Redetermination Process

HIP 2.0 redetermination process

By law, all HIP members must have their eligibility renewed every 12 months. The redetermination period is also one of the periods when a HIP Basic member can move to HIP Plus. This process also provides an opportunity for members to change health plans.

This process involves a series of notices sent to the members by mail.

Initial notice:

HIP members can expect to receive a redetermination letter 90 days prior to the end of their current benefits. For example, members that began their coverage in March will receive this letter in December. HIP members need to carefully read this letter, and all subsequent correspondence, and follow all instructions.

An example of this letter is found by clicking here.

Changing plans:

Individuals who want to select a different health plan for their next coverage year must do at the beginning of their redetermination process. As noted above, the Initial Notice will be sent 90 days before the end of the benefit period. An individual has 45 days from the issuance of the 90 day notice to notify the state that they would like to select a different health plan (Anthem, CareSource, MDwise or MHS) for their next benefit year.

For example, for an individual that began their HIP coverage on March 1 will receive their Initial Notice on or around December 1 and have until January 15 to notify the State that they would like to select a different benefit plan. This new benefit plan would then begin to deliver services on March 1 which is the beginning of the new benefit year.

The initial 90-day notice contains instructions on how to change plans during this timeframe. Plan changes requested will be effective for the next benefit year if the individual is confirmed to be eligible for another year of HIP coverage.

Follow up notice:

After the initial notice, HIP members will fall into one of three categories.

  1. Members who do not need to take action. These are members who have recently confirmed their information with the state and who, therefore, can be automatically found eligible for another year of coverage. These members will not receive additional communication asking for more information, as no information is needed. These members will receive notice of their new benefit period. This notice also provides these members the amount of their HIP Plus POWER Account Contribution. This begins the opportunity for HIP Basic members to transition to HIP Plus. Members can expect to receive a POWER Account Contribution invoice from their health plan. Paying this invoice will result in the member receiving HIP Plus benefits at the beginning of their next benefit year.
  2. Members who need to take action if there are changes. The state may have enough information about some members to determine their eligibility for the next year. However, members who have not had their information confirmed with the state recently will receive a letter indicating what information the state will use to determine their eligibility for the next benefit year. If the information is incorrect, the member will be instructed to return their form and provide the correct information so their eligibility can be determined. Members confirmed to be eligible will receive a notice of their new benefit period. This notice will also provide these members the amount of their HIP Plus POWER Account Contribution. This begins the opportunity for HIP Basic members to transition to HIP Plus.  Members can expect to receive a POWER Account Contribution invoice from their health plan. Paying this invoice will result in the member receiving HIP Plus benefits at the beginning of their next benefit year.
  3. Members who MUST take action. HIP members who have not recently confirmed their information with the state and who cannot have their eligibility confirmed through electronic sources will receive a form that will indicate it must be returned. This form must be returned by the due date on the form, and these members must verify their information even if the information preprinted on the form has not changed. Individuals who do not return this form will not be eligible for continued coverage and will not be eligible to reapply for six months after the end of their benefit period. The form will make clear that action is required to continue HIP eligibility. Members in this group who successfully complete their redetermination and are found eligible for HIP for another year will receive notice of their new benefit period. This notice also provides these members the amount of their HIP Plus POWER Account Contribution. This begins the opportunity for HIP Basic members to transition to HIP Plus. Members can expect to receive a POWER Account Contribution invoice from their health plan. Paying this invoice will result in the member receiving HIP Plus benefits at the beginning of their next benefit year.

Examples of these notices are contained within this document.

HIP Plus enrollment for HIP Basic members

During the first 60 days of their new benefit period, all members that are currently in HIP Basic or HIP State Plan Basic will have the opportunity to begin making POWER Account Contributions to enroll in HIP Plus. HIP Plus members receive enhanced benefits such as vision and dental coverage and do not face copayments unless using the ER for a non-emergency. HIP Basic members would continue to receive HIP Basic benefits and have copayments applied for services until they make their POWER Account Contribution for HIP Plus.