Provider Notice issued 0821/2023

This notice informs providers that beginning June 2023, in partnership with the Federal Centers for Medicare & Medicaid Services (CMS), HFS has implemented a new flexibility to minimize the loss of medical coverage for customers during the redetermination process. The new flexibility permits the delay of procedural terminations for one month (approximately 30 days) for customers who did not return their redetermination by their due date. This flexibility will last through the end of PHE unwinding of the Continuous Coverage Period, which is scheduled for May 31, 2024.

During the one-month grace period, additional efforts will be made to encourage customers to return their Medicaid Redetermination - Form B. These efforts will include the issuance of a 643RNW Courtesy Renewal Form – Follow Up Letter. This letter:

·Will be generated by the 20^th of each month when a customer’s redetermination has not been received by the mid-month cut-off date of the month in which their redetermination is due.

· Will remind customers to return their completed Form B redetermination no later than mid-month of their new, extended due date.

·Will remind customers of the ways in which they can renew their Medicaid.

·Will provide the customer an opportunity to indicate a reason, if they do not wish to continue receiving medical coverage.

It is important to know that every customer’s redetermination date is different.  Redetermination notices will arrive at the start of each month and are due by the date listed on their Redetermination Form but no later than the date on the 643RNW Courtesy Renewal (Redetermination) Follow Up Letter.

Example: Medicaid Redetermination: 30 Day Extended Grace Period

A Medicaid customer with an original due date of June 1, 2023, as printed on their notice, who did not submit their redetermination by the mid-month June cutoff date would be granted an extra 30 days to submit their redetermination. Therefore, their new redetermination due date would become July 15, 2023.

The customer has until the mid-month July cutoff to return their redetermination. If the State does not receive a redetermination by the mid-month July cut-off, the case will close on July 31 for “failure to respond”. The customer will then have a reinstatement period of 90 days from the date they lose coverage on July 31, 2023. During the reinstatement period, a customer must submit their redetermination or verifications to the State for them to be “reinstated” into their case, if eligible, with no loss in coverage.

Example: Timely Submission of a Redetermination

A case with an original due date of June 1, 2023, where a redetermination “is” received by the mid-month June cutoff, will remain open and active until a state caseworker processes the redetermination. If the state caseworker processes the case and finds that the customer is no longer eligible, the state caseworker will proceed to cancel the case and the customer will lose coverage effective the last day of the month in which the case was processed.    

Providers will know a redetermination has been approved when the redetermination date changes. If the redetermination is not approved, the individual’s case will close.  The last day of coverage will depend on the day of the month the redetermination is processed. If the redetermination is processed before the 15^th of a month, the case will close at the end of the month. If the redetermination is processed after the 15^th of a month, the case will close on the last day of the following month. 

Additional Important Information

MEDI will update no later than the 24^th of each month with status of coverage for the following month. Reminder, some members on a case may be approved for ongoing coverage while some may not. Be sure to look up everyone on a case when checking for active coverage.

Medicaid customers should check their redetermination due dates by clicking Manage My Case at ABE.illinois.gov and creating or logging into their account.

Customers who know their Recipient Identification Number (RIN) can retrieve their redetermination due dates by calling the HFS Automated Voice Response System (AVRS) at 855-828-4995. Providers with a Medicaid provider number can call the provider AVRS at 800-842-1461 to check for a patient’s redetermination date. 

Once a customer knows their due date, they should watch their mail as their redetermination month approaches. They could lose their Medicaid benefits if they do not respond to their redetermination notice timely. Customers can easily submit a redetermination and respond to a request for additional information through ABE’s Manage My Case. 

We ask all providers to use the Ready to Renew resources on the HFS Website to help encourage patients and clients keep their coverage.

Kelly Cunningham, Administrator
Division of Medical Programs

Tracy Keen, Acting Administrator
Division of Eligibility