Processing Applications & Verifications
- The outbreak of the COVID-19 pandemic led the Secretary of the Health and Human Services (HHS) to declare a Public Health Emergency (PHE).
- To respond to this PHE, the Center for Medicaid & CHIP Services (CMS) authorized the states to adopt many flexibilities in their Medicaid programs, including modifications to eligibility requirements, benefits packages, access to services, etc.
- The CMS released a letter on December 22, 2020, to guide states on the return to normalcy as the pandemic comes to an end and these flexibilities expire.
NJ agencies are now relieved from the requirement to process applications and redeterminations according to the timeliness standards “when there is a COVID-19 DHE administrative or other emergency beyond the agency’s control.” However, this exception does not relieve the states from complying with the timeliness standards once the emergency ends.
Because the CMS understands that at the end of the PHE, there will be many pending COVID-related cases, as well as several new cases, they have set forth the following timelines that they believe are reasonable for states “to resolve pending COVID-related eligibility and enrollment actions related to applications, post-enrollment verifications, changes in circumstances, and renewals” (pg. 28):
- Within two months of the end of the PHE, she states should have completed eligibility determinations for all pending MAGI and other non-disability relates applications reeved during the PHE
- Within three months of the end of the PHE, the states should have completed eligibility determinations for all pending disability-related applications received during the PHE
- Within four months of the end of the PHE, the states should resume timely processing of all applications in accordance with 42 CFR § 435.912(c)
- Verifications, Changes in Circumstances, and Renewals: States must complete all COVID-related actions pending in these areas within six months of the end of the PHE.
To assure that states are adhering to these guidelines, the CMS is requiring states to submit data regarding their progress in completing outstanding eligibility and enrollment actions. Baseline data will be collected at the end of the PHE, and then on a quarterly basis thereafter to monitor progress. Any state that is not meeting these timelines will be required to report progress more frequently.
If you are looking for additional details on this topic or if you require advice about your situation, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at firstname.lastname@example.org. Please ask us about our video conferencing or telephone consultations if you are unable to come to our office.
By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, Monmouth County, NJ Medicaid Attorney