Redetermination Module - FIS/ES

1. RedeterminationModule - FIS/ES Updated 03/02/2015

2. Objectives • Locate and Monitor cases due for Redetermination • Schedule an early Redetermination • Log in a Redetermination packet • Perform the Redetermination • Process Overdue and Not Logged Redeterminations

3. How to Take this Training In order to access the hyperlinks in this PowerPoint, you will need to view it in Slide Show mode. If it opens from within PowerPoint (in Edit mode), please follow these steps to play the slide show: • On the bottom status bar, click the Slide Show icon. • If you cannot see the bottom status bar, click Slide Show on the top menu, and then click From Current Slide or From Beginning. • If you cannot see the PowerPoint interface, you may be viewing the presentation in Slide Show mode already.

4. The Redetermination The Department of Human Services must periodically redetermine an individual’s eligibility for active programs. The redetermination process includes a thorough review of all eligibility factors. An ex parte reviewis required before Medicaid closes when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 calendar days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and BAM 220. A complete redetermination is required at least every 12 months (with the exception of FAP groups with a 24 month benefit period). Bridges sets the redetermination date according to benefit periods; seeEligibility Decisions in BAM 115.

5. FAP/MA/CDC Redetermination Periods 3 - month 12 - month 24 - month No Redetermination * If a CDC group is active for other programs, Bridges will set the CDC redetermination date to be the same redetermination date as the other program if 12 months or less. ** A review must be completed before closing an individual in one of these categories if the closure is for any reason other than total ineligibility for any MA (such as moved out of state or death).The review must consider eligibility in all other MA categories.

6. Cash Redetermination Periods 12 - month Refugee Cash Assistance (RCA) does not have a redetermination, the program closes in the eighth month.

7. FAP Semi-Contacts/Mid-Certifications Reviews 6 - month 12 - month A report is considered complete when all of the sections (including the signature section) on the DHS-1046 and the DHS 2240-A are answered completely and required verifications are returned by the client or client’s authorized representative. If an expense has changed and the client does not return proof of the expense, but all of the sections on the report are answered completely, remove the expense from the appropriate data collection screen in Bridges before running eligibility determination and benefit calculation (EDBC).

8. Redetermination Period Exceptions Newborn MA - Newborn cases must be redetermined no later than the month of the child’s first birthday; see BEM 145. Refugee Medical Assistance (RMA) - RMA is only available for a maximum of 8 months (based on date of US entry). An ex parte review should begin at least 90 days prior to the recipient’s eighth month; see BEM 630 page 9. Group 2 Persons Under 21 - If a member will reach age 21 before the month the case is scheduled for redetermination, an ex parte review should begin at least 90 days prior to the date the member turns 21; see BAM 220.

9. Scheduling Bridges generates a redetermination packet to the client three business days prior to the negative action cut-off date in the month before the redetermination is due. Bridges schedules required redetermination appointments in the redetermination month. The packet may include some of the following as determined by the TOA to be redetermined: • Redetermination/review form. • Notice of review as determined by policy. • Interview date. • Interview type. • Place and time. • Required verifications. • Program specific forms. • Due date. • Return envelope.

10. Redetermination/Review Forms May Include: Redetermination/Review forms may include all or some of the following (this list is not all inclusive): DHS-574, Redetermination Telephone Interview (FIP and FAP) DHS-1010, Redetermination (all programs). DHS-1046, Semi-Annual Contact Report (FAP). DHS-1171, Assistance Application (all programs except MA). DHS-2240-A, Mid-Certification Contact Notice (MA and FAP). DHS-2063-B, Continuing Your Food Assistance Benefits (FAP). DHS-1426, Application for Health Coverage and Help Paying Costs. DHS-4574, Medicaid Application (Patient of Nursing Facility).

11. Scheduling Early Redetermination of an active program may be scheduled up to three months before the redetermination date. This is a manual process by the specialist, a verification checklist (VCL) and additional forms may need to be manual sent by the specialist as well. Early redetermination of active programs may be necessary for one of the following reasons: • A case is found to be error-prone as a result of supervisory case reading, quality assurance data or quality enhancement data. • Specialist’s schedule requires early redetermination of active program. • Align dates to simultaneously process redeterminations for multiple programs. Bridges does this automatically for all programs except certain MA programs such as TMA.

