Effective Date: March 1, 2023 - December 31, 2023
An eligibility review is the process of gathering and verifying all factors of eligibility to determine if a member remains eligible.
1. Reviews are required for all CHIP programs once every 12 months, and no more frequently than once every 12 months.
2. The eligibility agency must begin the review process early enough that a redetermination can be made before the end of the current certification period.
3. The eligibility agency must attempt a redetermination of benefits based on current, reliable information without required any information for the member (ex parte review see 704-1).
a. Any form of verification may be used as long as it does not involve asking the member. (705)
b. Members may move between medical programs during the ex parte review.
c. If available information is insufficient to determine continued eligibility, member participation is the eligibility review is required (704-2).
d. If an ex parte review has not been attempted and an eligibility review (online, telephonic or pre-populated) has been completed, the ex parte must be attempted before using the completed eligibility review. If the ex parte can be completed, use the completed eligibility review as a change report form (804). If the ex parte cannot be completed, use the eligibility review form to complete a member participation eligibility review 704-2).
4. If unable to complete the ex parte review, member participation is required (704-2).
5. See 703 for length of a certification period.
6. See 435 for budgeting of income.
7. See 804 and 102-3 for changes during the certification period.