The Virginia Poverty Law Center is excited to learn of the proposed changes to the Medicaid Eligibility Manual from Transmittal 32 but recommends the following edits and additions for clarity and accuracy. 

Many of these proposed changes align with the final regulation issued by the Centers for Medicare Services entitled “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes Final Rule” 89 FR 22780, which became effective June 3, 2024. 

This regulation directs states to remove any option that allows limitation in the number of reasonable opportunity periods (ROPs) that an individual may receive.  

To this end, we take issue with the following sections that imply that the state may still limit the number of ROPs that may be provided:

• On page 9 of 58, section 2.b. states that “If the individual provides part of the information or is in the process of getting the information, a new reasonable opportunity period can be provided” and this language is repeated on pages 11 through 14 of 58.  We believe this language creates confusion and suggests that the State may have the option of denying a request for an ROP.  The use of “can be provided” indicates that it is within the state’s discretion to provide an ROP and this is not what the federal regulation requires.   

Instead, we suggest that this language be replaced with the following:

• “If the individual provides part of the information or is in the process of getting the information, a new reasonable opportunity period shall be provided upon the individual’s request.”

Additionally, we are happy to see that the State is applying the reasonable compatibility standard to resources in compliance with the above referenced final federal regulation.  However, the language used in this transmittal is unclear and could lead eligibility workers to misunderstand and incorrectly apply the reasonable compatibility standard.

The following excerpts are problematic:

• On page 45 of 58,

“If resource amounts reported are reasonably compatible with values received from electronic verification sources, the evaluation can continue. If reported resource amounts and verified resource amounts are both below the established limit, resource eligibility is assumed to exist. If both amounts are over the resource limit, the applicant is not resource eligible. The sources of the resources do not need to match.”  This language is repeated on page 46.  

• On page 48 of 58,  

“The reported values of the resources are not reasonably compatible with electronic sources AND below the resource limit.”

• On page 49 of 58,  

“You do not have to verify the value of resources for a period of review if the reported values of the resources are reasonably compatible with electronic sources AND below the resource limit (resource eligible), or both values are over the resource limit (resource ineligible).”

• And on page 50 of 58,  

“If the reported values of the resources are reasonably compatible with electronic sources AND below the resource limit (resource eligible), or both values are over the resource limit (resource ineligible) no additional development is required.”

To avoid any confusion, we suggest that the order of the wording make it clear that if the attestation of resources and the results of the electronic verification are both under the resource limit, no further analysis or request for documentation is required.  The reasonable compatibility standard should only apply if the results of the electronic verification are over the resource limit.

Further, a clearer definition of “reasonable compatibility” would be helpful in guiding eligibility workers in their analysis.  We are aware that the final federal regulation cited above does not provide any guidance on this point.  This is unfortunate and unhelpful.

However, we note that when this standard is applied to income verification on page 58 of 58, the manual states that:

• “if the income attested to by the applicant is within 20 percent of the income information obtained from electronic sources OR both sources are below the applicable income limit, no additional verification is required.”  

Perhaps a 20 percent guideline could also apply to resource verification.  Specifically, if the discrepancy between the attestation of resources and electronic verification is greater than 20 percent it is no longer reasonably compatible.

Thank you for considering our concerns.