12. Scheduling Early Step-by-Step Instructions to Schedule an Early Redetermination: On Left Navigation, select Redetermination. Select Initiate Redetermination. The Redetermination Ready page displays. Enter the case number. Click Search. The Redetermination Details displays at the bottom. Review the redetermination details to make sure you have retrieved correct case. Click the Schedule Early box for each TOA you want to schedule early. Click Submit. Submitted Successfully message displays at the top. You must complete the above steps at least 4 business days prior to the Negative Action Cut-Off Day the month prior to the month of the early redetermination.

13. Scheduling Early Here is the Bridges page where you can select the EDG you wish to schedule early. Notice that only one of the boxes is not “grayed out”. That is the box for the FAP EDG, and in this example, it is the only program that meets the criteria for scheduling early.

14. Scheduling Early Select “Schedule Early” for the FAP EDG.

15. Scheduling Early CLICK on the “Submit” button

16. Scheduling Early You will see a green message under the page title that states: “Submitted Successfully” and the “Schedule Early” box for the FAP EDG will now be grayed out. The “Revert” button in the next column will allow you to change your mind about rescheduling the review early, until the date the packets have been sent.

17. Redetermination Statuses • As your case moves through the various stages of a Redetermination, Bridges will assign it a status. • You can check the status of your Redeterminations by going to Left Navigation>Redetermination>Initiate Redetermination. • This is the same path you would take to schedule an Early Redetermination.

18. Redetermination Statuses Once Bridges has sent the packet and/or scheduled the appointment, Bridges will update the redetermination status to Redetermination Packet and/or Appointment Sent. This indicates that the redetermination process has been started. If this status remains and the redetermination packet and/or appointment are never updated to being received and/or shown, Bridges will automatically close the program based on policy. Bridges will update to Redetermination Completed once the data has been updated, EDBC has been run, and the programs have been certified.

19. Redetermination Statuses

20. Scheduling Early Example Mrs. Imma Worker checks her future redeterminations in Bridges and notices she has 83 redeterminations in December 2014. Mrs. Worker decides to send some of her December redeterminations out early to balance her caseload. She decides to schedule 15 December redeterminations in September and 20 December redeterminations in October. To schedule 15 of Mrs. Worker’s December redeterminations in September, by what day will she have to schedule them early? Negative Action Cut Off Days: August = 08/18/2014 September = 09/19/2014 October = 10/20/2014 November = 11/15/2014 08/12/2014 is correct! To schedule 20 of Mrs. Worker’s December redeterminations in October, by what day will she have to schedule them early? 09/15/2014 is correct!

21. Impact of Scheduling Early If the client is found eligible, a new redetermination date for the EDG is set based on the month you processed the redetermination. For FAP the client’s new benefit period begins the month following the month you processed the redetermination. • Children Under 19 (U19) Only Exception: • Do not shorten a recipient’s 12-month eligibility period. • Once eligible for Children Under 19, a recipient remains eligible until the next redetermination unless any of the following occurs: • Reaches age 19. • Moves out of state. • Is ineligible due to institutional status; see BEM 265. • Death. • A member may be added to an existing case even though the redetermination date is less than 12 months in the future. • FAP Exception: • When a redetermination is scheduled early, FAP benefits cannot be terminated prior to the end of the benefit period for failure to complete the redetermination process.

22. Redetermination Interview Requirements No Interview Required Interview Required Telephone In-Person If both a telephone and in-person interview are acceptable choose the method that is more convenient for the client. Conduct an in-person interview if the client requests one or fraudulent information is suspected. For more information on who can be interviewed for each program see BAM 210. * For FAP, DHS currently has a waiver to conduct a telephone interview. A telephone interview should be conducted unless the client requests an in-person interview or if the specialist determines an in-person interview is appropriate (i.e. suspected fraud).

23. Monitor Your Upcoming Redeterminations • Bridges Left Navigation > Inquiry > Case Load Search. • Change the Level to EDG and the Status to Approved. • You can choose Redetermination Due Date On or Before or leave the date blank.

24. Monitor Your Upcoming Redeterminations • Bridges Left Navigation > Inquiry > Case Load Search. • Change the Level to EDG and the Status to Approved. • You can choose Redetermination Due Date On or Before or leave the date blank.

