Government of Puerto Rico

Department of Health Medicaid Program

NOTIFICATION EXTENSION OF ELIGIBILITY DUE TO COVID-19

January 12, 2021

Dear beneficiary:

On March 18, the Federal Families First Coronavirus Response Act (FFCRA), Pub L. No. 116-127 (2020), was signed. This Act provides that as of March the Program cannot cancel the eligibility of any beneficiary during the state of health emergency decreed by the Secretary of Health of the United States. To this day, the emergency decree continues.

The Centers for Medicare and Medicaid Services (CMS) has issued specific instructions regarding the rule to follow regarding the extension of beneficiary eligibility, as well as the subject of recertifications.

1. The state of emergency due to COVID-19 will be in effect as long as it is decreed or extended by the Secretary of Health of the United States. The state of health emergency is in effect today, since on January 7, 2021, the United States Secretary of Health extended the emergency due to COVID-19 until April.

2. CMS established that a beneficiary's eligibility will extend until the last day of the month in which the Secretary of Health of the United States indicates that the state of health emergency due to COVID-19 has ended. At the moment, the extension of eligibility is until April 30, 2021, but it can continue beyond this date if the Secretary of Health renews the emergency decree.

3. CMS also indicated that upon completion of the state of emergency, the recertification process will begin. In this case, the eligibility of beneficiaries will remain active until the Medicaid Program can carry out recertification.

4. The Medicaid Program will comply with the rules issued by CMS.

Extension of Eligibility:

The following table illustrates the extensions of eligibility that have been granted due to the state of health emergency.

NOTIFICATION EXTENSION OF ELIGIBILITY DUE TO COVID-19 Page 2 January 12, 2021

Extension of Eligibility for Coronavirus or COVID-19 Eligibility Extension of Eligibility expired or expires: Starting Date Expiration Date April 2021 If in October, the Federal March 31, 2020 April 1, 2020 April 30, 2021 Secretary of Health decides to April 30, 2020 May 1, 2020 April 30, 2021 extend or terminate the emergency declaration we May 31, 2020 June 1, 2020 April 30, 2021 must revisit this subject.

If the state of emergency is June 30, 2020 July 1, 2020 April 30, 2021 extended, the eligibility will be extended until July 2021. July 31, 2020 August 1, 2020 April 30, 2021 If the state of emergency is not August 31, 2020 September 1, 2020 April 30, 2021 extended, eligibility will remain active and the September 30, 2020 October 1, 2020 April 30, 2021 recertification process begins to determine whether or not you are eligible. If the decision October 31, 2020 November 1, 2020 April 30, 2021 is that you are not eligible, you will be notified of the ending November 30, 2020 December 1, 2020 April 30, 2021 date.

December 31, 2020 January 1, 2021 April 30, 2021 Recertification is an individual determination.

January 31, 2021 February 1, 2021 April 30, 2021 It is important to indicate that February 28, 2021 March 1, 2021 April 30, 2021 before April 30, 2021, the Program will verify the March 31, 2021 April 1, 2021 April 30, 2021 decision made by the Secretary of Health of the April 30, 2021 May 1, 2021 Pending United States in terms of extending or ending the May 31, 2021 June 1, 2021 Pending emergency due to COVID-19.

June 30, 2021 July 1, 2021 Pending NOTE: This extension will apply to all beneficiaries whose natural or extended eligibility, for any reason, expires on or on the last day of the corresponding month.

PO BOX 70184, SAN JUAN, PR 00936 -8184 • www.medicaid.pr.gov • 787.765-2929 Ext. 6700 NOTIFICATION EXTENSION OF ELIGIBILITY DUE TO COVID-19 Page 3 January 12, 2021

To facilitate access to health services and in compliance with federal law, the Program proceeded: (i) to cancel the reevaluations carried out in the month of March and in which the beneficiary was ineligible, (ii) reactivate the eligibility that the beneficiary had prior to the reevaluation and (iii) to extend eligibility for the duration of the COVID-19 emergency, as shown in the Table.

Recertification:

The rules established by CMS indicate that:

1. When the state of emergency ends, the eligibility of these beneficiaries cannot be terminated or canceled at that time.

2. CMS indicated that Puerto Rico must prepare a Plan to comply with Recertification and that the Program must send said Plan for CMS consideration.

3. Beneficiaries will continue to be active and will be notified of the process to follow to comply with the recertification or reevaluation requirement, as well as the pertinent warnings regarding the start or end date of eligibility.

4. Recertification is an individual determination.

We also inform you that, although we are working, we are not receiving public. That is why we encourage you to visit our website: www.medicaid.pr.gov or contact our call center (787) 641-4224 or TTY (787) (787) 625-6955, Monday through Friday 8 : 00 am 6:00 pm, to clarify any doubts or questions that you have.

We urge you to follow the instructions issued by the Government of Puerto Rico regarding this emergency. Take care of your health and that of yours.

Cordially,

Luz E. Cruz Romero Acting Executive director

PO BOX 70184, SAN JUAN, PR 00936 -8184 • www.medicaid.pr.gov • 787.765-2929 Ext. 6700