Iowa Admin. Code r. 441-75.52 - Continuing eligibility
Current through Register Vol. 44, No. 20, April 6, 2022
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441—75.52(249A) Continuing eligibility.
75.52(1) Reviews. Eligibility factors shall be reviewed at least annually for the FMAP-related programs. Reviews shall be conducted using information contained in and verification supplied with the review form specified in subrule 75.52(3).
75.52(2) Additional reviews. A redetermination of specific eligibility factors shall be made when:
a. The member reports a change in circumstances (for example, a change in income, as defined at rule 441—75.50(249A)), or
b. A change in the member’s circumstances comes to the attention of a staff member.
a. Information for the annual review shall be submitted on Form 470-2881, 470-2881(M), 470-2881(S), or 470-2881(MS), Review/Recertification Eligibility Document (RRED), with the following exceptions:
(1)When the client has completed Form 470-0462 or 470-0466 (Spanish), Health and Financial Support Application, for another purpose, this form may be used as the review document for the annual review.
(2)Information for recertification of family medical assistance-related medically needy shall be submitted on Form 470-3118 or 470-3118(S), Medicaid Review.
b. The department shall supply the review form to the client as needed, or upon request, and shall pay the cost of postage to return the form.
(1)When the review form is issued in the department’s regular end-of-month mailing, the client shall return the completed form to the department by the fifth calendar day of the following month.
(2)When the review form is not issued in the department’s regular end-of-month mailing, the client shall return the completed form to the department by the seventh day after the date the form is mailed by the department.
(3)A copy of a review form received by fax or electronically shall have the same effect as an original form.
c. The review information for foster children or children in subsidized adoption or subsidized guardianship shall be submitted on Form 470-2914, Foster Care, Adoption, and Guardianship Medicaid Review.
75.52(4) Client responsibilities. For the purposes of this subrule, “clients” shall include persons who received assistance subject to recoupment because the persons were ineligible.
a. The client shall cooperate by giving complete and accurate information needed to establish eligibility.
b. The client shall complete the required review form when requested by the department in accordance with subrule 75.52(3). If the department does not receive a completed form, assistance shall be canceled. A completed form is one that has all items answered, is signed, is dated, and is accompanied by verification as required in paragraphs 75.57(1)“f” and 75.57(2)“l.”
c. The client shall report any change in the following circumstances at the annual review or upon the addition of an individual to the eligible group:
(1)Income from all sources, including any change in care expenses.
(3)Members of the household.
(5)A stepparent recovering from an incapacity.
(6)Change of mailing or living address.
(7)Payment of child support.
(8)Receipt of a social security number.
(9)Payment for child support, alimony, or dependents as defined in paragraph 75.57(8)“b.”
(10)Health insurance premiums or coverage.
d. All clients shall timely report any change in the following circumstances at any time:
(1)Members of the household.
(2)Change of mailing or living address.
(3)Sources of income.
(4)Health insurance premiums or coverage.
e. Clients described at subrule 75.1(35) shall also timely report any change in income from any source and any change in care expenses at any time.
f. A report shall be considered timely when made within ten days from the date:
(1)A person enters or leaves the household.
(2)The mailing or living address changes.
(3)A source of income changes.
(4)A health insurance premium or coverage change is effective.
(5)Of any change in income.
(6)Of any change in care expenses.
g. When a change is not reported as required in paragraphs 75.52(4)“c” through “e,” any excess Medicaid paid shall be subject to recovery.
h. When a change in any circumstance is reported, its effect on eligibility shall be evaluated and eligibility shall be redetermined, if appropriate, regardless of whether the report of the change was required in paragraphs 75.52(4)“c” through “e.”
75.52(5) Effective date. After assistance has been approved, eligibility for continuing assistance shall be effective as of the first of each month. Any change affecting eligibility reported during a month shall be effective the first day of the next calendar month, subject to timely notice requirements at rule 441—16.3(17A) for any adverse actions.
a. When the change creates ineligibility, eligibility under the current coverage group shall be canceled and an automatic redetermination of eligibility shall be completed in accordance with rule 441—76.11(249A).
b. Rescinded IAB 10/4/00, effective 10/1/00.
c. When an individual included in the eligible group becomes ineligible, that individual’s Medicaid shall be canceled effective the first of the next month unless the action must be delayed due to timely notice requirements at rule 441—16.3(17A).
[ARC 8260B, IAB 11/4/09, effective 1/1/10; ARC 8500B, IAB 2/10/10, effective 3/1/10; ARC 4973C, IAB 3/11/20, effective 4/15/20]