25. Monitor Your Upcoming Redeterminations • Bridges Left Navigation > Inquiry > Case Load Search. • Change the Level to EDG and the Status to Approved. • You can choose Redetermination Due Date On or Beforeor leave the date blank.

26. Monitor Your Upcoming Redeterminations • Bridges Left Navigation > Inquiry > Case Load Search. • Change the Level to EDG and the Status to Approved. • You can enter a Redetermination Due Date On or Before dateor leave the date blank.

27. Log Packets Received DHS-1010/1171 DHS-2240-A - Review DHS-1046 - Review To log in the completed redetermination packet as received: Bridges Left Navigation > Redetermination > Packet Received

28. Failure to Log In Redetermination Packet

29. Perform Redeterminations After you have logged in the redetermination packet as received you can proceed with the redetermination. Go to Bridges Left Navigation > Data Collection > Initiate Interview. What Case Action will you use? For annual redeterminations, use the Redetermination Case Action. You must update all information that has changed or requires re-verification at Redetermination (examples include but are not limited to income, assets, and medical/support/ dependent care expenses). Bridges will update the redetermination dates for a program ONLY if the redetermination has been initiated.

30. Perform Reviews After you have logged in the review packet as received you can proceed with the redetermination. Go to Bridges Left Navigation > Data Collection > Initiate Interview. What Case Action will you use? Forsemi-annualormid-certificationcontacts,usetheCaseChangeCaseAction.Youmustupdateall information thathaschangedorrequiresre-verification(examples include but are not limited to income, assets, childsupportexpense,etc.). Bridges will update the review dates for a program ONLY if the semi-annual or mid-certification was logged in.

31. New Redetermination Due Date Established • After you have certified the results of the review, you can check to verify that a new Redetermination due date has been established: • Go to Left Navigation>Inquiry>Case. • Click the EDG# hyperlink on the Case Search/Summary page. • View the new Redetermination Date on the EDG Search/Summary page..

32. Overdue Redetermination A redetermination is considered “overdue” when: • The client returned the redetermination packet, and • The client kept the interview (if required) and • The specialist did not completed the redetermination in Bridges by the end of the redetermination month.

33. Client fails to return Packet

34. Income Dates at Redetermination and When Processing the Semi-Annual Contact/Mid-Certification Review Entering Income Dates at Redetermination/Review Income needs to be re-verified at Redetermination; update the income record to move the current information to history and create a new record for ongoing benefit calculations. This also documents that the income was re-verified at redetermination/review. For the Semi Annual Review, if the client's income changed by $100 in earned income and/or $50 in unearned income, income must be verified. At Mid-Certification if the unearned income has changed by more than $50 per month, it must be verified. Using the above rules, when you are required to update income dates there are several factors to consider, such as: Did the income change, if so, when? Is the income change temporary? Did the income end, if so, when?

35. Previous Slide Continued… When re-verifying income you should always enter a new CSCD and update the other dates in the Standard Date Block accordingly. • The CSCD is the check date reflecting a change or the Packet Received Date, whichever is earlier. • Whenever a new CSCD is entered, a historical record is created. • If a new CSCD is not entered, the existing information is overwritten by the new information and history is not created. • Bridges calculates eligibility for up to 12 previous months, so the loss of historical information may result in inaccurate under/over issuances. Select a new Pay History Projection Period when re-verifying income at redetermination and review if the current Pay History Projection Period is too old or does not accurately reflect the client’s future income. Complete the Pay Details page, adding each income record received. Remember, at least one pay must be included in projections. Never delete the existing pay records. They are required so Bridges can store the client’s pay history that was used when eligibility was recalculated for prior months.

36. Asset Dates at Redetermination and Review – BEM 400, Verification Requirements Asset Dates at Redetermination For programs with an asset test, countable assets need to be verified or re-verified at redetermination. Even if the accounts and/or the amounts in the accounts did not change, specialists should update the CSCD, the Date the Client Became Aware, the Verification Received on Date, the Verification Type and amounts. This process creates a historical record and shows that the assets were verified or re-verified. Asset Dates at FAP Review For FAP, verify assets at semiannual and mid-certification contacts only if a change is reported. When required to update assets, at redetermination or review, always update the CSCD to the first of the redetermination or review month. For example: Your case is due for redetermination for FAP in September, the CSCD for assets is 09/01/(current year), even if the bank statement received is from August.

37. Previous Slide Continued…

38. Any Questions?