Option 1

Under the option defined at § 435.558(b)(2)(i), a State must consider that it is unable to verify an applicable individual's compliance with the community engagement requirement when the reliable information available to the State accessed at renewal, consistent with § 435.916(a)(2), is not sufficient to verify compliance with the community engagement requirement. This situation could arise when sources of reliable information available to the State either: (1) do not return information to indicate the individual demonstrated community engagement or qualified for an exception to the community engagement requirement, or that the individual is a specified excluded individual; or (2) return information that suggests that the individual did not demonstrate compliance with or an exception to the community engagement requirement for the number of months considered under the review period defined under § 435.556(a)(2) (for example, the reliable information indicates the individual worked less than 80 hours and no other information is identified about other qualifying activities for a required month). When this occurs, the State is considered unable to verify compliance with the community engagement requirement and must provide the beneficiary the notice of noncompliance under § 435.558(c) concurrently with the pre-populated renewal form provided under § 435.916(a)(3).

We note that the regulations at § 435.916(a)(3)(B) require the State to provide MAGI beneficiaries with a minimum of 30 days to respond to a renewal form, but States are permitted to provide more time. Under this option, States that provide beneficiaries more than 30 days to return their renewal form may want to consider adjusting their response timeframe so it aligns with the 30-calendar day period to respond to a notice of noncompliance under section 1902(xx)(6)(A) of the Act. The 30-calendar day timeframe for the notice of noncompliance cannot be extended to align with a longer period for beneficiaries to return their renewal form. Aligning the response timeframe for the renewal form and notice of noncompliance can help a State gather as much information as possible if it needs to consider eligibility on other bases or for other insurance affordability programs timely. A State may also avoid sending beneficiaries multiple requests for information with different deadlines, which could be potentially confusing to beneficiaries.