This proposed change would reduce burden on Of those 6 hours, we estimate it would take a Business Operations Specialist an average of 4 hours at $77.28/hr and a Management Analyst 2 hours at $96.66/hr. For example, in some States, a single State agency may administer the employee health plan for all State employees, and the plan may be available only to State employees and their dependents. Start Printed Page 54825 If the beneficiary does not respond with the requested information or the information provided does not establish the beneficiary's continued eligibility or entitlement to the same level of assistance, the State must: (1) provide advance notice of termination or other adverse action and fair hearing rights consistent with part 431, subpart E; and (2) before terminating the beneficiary's coverage, assess eligibility for other insurance affordability programs in accordance with proposed revisions to current 435.916(f)(2), redesignated at 435.916(d)(2) in this rulemaking, and transfer the individual's account, as appropriate. Start Printed Page 54818 31. Key Findings. However, we are aware that several States do not use the leads data to begin the application process. [47] (iii) The agency may elect to utilize any combination or order of other modalities. MIPPA included new requirements for States to leverage the Medicare Part D Low-Income Subsidy (LIS) program to help enroll likely-eligible individuals in MSPs. Section 435.911 is amended by revising paragraph (c) introductory text and adding paragraph (e) to read as follows: (c) For each individual who has submitted an application described in 435.907, whose eligibility is being renewed in accordance with 435.916, or whose eligibility is being redetermined in accordance with 435.919 and who meets the non-financial requirements for eligibility (or for whom the agency is providing a reasonable opportunity to verify citizenship or immigration status in accordance with 435.956(b)), the State Medicaid agency must comply with the following. Therefore, we estimate a total of 499,185 individuals (405,963 + 41,507 + 30,327 + 21,388) would newly enroll without the need to complete an application. Amerigroup Arizona Health Care Cost Containment System, https://www.colorado.gov/hcpf/how-to-apply, Applying for HUSKY Health can be done online, http://www.ct.gov/dss/cwp/view.asp?a=2345&q=490624. Taking into account the 50 percent Federal contribution to Medicaid and CHIP program administration, the estimated State share would be $9,024,603. (4) to add a new paragraph (b) at 435.909 that generally would require States to deem an individual enrolled in the mandatory SSI or 209(b) group eligible for the QMB group the The Medicare Part D LIS program, also sometimes referred to as Extra Help, is administered by SSA and pays Medicare Part D prescription drug premiums and cost-sharing for over 13 million individuals with low income. (2) Upon approval from the Secretary, the agency may treat updated in-state address information from other trusted data sources in accordance with paragraph (g)(1) of this section. We are proposing a 30-day reconsideration period at application, rather than a 90-day reconsideration period similar to the 90-day period proposed at redetermination, because we believe applicants will generally be expecting a communication from the State regarding the status of the submitted application and will be less likely than current beneficiaries to miss requests for additional information. refer to the maximum periods of time, subject to the exceptions in paragraph (e) of this section and in accordance with 435.911(c), in which every applicant is entitled to a determination of eligibility, a redetermination of eligibility at renewal, and a redetermination of eligibility based on a change in circumstances. The calculations exclude all Childrens Health Insurance Program (CHIP) spending and enrollment through both Medicaid CHIP and separate CHIP programs. You must be a resident of the state to qualify for Medicaid. Proposed 457.348(b)(2)(ii) describes individuals who are determined CHIP eligible by a separate Medicaid (including as the result of a decision made by a Medicaid appeals entity). (ii) If unable to make a determination of eligibility for MAGI-based Medicaid, identify potential eligibility for other insurance affordability programs, including Medicaid on a basis other than MAGI, eligibility for the Basic Health Program (BHP) in accordance with 42 CFR 600.305(a), or insurance affordability programs available through the Exchange as indicated by information provided on the application or renewal form provided by or on behalf of the beneficiary. The elimination of income disregards under MAGI-based methodologies (see 435.603(g)) also effectively limits the flexibility States previously had to raise the effective income standard for coverage under 435.222 to meet the needs of new reasonable classifications of individuals under age 21 who are not eligible under the mandatory group for children at 435.118 or, in the case of 19 and 20-year-olds, under the adult group at 435.119. We also seek comment on whether a minimum of 15 calendar days from the date the State's request for additional information is postmarked or electronically sent is sufficient for applicants generally (that is, regardless of any need for a determination of CSHCN status) or whether a longer timeframe, such as 20, 25, or 30 calendar days from the date the request is postmarked or electronically sent, similar to the longer time (30 calendar days) proposed for