PM 06-26-06-a Redetermination Scenario Tables

WAG 06-26-06-a

Family Planning redetermination scenarios:

Current Coverage Scenario Form Type
Family Planning Eligibility for Family Planning is confirmed using electronic data sources and case information. IES will send Form A - no response is required. The certification will be extended one year if no response is received.
Family Planning Eligibility cannot be determined electronically.

IES will send Form B - Response is required.

If redetermination is received - process the rede or send a VCL as appropriate. If the customer remains eligible when the rede is completed a new 12 month certification period will be established.

Full medical redetermination scenarios:

Current Coverage Scenario Form Type
Medical Individual receiving ongoing Medical and the redetermination process finds them ineligible for medical but individual opted-in. IES will send Form B. After Form B is returned and processed through IES, individual will be evaluated for Family Planning if no longer eligible for medical benefits.
Medical Individual receiving ongoing medical and opted-out for Family Planning. Redetermination process finds individual ineligible for medical. IES will send Form B. Individual will NOT be evaluated for Family Planning.