Conducting Eligibility Redeterminations at the Individual Level: State Diagnostic Assessment Tool

Kinda Serafi, Patti Boozang, and Kaylee O’Connor, Manatt Health

Early unwinding-related renewal data shows that many states have low ex parte renewal rates and high procedural termination rates. One contributing factor that the Centers for Medicare & Medicaid Services and states have identified is that some states are conducting ex parte renewal processes at the household level, rather than at the individual level, as required by federal regulations. This diagnostic assessment tool is designed to assist states in assessing whether they are conducting ex parte and other renewal processes at the individual level in accordance with federal regulatory requirements. To use this tool, states should convene a team of key policy, operations and systems owners to review and answer these questions. This will require close review and analysis of eligibility and enrollment policies, IT system business rules and other system artifacts, and operating procedures.

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