WAG 19-02-04

new textFederal regulations require an automated process for medical redeterminations (REDE) without requiring information from the customer if verifications are available electronically.  Upon implementation of the Integrated Eligibility System (IES) phase 2, the process for completing a redetermination is changed. The Integrated Eligibility System (IES) phase 2 uses a two step process to determine which medical cases can be selected for auto-REDE and which ones require manual processing.

Auto-REDE Selection

Medical REDE Step 1

In step 1, IES identifies the cases that are potentially eligible (non-excluded) for auto-REDE.  These cases include Family Health Plan cases, ACA Adult, Former Foster Care and AABD cases containing SSI recipients.  See the table for more detail in WAG 19-02-04.  Potentially eligible cases contain household members who have electronically verifiable data.

Medical REDE Step 2

In step 2, approximately 75 days prior to the REDE due date (after cutoff of the 3rd month prior to certification end date), IES runs clearances (The Work Number (TWN), AWVS and Secretary of State/IL residency) for all cases due for a medical REDE. IES checks the clearance data to determine if it is adequate to process an auto-REDE (Process A).

For cases that do not qualify for auto-REDE or are excluded from auto-REDE, IES initiates Process B for a manual REDE. If data found in the clearances would cause an individual's eligibility to end, the case does not qualify for auto-REDE. IES will divert such cases to the manual REDE process.

By the 60th day prior to the end of the certification period, IES sends the appropriate REDE forms. The manual REDE due date is the 1st day of the last month in the current certification period.