individuals applying for Medicaid on the basis of disability, is appropriate. ICRs Regarding Returned Mail (435.919 and 457.344), 11. Of those 200 hours, we estimate it would take a Business Operations Specialist 50 hours at $77.28/hr and a Management Analyst 150 hours at $96.66/hr. Thus, we believe that State verification of this data prior to adjudicating eligibility is duplicative and inefficient. Standard for redeterminations based on changes in circumstances. To see if you qualify, submit your application of Medicaid benefits online. The applicable time period (25 or 90 days) is measured in calendar days from the date the agency determines the individual not eligible on the basis on which he or she had been receiving coverage. Applying for WIC. This would also be true of individuals who are eligible for Medicaid on the basis of their receipt of assistance under title IV-E of the Act (see 435.145). Nebraska residents can apply for Medicaid assistance online. Children's Health Matters. and For LIS eligibility determinations, under 20 CFR 418.3405, SSA only counts liquid (vi) All renewal forms and documentation returned by, or on behalf of, a beneficiary, to the Medicaid agency in accordance with 435.916 of this subchapter, regardless of the modality through which such forms are submitted, including the signature on the form and date received. Which Medicaid plan is best in New Jersey? Additionally, PERM eligibility reviews in the FYs 2019, 2020, and 2021 cycles found that insufficient documentation was a leading cause of eligibility errors.[64]. States that use the timeliness exception 435.912(e) must document the reason for delay in the case record in accordance with 435.912(f). Like all states, Indiana determines Medicaid eligibility based on your income, family size and age. v. documents in the last year, 1391 Start Printed Page 54794 Current 435.911(c) applies to individuals who submit an application described in 435.907 or whose eligibility is being renewed in accordance with 435.916. 2021 New Rhino, LLC. We also seek comment on extending the proposal relating to verification of dividend and interest income to individuals seeking eligibility based on MAGI, as well as whether there are additional income or resource types to which the proposals below could be extended for all individuals. Which Medicaid plan is best in Mississippi? (1)(i) The State plan must specify that, except to the extent precluded in 435.602, in determining financial eligibility of individuals, the agency will apply the cash assistance financial methodologies and requirements, unless the agency chooses the option described in paragraph (f)(1)(ii)(B) of this section, or chooses to apply less restrictive income and resource methodologies in accordance with paragraph (d) of this section, or both. , we issued the Medicaid and Children's Health Insurance Programs: Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Other Provisions Related to Eligibility and Enrollment for Medicaid and CHIP Final Rule[61] Many people enrolled in Medi-Cal pay nothing for their health insurance, while other families may pay a small monthly premium. As of 2014, there are 72.5 million people registered for Medicaid. L. 111-148, enacted on March 23, 2010), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. We are also interested in hearing from stakeholders and beneficiaries on the impact of more frequent renewals on maintaining coverage. Start Printed Page 54817 Through PERM, the MEQC program, and other CMS eligibility reviews, we partner with States to review their eligibility and enrollment processes and conduct case reviews to ensure that eligible individuals can enroll and stay enrolled without undue burden and that ineligible individuals are redirected to the appropriate coverage programs. Of the 6 Medicaid hours, we estimate it would take a Business Operations Specialist 4 hours (and 2 hr for CHIP) at $77.28/hr and a Management Analyst 2 hours (and 1 hr for CHIP) at $96.66/hr. BadgerCare Plus is one of Wisconsins Medicaid program. To redesignate current paragraph (f) at proposed 457.350(d), which is currently reserved. Per section 1902(e)(8) of the Act, coverage under the QMB group is effective the month following the month in which the QMB eligibility determination is made. Accessibility of renewal forms and notices. Start Printed Page 54823 We determined the number of people who were enrolled in the LIS program by: (1) State; (2) the category of LIS benefit they received; and (3) whether or not they were also enrolled in Medicaid. The new control number will be set out in the final rule. This approach would provide States with immediate access to new options, like the option to establish an earlier effective date for coverage provided to individuals eligible in the QMB group. Ku, L., & Ross, D.C. (2002). We also seek comment on whether the final rule should align the timeframe for all applicants or provide a longer period for individuals applying on the basis of disability, and whether a corresponding exception to the 45-day timeliness requirement at 435.912(c)(3)(ii) should accompany a longer timeframe. 