MR #24.26 Medical Redetermination Updates

Illinois Department of Healthcare and Family Services Logo Illinois Department of Human Services logo

10/25/2024

Summary

This manual release provides updates to the medical redetermination process.
Every individual due for medical redetermination is evaluated for ex parte eligibility.
HFS Forms 2381, 2381A, and 2381B are discontinued, and their contents are incorporated into the dynamic HFS 2381C Medical Redetermination Notice.
Historical redetermination records are available in the Auto Redetermination Summary tab in IES.
IES pages have been updated to capture ex parte eligibility and assist caseworker processing.
The ABE-Renew My Benefits page has been updated to reflect the HFS 2381C notice.

Background
1. Medical Redetermination Timeline
2. Continuous Eligibility and Ex Parte Eligibility
New HFS 2381C Medical Redetermination Notice
Redetermination Changes in IES
Changes Reported During the Redetermination Process
1. Ex Parte Eligible Only EDGs due for Redetermination
2. Ex Parte Eligible and Ineligible EDGs Due for Redetermination
Redetermination Changes to ABE: Manage My Case
Manual Revisions

Background

Ex parte redetermination is a renewal process used to determine medical eligibility based on reliable information available without requiring verification from the customer. See PM 19-02-04-a: Ex Parte Redeterminations. This is commonly known as auto-rede, auto-redetermination, or Form A. Effective 10/01/2023, pursuant to 42 CFR 435.916, each person due for medical redetermination must be reviewed for ex parte eligibility on an individual basis. Previously, if one person in a household was determined ineligible for ex parte, all members due for medical redetermination were required to complete a manual redetermination.

Note: Specific criteria must be met to be determined ex parte eligible. See PM 19-02-04-b: Criteria for Ex Parte Eligibility for more information.

Medical Redetermination Timeline

The following provides a simplified timeline of the medical redetermination process:

Approximately 75 days before the redetermination due date, medical EDGs are evaluated for ex parte eligibility.

Approximately 60 days before the redetermination due date, 2381C notices (and, if applicable, a redetermination form) will be mailed to the household and made available in ABE under "Manage My Case."

Approximately 45 days before the redetermination due date, medical EDGs determined ex parte eligible will be certified for a new 12-month certification period, which begins the month after the current certification period ends.

Continuous Eligibility and Ex Parte Eligibility

Once determined ex parte eligible (approximately 75 days before the redetermination due date), continuous eligibility customers will retain coverage for their current and new certification periods regardless of reported changes.

Example: Seventy-five (75) days before the certification due date, a ten-year-old child due for medical redetermination is found ex parte eligible. Fifty (50) days before the redetermination due date, the head of household for the child's case reports a change of income that puts the child over the program income standard. The caseworker processes as a case change, and the child retains coverage for the current and new 12-month certification periods.

New HFS 2381C Medical Redetermination Notice

Effective 08/06/2024, HFS Forms 2381, 2381A, and 2381B will be discontinued and replaced by the dynamic HFS 2381C Medical Redetermination Notice. This notice captures ex parte eligible and ineligible household members and informs customers of their redetermination status.

Note: The 2381A notice was commonly known as "Form A." The 2381 and 2381B notices were commonly known as "Form B."

The 2381C displays the information previously contained in the 2381, 2381A, and 2381B notices, although some formatting and language have been updated. Language is dynamic based upon ex parte eligibility, programs being renewed, and electronic and record information available. There are three possible household compositions for the 2381C:

1. All household members found ex parte eligible.

Notice informs the customer(s) that medical benefits will be renewed with no customer action required.

2. All household members found ex parte ineligible.

Notice informs the customer(s) that medical benefits cannot be automatically renewed. Action is required by the customer(s) to redetermine medical eligibility.
Notice includes a 643 or 1893 redetermination form, depending on which benefits are being redetermined.

3. Household contains both ex parte eligible and ineligible members.

Notice informs which customer(s) are renewed with no action required and which customer(s) must submit a manual redetermination form to redetermine medical eligibility.
Notice includes a 643 or 1893 redetermination form, depending on which benefits are being redetermined.

