PM 06-26-06-a: Family Planning Redetermination Scenarios

WAG 06-26-06-a

Family Planning redetermination scenarios:

Current Coverage	Scenario	Outcome
Family Planning	Customer receiving Family Planning coverage and the redetermination process determines the customer eligible for ex parte redetermination.	Customer will receive a 2381C form only. Certification will be extended for one year with no response from customer required.
Family Planning	Customer receiving Family Planning coverage and the redetermination process determines the customer ineligible for ex parte redetermination.	Customer will receive a 2381C form and a manual redetermination form (form type dependent on benefits being redetermined). If redetermination is returned, the customer will be evaluated for Family Planning coverage.

Full medical redetermination scenarios:

Current Coverage	Scenario	Outcome
Medical	Customer receiving ongoing Medical and the redetermination process finds them ineligible for ex parte redetermination. Customer opted-in to Family Planning on application.	Customer will receive a 2381C form and a manual redetermination form (form type dependent on benefits being redetermined). If redetermination form is returned, customer will be evaluated for full medical coverage. If customer found no longer eligible for full medical coverage, IES will cascade to evaluate customer for Family Planning coverage (see note).
Medical	Customer receiving ongoing Medical and the redetermination process finds them ineligible for ex parte redetermination. Customer did not opt-in for Family Planning.	Customer will receive a 2381C form and a manual redetermination form (form type dependent on benefits being redetermined). If redetermination form is returned, customer will be evaluated for full medical coverage. Customer will not be evaluated for Family Planning (see note).

Note: In both full medical redetermination scenarios the customer would receive a 2381C notice along with a manual redetermination form.