§ 435.916 Regularly scheduled renewals of Medicaid eligibility. ( a ) *Frequency of renewals.* Except as provided in § 435.919: ( 1 ) The eligibility of all Medicaid beneficiaries not described in paragraph (a)(2) of this section must be renewed once every 12 months, and no more frequently than once every 12 months.
( 2 ) The eligibility of qualified Medicare beneficiaries described in section 1905(p)(1) of the Act must be renewed at least once every 12 months, and no more frequently than once every 6 months.
( b ) *Renewals of eligibility* — ( 1 ) *Renewal on basis of information available to agency.* The agency must make a redetermination of eligibility for all Medicaid beneficiaries without requiring information from the individual if able to do so based on reliable information contained in the individual's account or other more current information available to the agency, including but not limited to information through any data bases accessed by the agency under §§ 435.948, 435.949, and 435.956. If the agency is able to renew eligibility based on such information, the agency must, consistent with the requirements of this subpart and subpart E of part 431 of this chapter, notify the individual— ( i ) Of the eligibility determination, and basis; and
( ii ) That the individual must inform the agency, through any of the modes permitted for submission of applications under § 435.907(a), if any of the information contained in such notice is inaccurate, but that the individual is not required to sign and return such notice if all information provided on such notice is accurate.
( 2 ) *Renewals requiring information from the individual.* If the agency cannot renew eligibility for beneficiaries in accordance with paragraph (b)(1) of this section, the agency— ( i ) Must provide the individual with— ( A ) A pre-populated renewal form containing information, as specified by the Secretary, available to the agency that is needed to renew eligibility.
( B ) At least 30 calendar days from the date the agency sends the renewal form to respond and provide any necessary information through any of the modes of submission specified in § 435.907(a), and to sign the renewal form under penalty of perjury in a manner consistent with § 435.907(f).
( C ) Notice of the agency's decision concerning the renewal of eligibility in accordance with this subpart and subpart E of part 431 of this chapter.
( ii ) Must verify any information provided by the beneficiary in accordance with §§ 435.945 through 435.956.
( iii ) If the individual subsequently submits the renewal form or other needed information within 90 calendar days after the date of termination, or a longer period elected by the State, must treat the renewal form as an application and reconsider the eligibility of an individual whose coverage is terminated for failure to submit the renewal form or necessary information in accordance with the application time standards at § 435.912(c)(3) without requiring a new application.
( iv ) Not require an individual to complete an in-person interview as part of the renewal process.
( v ) May request from beneficiaries only the information needed to renew eligibility. Requests for non-applicant information must be conducted in accordance with § 435.907(e).
( 3 ) *Special rules related to beneficiaries whose Medicaid eligibility is determined on a basis other than modified adjusted gross income.* ( i ) The agency may consider blindness as continuing until the reviewing physician under § 435.531 determines that a beneficiary's vision has improved beyond the definition of blindness contained in the plan; and
( ii ) The agency may consider disability as continuing until the review team, under § 435.541, determines that a beneficiary's disability no longer meets the definition of disability contained in the plan.
( c ) *Timeliness of renewals.* The agency must complete the renewal of eligibility in accordance with this section by the end of the beneficiary's eligibility period described in paragraph (a) of this section and in accordance with the time standards in § 435.912(c)(4).
( d ) *Determination of ineligibility and transmission of data pertaining to individuals no longer eligible for Medicaid.* ( 1 ) Prior to making a determination of ineligibility, the agency must consider all bases of eligibility, consistent with § 435.911.
( 2 ) Prior to terminating coverage for individuals determined ineligible for Medicaid, the agency must determine eligibility or potential eligibility for other insurance affordability programs and comply with the procedures set forth in § 435.1200(e).
( e ) *Accessibility of renewal forms and notices.* Any renewal form or notice must be accessible to persons who are limited English proficient and persons with disabilities, consistent with § 435.905(b).
[89 FR 22869, Apr. 2, 2024]