Haw. Code R. § 17-1712.1-2 - Annual redetermination of a MAGI beneficiary

(a) The beneficiary may request assistance with an annual redetermination under the provisions described in subchapter 2 of chapter 171711.1.

(b) The annual redetermination of an individual or household, whose Medicaid eligibility is based on modified adjusted gross income methods (MAGI), shall be completed by the department no more frequently than once every twelve months.

(c) The annual redetermination of Medicaid eligibility shall be based on reliable information available to the department to include information through a federal or state database as described in chapter 17-1714.1, without requiring additional information from the beneficiary.

(d) If able to redetermine eligibility based on available information, the department shall notify the beneficiary as described under the provisions of chapter 17-1713.1, of the following:

(1) The eligibility redetermination decision and basis; and

(2) If the information is accurate, the beneficiary is not required to sign and return the notice; or

(3) If the information is not accurate, the beneficiary is required to correct, sign and return the notice.

(e) If the department is unable to redetermine eligibility in accordance with paragraph (c) of this section, the department shall:

(1) Send a pre-populated redetermination form containing information available to the department that is needed to redetermine eligibility, allowing at least thirty days from the date the redetermination form is sent to respond and provide any necessary information through any mode of communication under the provisions of chapter 17-1711.1;

(2) Upon receipt, verify the information provided by the beneficiary; and

(3) Inform the beneficiary of the eligibility decision under the provisions described in chapter 17-1713.1.

(f) A beneficiary who is terminated for failure to submit the redetermination form or necessary information, then later submits the redetermination form within ninety days after the date of termination, shall not be required to submit a new application. The new effective date of eligibility shall be the date the redetermination form is received.

(g) The beneficiary shall not be required to complete an in-person interview as part of the annual redetermination process.

(h) Verification of eligibility criteria may occur between scheduled eligibility redeterminations as described in subchapter 5 of chapter 17-1714.1.

Notes

Haw. Code R. § 17-1712.1-2

[Eff 09/30/13] (Auth: HRS § 346-14; Imp: 42 C.F.R. §§435.531, 435.541, 435.911, 435.916, 435.952) (Imp: 42 C.F.R. §§435.531, 435.541, 435.911, 435.916, 435.952)