Critical Age Review_Benefits should not change until Ex-Parte Review is completed

Current OOTB Functionality: OOTB looks at a person and will react to a critical age, if it occurs during the certification period. As a result, there will be a break or reduction in benefits without a worker completing an Ex-Parte Review or notice being sent.

Expected: A Critical Age Review needs to be complete in NC FAST before reacting to a critical age change.

For all Critical Age scenarios, the benefit should never change in the middle of the certification period until the worker has completed the ex-parte. Benefits will continue for the 12 month certification period until the worker has completed the Critical Age Review. Per DHB, we cannot shorten a certification period for the Critical Age groups.

We need to add a new page on the MAGI Certifications tab for the Critical Age Review to allow the worker to indicate the Critical Age Review was completed. This functionality should be similar to Recertification (when Submitted, it will reassess and allow the worker to accept the changed decision (showing the change in benefit), which will complete the Critical Age Review).

The State has been through a lawsuit (Hawkins v. Cohen) in which a Federal judge ruled in part in favor of the plaintiff.

One of the basis for this suit was a mid-cert change in benefits due to reaching a critical age.

In addition, per Federal regulations, before an individual can be terminated or benefits reduced, they must be evaluated for “all MA”.

The Federal regs that support this request can be found below (under Business Justification):

These regulations define the 12 month certification period, completing a “redetermination” before the end of the 12 month cert, point in time, and must consider eligibility for “all MA” before termination or reduction in benefits.