Understanding the Ex-Parte Renewal Process for Continued Medicaid Eligibility When the COVID-19 Public Health Emergency Ends

HNWMedicaid Eligibility and Asset Protection Planning

In my previous blog I discussed how NJ will conduct renewals for continuing Medicaid eligibility. In this blog I will go over understanding the ex-parte renewal process for Medicaid eligibility when the COVID-19 public health emergency ends.

New Jersey must attempt to renew eligibility for all individuals enrolled in Medicaid on an ex parte basis (meaning evaluating eligibility from known sources of information) and reliable information contained in the beneficiary’s account or other more current information available to the agency, without requiring information from the beneficiary.

  • Ex-parte renewal is also known as “auto renewal”, or “passive renewal”, or “administrative renewal”.
  • An ex-parte renewal does not require any beneficiary involvement, and NJ will begin the process 60-90 days prior to the beneficiary’s renewal date.
  • If DMAS (the state Medicaid agency for long-term care) is able to renew eligibility based on the available reliable information, the agency must provide notice to the beneficiary, which includes:
    • That the individual’s coverage has been renewed for another eligibility period (and length of that period – i.e., 12 months and the time period up to 12 months elected by NJ for non-MAGI beneficiaries, as specified in the state plan). MAGI means Modified Adjusted Income.
    • Disclosure of the information NJ used to determine eligibility and the basis of continued eligibility.
    • The obligation by the beneficiary to inform NJ if any of the information in the notice is inaccurate or requires changes.

Beneficiary does not need to sign or return the notice if all information contained in the notice is accurate, however, NJ generally does have to complete an ex parte renewal if information needed to make a determination of eligibility is missing, or available information suggests that a beneficiary may be ineligible.

To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  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

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