B-8200, Redetermination Cycles

Revision 15-4; Effective December 1, 2015

A recipient’s eligibility is redetermined:

  • when necessary because of previously obtained information indicating an anticipated change;
  • within 10 workdays after receipt of a report indicating changes that may affect eligibility or co-payment, including program transfers;
  • within 30 workdays after receipt of a report indicating changes that affect neither eligibility nor co-payment;
  • at periodic intervals not to exceed 12 months; and
  • at least every six months, if income is averaged or an incurred medical expense is budgeted. The person's income is verified and documented and past co-payment is reconciled.

For more information on redeterminations, see Section B-8430, Special Reviews, and Section B-8440, Streamlined Redetermination (Passive Redetermination).

Note: For couple cases, including cases with spouses who may be certified under different type programs, redeterminations should be synchronized to minimize the redetermination process for the recipients and the workload for the eligibility specialist. A complete redetermination of each person's eligibility must be completed at least once every 12 months.

It is a recommended practice to review community-based cases at least every three months if the recipient's countable resources are within $100 of the resources limit.

Monitor eligibility at least every three months if the person's:

  • countable resources are within $100 of the resources limit, or
  • total countable income is within $10 of the income limit.

The following information must be included in the case record documentation:

  • Whether a special review is needed
  • Date special review will be conducted
  • Method of monitoring for special review

Clearly document:

  • specific information regarding the reason a special review is set,
  • which person is affected, and
  • the eligibility area(s) subject to the review.

Example: If someone has a private pension and the pension amount is anticipated to increase in the future, a special review must be set for the anticipated change. The eligibility area will be income. Documentation must specify pension information that will need to be verified at the special review, including:

  • date on which the anticipated change is to occur,
  • type of pension,
  • source of pension, and
  • frequency of payment of pension that will need to be verified at the special review.

Use Form H1020, Request for Information or Action, and Form H1020-A, Sources of Proof, to request information from the person or authorized representative. When requesting missing information on a redetermination, allow 10 calendar days from the date the notice is mailed for the individual to provide the information. Do not deny the case for failure to furnish information before the due date listed on Form H1020.

Note: Monitor special reviews for resource or income elements through entry of the special review due date in the applicable TIERS screen.

Data Broker is not required on redeterminations, including the streamlined versions.