See PM and WAG Medical Redetermination Notices

Note: The customer should not return the 2381C Notice. However, if it is returned, staff should review it for any updates or changes the customer may have reported.

Redetermination Changes in IES

The following pages in IES have been updated to capture the redetermination process better.

Auto Redetermination Eligibility Results Page

Effective 10/24/2023, the Auto Redetermination Eligibility Results page will become continuously enabled after at least one individual on the case has completed the ex parte determination process. This page will update each time a customer is reviewed for ex parte eligibility, approximately 75 days before the individual's current certification period ends. The page displays current and historical data back to 10/24/2023.

Reminder: Every customer due for medical redetermination will be evaluated for ex parte eligibility.

The Auto Redetermination Eligibility Results page is located under the Auto Rede Summary page on the Eligibility Summary page.

Before 10/24/2023 when no change was reported by the customer, income records found during the ex parte redetermination process were automatically updated in the Income logical unit of work (LUW). Currently, income records are no longer updated in the Income LUW when no change has been reported by the customer. If a change in income is reported, caseworkers processing the change must check the Auto Redetermination Eligibility Results page for the most recent income records. Caseworkers must document the reported income change vs. the income displayed on the Auto Redetermination Eligibility Results page in the case comments.

The table below provides a side-by-side comparison of the previous functionality of the Auto Redetermination Results page to the current functionality.

Changes to the Auto Redetermination Results Page	Previous	Current
Tab Title	Pending Auto Redetermination	Auto Rede Summary
Availability	Only enabled for a short period of time during the redetermination process.	Always enabled after one ex parte determination has been made on the case.
Historical Data	Only the current redetermination record is displayed.	Historical records are viewable for each ex parte determination on a case.

Note: Ex parte determination is defined as the EDG having been determined either ex parte eligible or ineligible.

Redetermination Received Search/Summary Page

Screenshot of the Redetermination Received Search/Summary page in IES displaying numbers 1-4 that correlate with the text listed below the screenshot.

Please review the updates listed below, which correspond to the numbers on the image above for the Redetermination Received Search/Summary page in IES.

1. New column titled "Form":

This column specifies if a medical EDG has been determined ex parte eligible or ineligible. EDGs determined ex parte eligible will show an "A" and EDGs determined ex parte ineligible will show a "B" ("A" and "B" are a reference to the discontinued 2381A and 2381B forms). Non-medical EDGs will display "N/A" under this column.
The pencil icon under the "Action" column will be disabled for medical "A" EDGs (ex parte eligible).
Data under this column will populate approximately 70 days before the redetermination due date.

2. Changes to the Redetermination Sent Date column:

Data in this column will be populated approximately 70 days before the redetermination due date. It will display the first day of the month before the redetermination due date month. Example: If the redetermination due date is 3/31/2024, "2/01/2024" will populate for the "Redetermination Sent Date" on approximately 1/20/2024.

3. Changes to the Redetermination Received Date column:

For medical EDGs determined ex parte eligible, data in this column will be updated approximately 70 days before the redetermination due date. It will display the first day of the month before the redetermination due date. The redetermination sent date and the redetermination received date will be identical for ex parte EDGs. Previously, this field would remain blank for ex parte EDGs. Example: If the redetermination due date is 3/31/2024, "2/01/2024" will populate for the "Redetermination Received Date" on approximately 1/20/2024.

Note: For medical EDGs found ex parte ineligible (and non-medical EDGs), data in this column will still be updated with the date the State received the submitted redetermination from the customer. This could be automatically populated via ABE submission or data-cap scanning, or manually entered by processing staff.

4. Changes to the Redetermination Last Processed Date column:

For medical EDGs determined ex parte eligible, data in this column will be updated approximately 45 days before the redetermination due date. Ex parte EDGs will display a date, which will be approximately 45 days before the redetermination due date. This date captures when the ex parte EDG receives the new 12-month certification period. Example: If the redetermination due date is 3/31/2024, the "Redetermination Last Processed" date may populate on 2/16/2024 with the date "2/15/2024."

