CMS has provided flexibility for states to perform ex parte renewals through the 1902(e)(14)(a) process. However, many states may have struggled with the implementation of these waivers, or may not have the most efficient implementation possible.
Waivers that states may be struggling with:
- 100% FPL Waiver: Anyone with a verified income less than 100% FPL can be renewed if there's no data available from electronic sources. A person can be ex parte renewed if: (1) the most recent income determination (either at initial application or most recent renewal) was no earlier than 12 months prior to the beginning of the PHE (i.e., March 2019) and was based on verified income at or below 100% of FPL; and (2) state has checked financial data sources in accordance with its verification plan and no information is received.
- 0% FPL Waiver: Anyone with a verified income at 0% FPL can be renewed if there's no data available from electronic sources. A person can be ex parte renewed if: (1) the most recent income determination (either at initial application or most recent renewal) was no earlier than 12 months prior to the beginning of the PHE (i.e., March 2019) and was based on verified income at or below 0% of FPL; and (2) state has checked financial data sources in accordance with its verification plan and no information is received.
- SNAP/TANF Categorical Eligibility: Anyone receiving SNAP or TANF is not subject to an income test.
- Removal of asset test: Assets are no longer a consideration for eligibility.
In some states, the implementation of these waivers may be manual (meaning that eligibility workers are determining who falls under these rules). This process is often inefficient and can lead to a backlog of individuals to be verified.
When the implementation is automatic, the new logic may be at the end of the renewal, meaning that there are logic and checks being run prior to the waiver logic being run. This may result in a person being excluded before they get the chance to be considered for the waiver logic.
A key sign that the implementation may be inefficient is a mismatch between estimates and measurements. Ask the state: how many people did we estimate to be caught by this logic? Ask the vendor: how many actually were? Are the numbers close?
In states where waivers are implemented manually, explore the opportunity to automate.
In states where waivers may be implemented inefficiently, recommend they be optimized by moving them up in the renewal process or expanding them to the largest group possible.