition to completing the pre-populated form, such as providing paper documentation or explaining a discrepancy, a timeline is included for completing the action as well as indication of the consequences for failure to do so.b. Renewal Action. At least ten (10) days prior to the renewal date, Medicaid beneficiaries are provided with a notice stating the outcome of the renewal process and explaining the basis for any agency action - continuation or termination of eligibility. The notice also contains the right to appeal and obtain an administrative fair hearing. Beneficiaries are also notified that they have the right to have their health coverage continued while awaiting a hearing if an appeal is filed in ten (10) days from the date of the renewal notice is received. The date the notice is received is presumed to be five (5) days from the date on the notice.4. Consent - At the time of initial application, Medicaid beneficiaries sign or provide an electronic signature giving the State consent to obtain and verify information through external data sources and from certain providers for the purposes determining eligibility and renewing health coverage. The first time IHCC group beneficiaries are renewed through the IES, such consent must be provided if it does not already exist.5. Modified Passive Renewal - All IHCC beneficiaries are subject to a modified passive renewal process that proceeds as follows: a. Initial Automated IES Renewal. During the first automated IES renewal, IHCC beneficiaries are provided with a pre-populated form containing all information related to eligibility on record, typically in their IES accounts, that has been self-reported and/or obtained through electronic data matches at application, post-eligibility verification, and change reports. Beneficiaries are required to review this form, make any necessary changes and required actions, and then attest to the accuracy and completeness of the information provided on any eligibility factor subject to change. In addition, the Medicaid beneficiary must provide consent to the EOHHS permitting automated data exchanges and/or retrieval of information on eligibility factors from outside sources for all future renewals.b. Continuing Renewals. After the initial automated renewal, IHCC beneficiaries receive a pre-populated form and are only required to return the form to self-report changes in eligibility factors or to respond to agency requests for information or documentation. If no such changes are required, the beneficiary is not required to take further action. Medicaid health coverage is renewed automatically and a new eligibility period is established.2.7.3Beneficiary ResponsibilitiesMedicaid beneficiaries must meet the requirements associated with making and completing an application as set forth in § 2.5 of this Part.
210 R.I. Code R. 210-RICR-40-00-2.7