MAGI-Medicaid and QHP Renewal Overview

RI UHIP supports eligibility renewals for MAGI-related RIte Care and Qualified Health Plans (QHPs). The Medicaid renewal process runs monthly for individuals whose current Medicaid eligibility will end in 60 days. QHP members renew enrollment during the annual open enrollment period.

MAGI Medicaid Renewals

Medicaid eligibility must be redetermined once every year. The scope of these reviews is limited to factors subject to change – income or residency, for example. The federal Affordable Care Act of 2010 strengthens this policy by requiring states to automate reviews and conduct them as a renewal instead of a redetermination or recertification. Changes to RI UHIP support the completion of such renewals.

MAGI Medicaid renewals may process without worker intervention if all information provided by the household can be verified using information from external sources. If required information cannot be verified with external sources, intervention by an admin worker may be required.

Process Steps

Day 1

·         The renewal process begins 60 days before current Medicaid benefits are due to expire. At this time, current application information is verified against external data sources.

·         RI UHIP sends a notice informing recipients it is time for their Medicaid to be renewed.

·         The notice reminds recipients to report any changes that pertain to their particular circumstances.

·         The notice also includes requests for documentation, if RI UHIP cannot verify data from external sources.

Day 1 thought Day 30:

·         If recipients have changes to report, they can indicate what has changed on the notice and return it to DHS for processing. They can also login to RI UHIP and make updates to their application using the RI UHIP change reporting function.

·         If recipients have no changes to report and all information on the current application can be verified by external sources, the renewal proceeds without any worker intervention.

Day 30:

·         Eligibility is redetermined for the MAGI Medicaid household.

·         If the individual submitted and verified new information, it is considered in the eligibility determination.

·         If no information was submitted, data from external sources is used to determine eligibility.

·         Individuals receive a Notice of Eligibility with the outcome of the renewal.

Day 60:

·   Current Medicaid benefits are due to expire on Day 60.

Change Reporting During the MAGI-Medicaid Renewal Process:

Individuals have 15 days to provide verification after change reporting. If an individual reports new information during the renewal process and it is not verified, change reporting rules apply.

·         If verifications are provided by Day 30 of the renewal process, eligibility is redetermined on Day 30 using the reported changes.

For example – A recipient change reports on Day 20, supplies verifications on Day 25, and the verification task is closed on Day 27. In this instance, eligibility is redetermined on Day 30.

·         If verifications are not confirmed by Day 30, RI UHIP does not redetermine eligibility that day, unless the 15 day deadline to provide verification has expired. In that case Medicaid is closed on the 30^th day.

For example – A recipient change reports on Day 27, supplies verifications on Day 32, and the verification task is closed Day 33. In this instance, eligibility is redetermined that night (Day 33) via a job run by RI UHIP each evening.

QHP Renewals

Each year, enrollment for QHP members must be renewed. As part of the QHP renewal process, eligibility for those seeking government assistance (Advanced Premium Tax Credits, and/or Cost Saving Reductions) toward healthcare costs is confirmed. Also as part of the renewal, an individual seeking reenrollment in a QHP must confirm plan selection.

QHP renewals are completed annually during the open enrollment period. The State has responsibility for identifying the annual open enrollment period and communicating that information to the public. .As part of the renewal process, QHP participants must login to RI UHIP (or call the Contact Center) to renew an existing plan or select a different plan.

Process Steps

Prior to Open Enrollment:

·         Shortly before open enrollment begins, RI UHIP identifies individuals with active eligibility who must reenroll.

·         RI UHIP sends notices to these individuals.

·         Notices provide information about open enrollment dates, projected eligibility, change reporting, and the plan selection process. It also includes information about the dates by which payment for plan coverage must be made.

·         Individuals requesting affordability assistance must provide consent to online verification of annual income.

Day 1 of Open Enrollment

·         Beginning on Day 1 of Open Enrollment, individuals can report changes and renew coverage for 2015. Changes that may be entered as part of the renewal are changes to existing household members requesting coverage and annual income. Other changes must be made through the change reporting process. Enrollment and plan selection are available throughout the open enrollment period.

Last Day of Open Enrollment

·         This is the last day QHP participants can reenroll and select a plan.

QHP Change Reporting During Open Enrollment

With the exception of changes to annual income and a change in household members, change reports must occur before 2015 enrollment activities. This includes:

•       Number of members in the household

•       Current income

•       Residential address

•       Pregnancy status

•       Access to other health insurance

•       Birth, adoption, placement for adoption, marriage, divorce, or death

•       The number of tax dependents claimed on federal income taxes

Users are prompted to access Report a Change in Income or Household before enrolling for the 2015 coverage year if any of these change types apply.

Results of the Procedure

Renewal for Medicaid and QHP recipients are completed.