HCR delivers an initial implementation of communications, primarily to the applicant or current enrollee to notify of eligibility determination. The notification for eligibility determination varies depending on whether or not there are still outstanding verifications associated with the application.
For the straight-through application process where client-attested information has been successfully verified, the eligibility determination and associated communication notify the applicant of the household's eligibility. This is a combined notice across the insurance affordability programs for the household members which notifies the household of their individual eligibility for Medicaid, CHIP, insurance assistance, or the state health plan.
Where outstanding verifications exist, the communication notifies the applicant of household eligibility on a temporary basis. This is a necessary in order to support the inconsistency period for an application, during which period eligibility must be determined using the client-attested information. This notification includes details of the client-attested information which have not yet been verified, and therefore requires follow-up with the caseworker.
Each notice includes details on the ability to appeal any decision associated with an eligibility determination along with instructions on how to file that appeal. There are currently four notifications available for HCR:
| Notification | Description |
|---|---|
| Eligibility decision for an application | If authorization of an application succeeds, then this notification is generated informing the household of the decision. It is stored as a communication with the integrated case for the primary client. |
| Eligibility decision for a life event | If evidence was added to the integrated case and applied successfully, then this notification is generated informing the household of the decision. It is stored as a communication with the integrated case for the primary client. |
| Preliminary eligibility determination with evidence inconsistencies | This is generated for an application case and the primary client when it is first created if the application has outstanding evidence that needs to be resolved. |
| Preliminary eligibility determination with evidence inconsistencies for a life event | This is generated for an integrated case when new evidence is introduced to the case. |