Initiate Interview-Initiate Review Page

Screenshot of the Initiate Interview-Initiate Review page in IES displaying numbers 1-2 which correlate to the text below.

Please review the updates listed below, which correspond to the numbers on the image above for the Initiate Interview-Initiate Review page in IES.

1. When ex parte eligible EDGs cannot be certified during the certification batch process, they will appear in the "EDGs for which REDE has been initiated" table. The certification batches run approximately 45 days before the redetermination due date.

2. The date under the "REDE Received Date" column in the "EDGs for which REDE has been initiated" table will be the first day of the month before the redetermination due date for the ex parte eligible EDGs.

Note: Ex parte eligible EDGs that failed the certification batch process will also appear on the MUE 100 Exception report.

Note: This page does not include the "Form" column as found on the Redetermination Received Search/Summary page. Caseworkers can identify EDGs determined ex parte eligible when the pencil icon is disabled under the "Action" column and the "REDE Received Date" displays the first day of the month before the redetermination due date.

REDE Received-Details Page

Previously, caseworkers could enter the "REDE Received Date" for ex parte EDGs on this page. However, since the "REDE Received Date" now populates automatically for ex parte EDGs, the edit pencil is disabled.

Changes Reported During the Redetermination Process

Ex Parte Eligible Only EDGs due for Redetermination

If the household contains only ex parte eligible EDGs for redetermination, and the customer reports a change or disagrees with the information listed on the 2381C notice, do not require the customer to complete a redetermination form. The caseworker must process the change as a "case change action" and not a "redetermination action" as soon as possible and certify the results. If the updated information results in ineligibility for medical benefits, IES will generate a 360C to notify the customer of the change. IES generates the Verification Checklist (VCL) form if verification is required.

Reminder: Continuous eligibility (CE) customers determined ex parte eligible will retain their medical coverage for both the current and new certification periods regardless of reported changes.

Ex Parte Eligible and Ineligible EDGs Due for Redetermination

If the household contains ex parte eligible and ineligible customers and a change is reported, caseworkers must use discretion on which action to take to process the change. If it is too early to process the redetermination for ex parte ineligible (manual) EDGs, caseworkers should process the reported change as a "case change action." If caseworkers can process the change at the same time as the redetermination, caseworkers may process the reported change as a "redetermination case action."

Reminder: The "REDE Received Details" table on the Redetermination Received Search/Summary page in IES will indicate if a medical EDG was determined ex parte eligible (A) or ineligible (B) under the "Form" column.

Note: Manual redeterminations submitted for a case containing both ex parte eligible and ineligible EDGs may affect the eligibility for ex parte determined EDGs. However, eligibility for CE EDGs determined ex parte eligible will not be affected.

Redetermination Changes to ABE: Manage My Case

The "Renew My Benefits" button will be accessible under the Manage My Case page in ABE for the head of household on a case with ex parte ineligible EDGs due for redetermination on the first day of the month before the redetermination due date.

Once a customer selects the "Renew My Benefits" button, the Redetermination Overview page will display. This page will provide a breakdown of each benefit type due for redetermination; the possible benefit types are Food Assistance, Cash Assistance, and Medical Assistance. The Medical Assistance section explains that only EDGs marked as "Yes" under the "Action Required" column must submit a redetermination to be evaluated for ongoing coverage. A table found at the bottom of this page lists each EDG due for medical redetermination along with the following data:

Name, Birth Date, Medical ID (RIN), Medical Group, Action Required, Redetermination Due Date, and Date Benefits will end if the Redetermination Form is not Returned.

Customers must select the "Next" button at the bottom of the Redetermination Overview page to begin the redetermination flow.

Once the redetermination is submitted, the "Renew My Benefits" button will no longer be visible.

Note: If all EDGs on a medical redetermination are ex parte eligible, the "Renew My Benefits" button will not be visible. However, the 2381C notice will be accessible through a link provided by an alert at the top of the Manage My Case home screen.