9300 Reviews

 

All categories of assistance require periodic review. At the expiration of the review period, entitlement to assistance ends. Further eligibility must be determined through the review process. Depending on the type of assistance received, the review may be either passive or non-passive. A non-passive review is based on a new application, an interview, if required, and verification as required.

Note: For those households who do not return the review by the end of their review period, the review form can be used to determine eligibility if the form is returned in the month following the end of the review period. Expedited service and pro ration are applicable when a Food Assistance household returns the review form in the month following the end of their review period. All food assistance households who return the review form in the month following the end of their review period must be screened for expedited service.

 

9310 Review Process - The review process is a complete re-examination by the agency concerning all factors of eligibility. In the process, the appropriate review form shall be used along with the rest of the agency record (except for review extensions per 9310.1 where a form is not required). The purpose of the review is to give the client an opportunity to bring to the attention of the agency his or her needs and to give the agency an opportunity to re-examine all factors of eligibility in order to determine the client's continuing eligibility for assistance.

 

9310.1 Review Extension (Medical Assistance Only) - A review extension is a review of eligibility without a formal application. An extension may be completed prior to the expiration of the current period in the following situations:

 

  1. moving from QMB to LMB or vice versa;
     

  2. moving from Medicaid (including Medically Needy) to QMB or LMB; or
     

  3. at the end of the regularly scheduled TB review for TB.
     

Except for TB cases, contact with the beneficiary is required to confirm current financial and non-financial factors prior to completing the extension review. The contact may be in person, phone or in writing. Failure to respond to the request will not result in negative action unless the request addresses other eligibility factors. The current review period remains in place. The prudent person concept (see 1310) applies for verification issues. A new application is required for regularly scheduled reviews and when required per KEESM 1410 and subsections.

 

A new 12 month review, or 6 months for TB cases, is established upon completion of the review extension.

 

9310.2 Passive Reviews (Medical Assistance Only) - In addition to the traditional non-passive review process using a paper review form described in this section, the medical programs, based on select criteria, may be reviewed on either a super-passive or passive basis.


  1.  Super-passive review - A super-passive review occurs when the medical assistance program is automatically re-evaluated based on the program type, income, resources and information already known or obtained by the agency to determine continued eligibility. Eligible individuals are automatically approved for an additional 12 months of coverage with notification of the eligibility extension sent to the individual.

  2.  Passive review - A passive review is similar to a super-passive review described above with a couple of differences. In addition to notification of the 12 month eligibility extension, a separate notice identifying the information used by the agency to make the determination is issued with instructions to contact the agency is any of the information needs to be updated or corrected. Contact with the agency is not required if there are no changes or corrections to report.

During the automated re-evaluation of eligibility, it may be determined that a passive or super-passive review is not appropriate. In that case, the individual will be required to complete a formal review as described in this section. A notice of expiration of the review period shall be sent to the household along with a pre-populated review form for completion and return.


A chart describing the criteria used to determine the review type for each medical assistance program (Item T-13, Review Type Matrix) is contained in the Appendix. The review type determination is an automated process within the eligibility system.

 

9320 Notice of Expiration - A notice of expiration of the review period shall be sent to each household. The local agency shall provide an application form with the notice of expiration and/or an appointment for an interview, if applicable. When a review must be made and it is known that the recipient is temporarily visiting away from his or her residence, the notice of expiration and appropriate form should be mailed to the temporary address.

 

In all programs, except those super-passively or passively reviewed, a notice of expiration shall be mailed to the household no earlier than the first day of the next-to-the-last month of the review period and no later than the first day of the last month of the current review period.

 

NOTE: This provides timely notice of the ending of benefits; therefore, further timely notice is not required to affect benefits for the start of the new review period.

Food Assistance - For households approved for 2 months of Food Assistance benefits, the notice of expiration shall be provided at the time of approval, i.e., expedited benefits.