Medicaid Redetermination

Medical Redetermination Process

The new Integrated Eligibility System (IES) is now being used for all application processing and case maintenance for medical, cash and SNAP benefits.  Many of the processes that were done manually in the past are automated in IES.  This includes the annual medical redetermination process.  IES is prepopulating and generating the redetermination forms.  The first mailing of medical redetermination forms generated by IES was sent in early December 2017 with a due date of January 1, 2018.  The first redetermination cycle was completed on January 17, 2018.

Approximately two months before the medical benefit is set to end, IES gathers electronic clearance data and known case information for each medical case due for redetermination.  The results determine if eligibility for medical coverage can be determined by electronic means.  Cases where the income found electronically is within the medical income standard, and other nonfinancial criteria are verified, will have an automatic redetermination processed.  IES generates Form 2381A, pre-populated with the information found electronically, to inform the customer of continued eligibility.  No response is required if the information on the form is correct.  If there are changes, the customer has 30 days to report them.  Any new information reported or found electronically within that timeframe will be applied to the case and used to make the final redetermination decision. 

Cases that do not qualify for an automatic redetermination are sent Form 2381 or Form 2381B, depending on their benefit package.  These forms are also pre-populated with information found electronically.  The customer has 30 days to respond, either by mail, fax or online through Manage My Case (MMC) in ABE.  If the customer does not respond, their case will automatically cancel and their medical benefits will end.  If they do respond, their medical coverage will continue unchanged until a review is completed.  A notice will be sent informing the customer of the outcome.

If medical coverage was canceled because the redetermination form was not returned, there is a 90 day reinstatement period.  If the customer returns the form within 90 days of the date the coverage ended, and they are eligible for any of our medical programs, their coverage will be reinstated without a break in coverage.


Medicaid Redetermination

 

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