Whenever a Medicaid member no longer meets the eligibility
requirements of the current coverage group, an automatic redetermination of
eligibility for other Medicaid coverage groups shall be made. If the reason for
ineligibility under the initial coverage group pertained to a condition of
eligibility which applies to all coverage groups, such as failure to cooperate,
no further redetermination shall be required. When the redetermination is
completed, the member shall be notified of the decision in writing. The
redetermination process shall be completed as follows:
(1)
Information received by the tenth
of the month. If information that creates ineligibility under the
current coverage group is received in the department by the tenth of the month,
the redetermination process shall be completed by the end of that month unless
the provisions of rule
441-76.14 (249A)
apply. The effective date of cancellation for the current coverage group shall
be the first day of the month following the month in which the information is
received.
(2)
Information
received after the tenth of the month. If information that creates
ineligibility under the current coverage group is received in the department
after the tenth of the month, the redetermination process shall be completed by
the end of the following month unless the provisions of rule
441-76.14 (249A)
apply. The effective date of cancellation for the current coverage group shall
be the first day of the second month following the month in which the
information is received.
(3)
Change in federal law. If a change in federal law affects the
eligibility of large numbers of Medicaid members and the Secretary of Health
and Human Services has extended the redetermination time limits, in accordance
with 42 CFR §
435.1003 as amended to January 13,1997, the redetermination
process shall be completed within the extended time limit and the effective
date of cancellation for the current coverage group shall be no later than the
first day of the month following the month in which the extended time limit
expires.
Notes
Iowa Admin. Code
r. 441-76.17
ARC 1069C, IAB
10/2/2013, effective 10/1/2013
