Haw. Code R. § 17-1712.1-4 - Redetermination due to a change in beneficiary household circumstances

(a) Between annual redeterminations of eligibility, an individual or household shall report any changes in circumstance that may affect eligibility through their elected mode of communication within ten days of the change.

(b) Upon receipt of the change in circumstance information, the department shall redetermine eligibility according to the provisions of sections 17-1712.1-2 or 17-1712.1-3, as applicable.

(c) For an individual determined eligible using MAGI-based methodology, the department shall:

(1) Limit requests for additional information solely to the reported change in circumstance;

(2) If able to redetermine eligibility of all requirements based on the reported change, a new twelve-month period of eligibility may be established;

(3) If informed of an anticipated change, redetermine eligibility at the appropriate time of the change;

(4) Process the addition of a new member to the household in accordance with paragraphs (b) and (c) of this section; and

(5) Prior to making a determination of ineligibility, determine all bases of eligibility under other chapters under this subtitle; and

(6) For an individual determined ineligible for Medicaid, the department shall transfer the individual's application information for other insurance affordability programs as appropriate pursuant to 42 CFR §435.1200(e).

(d) For an individual determined eligible using MAGI-excepted methodology, the department:

(1) May utilize the change in circumstance opportunity to collect additional information in order to complete a redetermination of eligibility for the household. Requests for non-applicant information shall be limited as described under section 17-1711.1-21(e);

(2) May establish a new twelve month period of eligibility if able to redetermine eligibility of all requirements;

(3) Except for the addition of a newborn to a household, shall require a beneficiary requesting the addition of a new household to submit a completed application and supporting documentation as described in chapter 17-1711.1. A redetermination of eligibility for the household shall be completed based upon the submitted application and information;

(4) If informed of an anticipated change, shall redetermine eligibility at the appropriate time of the change;

(5) Prior to making a determination of ineligibility, shall determine all bases of eligibility under other chapters of this subtitle; and

(6) For an individual determined ineligible for Medicaid, the department shall transfer the individual's application information for other insurance affordability programs as appropriate pursuant to 42 CFR §435.1200(e).

Notes

Haw. Code R. § 17-1712.1-4

[Eff 09/30/13] (Auth: HRS § 346-14; 42 C.F.R. §§435.902, 435.916, 435.1200) (Imp: 42 C.F.R. §§435.902, 435.916, 435.1200)