Situations Requiring a Reinstatement

Situations Requiring a Reinstatement A. Certain situations require a reinstatement of services which means eligibility is restored or Medicaid income is corrected for a prior period. Both types of reinstatements are completed without requiring that a new application be filed on behalf of the recipient. B. A reinstatement is issued r in the following situations, as applicable: 1. Hearing Decision a) When a decision granting eligibility or increased benefits is rendered as part of a state or local hearing, the regional office may be required to reinstate and/ or correct Medicaid income. b) The effective date of the reinstatement is retroactive to the date decided by the hearing official. 2. Action Taken During Advance Notice Period a) When the individual or beneficiary makes a timely hearing request during the advance notice period, benefits will be continued at the same level through the reinstatement process until a hearing decision is reached. b) If advance notice of benefit reduction or termination is not issued as required, benefits must be reinstated at the time the error is discovered, regardless of whether the individual or beneficiary is currently eligible. c) After benefits are reinstated, advance notice is issued. 3. Information Provided Prior to Effective Date of Closure a) If the individual or beneficiary provides information that changes the adverse action decision or fully complies with unmet requirements prior to the effective date of the closure, benefits are reinstated to ensure no loss of benefits if the individual or beneficiary remains eligible. b) If the information provided does not change the adverse action no further action is required. 4. Ninety (90) Day Reinstatement Period for Modified Adjusted Gross Income (MAGI) and Aged, Blind and Disabled (ABD) Renewals a) A ninety (90) day reinstatement period applies to closures at the time of a case review if a case closes due to the failure to return the renewal form and a signed renewal form is returned within the ninety (90) day period following the effective date of the closure. 1) If the returned form is incomplete, action is taken to obtain complete information. 2) If requested information is not provided within the time period allowed for requesting information the case will not be reinstated. b) If the case closed due to failure to provide needed information and the requested information is provided, in full or in part, within the ninety (90) day period following the effective date of the closure, the case will be reinstated provided all information is provided within the time period allowed for requesting the remainder of the needed information. c) The effective month of a reinstatement is the month following the month of closure. d) If a returned renewal form is not signed the ninety (90) day reinstatement provision is not applicable. 5. Whereabouts Become Known a) Eligibility must be terminated if a beneficiary’s whereabouts remain unknown after the Division of Medicaid has made reasonable efforts to locate the beneficiary. b) If the beneficiary’s location subsequently becomes known during the time he or she is eligible benefits will be reinstated. c) For a child who has continuous eligibility, Medicaid benefits are reinstated with no break in coverage. d) For an adult, the Division of Medicaid determines eligibility for each month that the adult beneficiary’s whereabouts were unknown and reinstate for any period he or she would have been eligible. 6. Temporary Case Closure a) When it is known that a beneficiary will be ineligible for three (3) months or less, the closure is processed in the usual manner but at the end of the temporary period the case may be reinstated without completing new eligibility forms necessary for reapplication. b) In this situation a break in eligibility correctly exists with the eligibility begin date adjusted to reflect the most recent eligibility begin date. 7. Reapplication a) When an applicant has a prior application which has been in rejected status for three (3) months or less, the rejected application form can be reinstated. b) A new application is not required provided all information is provided to determine eligibility. 8. Agency Error a) When the Division of Medicaid has denied or terminated eligibility in error or reduced benefits in error, benefits are reinstated retroactively. b) The date of reinstatement is the month the error occurred.