48. We propose that the application timeliness standards provided under 435.912(c)(3) would apply to redeterminations initiated during the 90-day reconsideration period proposed at 435.919(d). Heres how tocontact the Michigan Medicaid Agency: MI ENROLLS: 1-800-975-7630 (ii) If whereabouts of a beneficiary whose coverage was terminated or suspended in accordance with this paragraph become known within the beneficiary's eligibility period, as defined in 435.916(b) of this chapter as referenced in 457.343, the State. by the Securities and Exchange Commission In paragraph (a)(4), by removing the phrase Provide for coordination of notices with other insurance and adding in its place the phrase Provide for a combined eligibility notice and coordination of notices with other insurance; d. In paragraph (c)(3), by removing the reference to 457.350(i) and adding in its place the reference 457.350(g); and. Of those 20 hours, we estimate it would take a Database and Network Administrator and Architect 5 hours at $98.50/hr and a Computer Programmer 15 hours at $92.92/hr. We considered allowing States, which have not yet transitioned their enrollee records into an electronic format, to continue to maintain a paper-based record keeping system. Heres the list of documents you may have to provide: After you submit your Michigan Medicaid application, you may be required to attend an interview with a Department of Health and Human Services (MDHHS) caseworker. Women with some cancers also qualify. We estimate that it would take all 40 States with a separate CHIP an average of 42 hours each to review any policy differences between their Medicaid and CHIP programs and make any necessary administrative actions to permit coordination of enrollment, such as a delegation of eligibility determinations or alignment of financial eligibility requirements between the two programs approximately. 4. Washington Medicaid Application:https://www.dshs.wa.gov/esa/community-services-offices/how-apply-services. In SSI criteria and 209(b) States, SSA notifies both the State and CMS that an individual has been determined eligible for SSI and Medicare Part B; however, because such individuals must submit a separate Medicaid application for determinations of eligibility, CMS does not automatically initiate Part B buy-in. We similarly propose changes to 457.340 to require the use of a combined notice for transitions between separate CHIP and Medicaid. As noted above, SSA automatically enrolls individuals who receive Social Security or RRB retirement benefits or disability benefits for 24 months into premium-free Part A. SSA data for States (including those with a 1634 agreement and those without a 1634 agreement) indicates whether an SSI recipient is entitled to premium-free Part A. Allowing all Medicaid-eligible members who meet a nursing facility level of care to access the Community Benefit will maintain New Mexicos accomplishments in rebalancing efforts. on The agency must, (1) Maintain the records described in paragraph (b) of this section in an electronic format; and. We believe these changes could address potential declines in enrollment that may result from eligible individuals not being seamlessly transitioned to Medicaid from CHIP and from Medicaid to CHIP when available information indicates eligibility for the other program. Proposed 435.912(c)(1)(iii) would provide that timeliness and performance standards adopted by the agency for conducting redeterminations of eligibility based on a change in a beneficiary's circumstances must cover the period from the date that the agency receives information indicating a potential change in circumstances that may affect eligibility to the date that the agency sends the individual a notice regarding their continued eligibility for coverage, or as applicable, terminates eligibility and transfers the individual's electronic account to another insurance affordability program in accordance with 435.1200(e). We reiterated the 2010 guidance in 2020 through updates to the Manual for the State Payment of Medicare Premiums.[25]. . First, individuals who are Medicaid eligible based on being age 65 or older or having blindness or a disability are more likely to live on a fixed income and, therefore, are more likely to remain financially eligible for coverage than the non-disabled beneficiaries under age 65 who qualify for Medicaid based on MAGI. (8) A data match with the Department of Homeland Security Systematic Alien Verification for Entitlements (SAVE) Program or any other process Thirty-three States and the District of Columbia (DC) that cover the mandatory SSI group have an agreement with SSA under section 1634(a) of the Act under which SSA completes the determination of eligibility for the mandatory SSI group, and the Medicaid agency automatically enrolls the individual in Medicaid following a data exchange with SSA. This means that individuals receiving SSI are not guaranteed Medicaid. States that include payment of Part A premiums for QMBs in their buy-in agreements are called Part A buy-in States. In Part A buy-in States, individuals determined eligible for the QMB group can enroll in premium Part A at any time of the year and without regard to late enrollment penalties. [7879]. established by DHS to verify that an individual is a citizen. Under proposed 435.916(b)(2), we estimate 37 States will need to establish a reconsideration period for non-MAGI beneficiaries or extend the timeframe of their existing reconsideration period for non-MAGI beneficiaries to 90 calendar days. The agency may accept the third-party information if the beneficiary does not respond to agency requests for additional information under this paragraph (b); (iv) Except as provided in paragraphs (f) and (g) of this section, if the agency determines that the third-party information is not reliable or does not impact the beneficiary's eligibility, no action is required. 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