
Navigating the Intersection of Continuous Eligibility and Individual Renewal Processes in a 12-month eligibility state, when a child’s eligibility is determined via ex parte review, and new information emerges from the parent/caretaker, states can choose between two options. Option 1 delays the child’s eligibility determination until the parent’s determination is made, with any new information impacting the child’s renewal. Option 2 treats the ex parte determination as final, with new information having no bearing on the child’s ongoing eligibility. In both cases, the child’s new 12-month continuous eligibility period begins at different times based on the chosen approach.
In states with 12-month continuous eligibility, the challenge arises when a child’s eligibility, initially determined through an ex parte review, faces potential modifications due to new information provided by the parent or caretaker. This article explores two distinct options for handling such situations, each with unique implications for the child’s renewal process.
State Strategies for Handling Renewal Decisions in Light of Fresh Information
Challenge: In a state where continuous eligibility spans 12 months, the eligibility of a child is initially determined through an ex parte review during the redetermination process. Subsequently, the parent or caretaker provides new information that could impact the child’s eligibility.
Approach: States have two potential courses of action when dealing with the newly provided information from the parent or caretaker.
Option 1: Delay the final determination of the child’s eligibility until the parent’s eligibility determination is established.
• Information submitted by the parent before the commencement of the child’s new continuous eligibility period is considered part of the child’s renewal.
• The child must remain enrolled throughout their existing continuous eligibility period.
• If the provided information indicates that the child no longer meets the eligibility criteria, they may be deemed ineligible and disenrolled after the 12-month eligibility period. Adequate notice and appeal rights must be extended.
Option 2: Consider the ex parte determination as a conclusive decision effective after the conclusion of the current coverage and continuous eligibility period.
• Information submitted by the parent after the child’s ex parte determination will not impact the child’s ongoing eligibility.
• Once a child is determined eligible through the ex parte process, that determination is final.
• The child’s new 12-month continuous eligibility period will not commence until the conclusion of the current 12-month period.