Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 00 - Affordable Coverage Groups › Part 3 - Medicaid Application and Renewal Processes › Section 210-RICR-30-00-3.2 - Renewal of Eligibility for Medicaid Affordable Care Coverage Groups

Current through June 14, 2024
3.2.1
Scope and Purpose
All MACC group members are subject to MAGI-based renewals,
					 focusing on the eligibility factors subject to change. Such factors include
					 changes in income, household composition or family size (due to death, marital
					 status, birth or adoption of child), and/or State residency. Disenrollments for
					 any reason that are followed by requests for eligibility reinstatements are
					 also subject to this process for members of the MACC groups.
3.2.2
Responsibilities of the
				  State
A. The State is responsible to
				  ensure that the Medicaid renewal process occurs once every twelve (12) months
				  for all MACC group members. EOHHS will postpone the processing of annual
				  Medicaid eligibility renewals that would result in a termination of Medicaid
				  eligibility that fall during the novel Coronavirus Disease (COVID-19)
				  declaration of emergency. This includes the suspension of eligibility
				  determinations based on information gathered from periodic data checks for
				  unemployment, SWICA, TALX and other sources and suspension of quarterly
				  post-eligibility verifications. These provisions will not cease upon the
				  termination of the State-declared Public Health Emergency, in order to ensure
				  the continuation of EOHHS' eligibility for enhanced Federal funding. In
				  anticipation of the termination of the Federal declaration of the COVID-19
				  public health emergency (PHE), EOHHS will begin requesting information from
				  Medicaid eligible members for annual Medicaid eligibility renewals that were
				  postponed due to the COVID-19 PHE prior to the termination of the Federal
				  declaration of the COVID-19 PHE. EOHHS will not terminate any Medicaid eligible
				  individual, unless the individual has moved out of State, they requested to be
				  disenrolled, or the individual is deceased, until after the termination of the
				  Federal declaration of the COVID-19 PHE. Towards this end, the State must meet
				  the following requirements:
1. Basis of
				  Renewal - The eligibility renewal must be based on information already
				  available to the State to the full extent feasible. Accordingly, the State must
				  use information about the Medicaid member from reliable sources including, but
				  not limited to, the member's automated eligibility account, current paper
				  records, or data bases that may be accessed through the Federal data hub or the
				  State's own affordable care coverage eligibility system.
2. Restrictions - The State must not request
				  or use information when conducting renewals pertaining to: eligibility factors
				  that are not subject to change or concern matters that are not relevant to
				  continuation of Medicaid eligibility. Eligibility factors subject to change
				  include income, household or family size, State residency and certain
				  immigration statuses. Factors that are not subject to change include, but are
				  not limited to, native born or naturalized U.S. citizenship, date of birth, and
				  Social Security Number.
3. Renewal
				  Strategy - The State utilizes a passive "
ex parte
" renewal
				  process for all MACC group members when determining continuing eligibility and
				  whether a beneficiary who is losing coverage due to a change in an eligibility
				  factor qualifies for Medicaid in another coverage group to the full extent
				  feasible. This renewal method confirms eligibility factors subject to change
				  through electronic data sources and only requires action on the part of the
				  beneficiary if certain discrepancies are detected by the State or
				  self-reported. The State will use both active and passive renewal methods until
				  all MACC group members have been subject to a MAGI-based income eligibility
				  determination at least once. Accordingly, the State will conduct renewals as
				  follows:
a. Initial review. The State
				  redetermines eligibility at least sixty (60) days before the renewal date using
				  information known to the IES and from various data sources and provides notice
				  to the beneficiary indicating the results of this review. The notice contains
				  the information that served as the basis for this eligibility review and
				  indicates one (1) of the following:
(1)
				  Passive
Ex Parte
Renewal - Medicaid eligibility has been
				  renewed "
ex parte
" and no further action on the part of the
				  beneficiary is required unless, upon reviewing the information in the notice,
				  the beneficiary identifies an error or a change in an eligibility factor
				  subject to change that must be reported to the State; or
(2) Modified Passive Renewal - Medicaid
				  eligibility has not been renewed due to missing information or a discrepancy
				  between sources of information related to an eligibility factor subject to
				  change. In such instances, the notice contains an additional documentation
				  request (ADR) specifying the type of information that must be submitted for the
				  renewal of eligibility to proceed.
b. Renewal decision. If the beneficiary is
				  not required to take any action and does not find cause to self-report a
				  change, Medicaid eligibility is continued automatically for another year,
				  effective on the renewal date. However, in order to be considered in this final
				  renewal decision, change self-reports and ADR responses must submitted at least
				  thirty (30) days from the date of the renewal notice. The State redetermines
				  eligibility based on this information. If the beneficiary receives an ADR and
				  does not take the action required, this redetermination is based solely on the
				  information known to the IES through self-attestations and applicable data
				  sources. A formal notice is issued with the State's final renewal decision if
				  eligibility is discontinued on this basis at least fifteen (15) days prior to
				  the eligibility continuation or termination date. Information received by the
				  State at any time prior to the eligibility termination date is considered.
				  However, if the information is submitted after the tenth day of the renewal
				  month, a change from managed care to fee-for-service service delivery may
				  result.
c. Reinstatement. A
				  reinstatement of Medicaid eligibility is permitted without a full
				  reapplication, in instances in which a beneficiary takes the actions required
				  to resolve a discrepancy or information gap in the ninety (90) day period after
				  eligibility is terminated.
4. Consent - The State must obtain the
				  consent of the Medicaid member to retrieve and verify electronically
				  information related to eligibility factors subject to change including any
				  federal tax information required to review income eligibility. Such consent is
				  obtained during the initial application for Medicaid eligibility when the
				  Medicaid member signs the application, under penalty of perjury.
5. Enrollment - A Medicaid member whose
				  eligibility has been continued through the annual renewal process must remain
				  in the same Medicaid health plan unless the renewal occurs during an open
				  enrollment period. If an open enrollment process is not underway at the time of
				  renewal, the provisions set forth in Subchapter 05 Part 2 of this Chapter
				  prevail.
6. Access - The State must
				  ensure that any application or supplemental forms required for renewal are
				  accessible to persons who have limited proficiency in English or who have a
				  disability.