In August of every year, SSA systems identify initial Extra Help awards and randomly
selects cases for initial redeterminations. The selection criteria includes beneficiaries,
both individuals and couples, who became eligible from May of the prior year through
April of the selection year.
Example: The initial redetermination process completed in August 2023 are selected from beneficiaries
who became eligible from May 2022 through April 2023. The System selects these beneficiaries
for an initial redetermination if the beneficiaries have not already had a subsidy-changing
event (SCE) or Other Event reported between May and December of 2022. SSA uses agency
data in all cases.
Example: Beneficiaries selected for an initial redetermination will receive an SSA-1026-OCR-SM-REDE (Social Security Administration Review Of Your Eligibility For
Extra Help). The selection criteria include:
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1.
Cases where agency data indicate a potential change in Extra Help;
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2.
Beneficiaries who reported an Other Event between January and the redetermination
selection date in August;
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3.
Beneficiaries who did not respond to an Office of Quality Review (OQR) report finding
during the review period;
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4.
Beneficiaries whose records had errors OQR found during the OQR review;
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5.
Members of a couple who have different Extra Help filing dates, different Extra Help
eligibility determinations, or a spouse who reported an SCE; and
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6.
Cases that fall into the category of special outreach, if any, for the year.
On August 16, 2022, the President signed the Inflation Reduction Act (IRA) of 2022,
Public Law 17-169. Section 11404 expands full subsidy eligibility and ends what is
currently known as partial subsidy eligibility. Starting January 1, 2024, only subsidy
cases with subsidy determination effective dates before January 1, 2024 can receive
partial subsidy awards. For applications that have not been sent to subsidy determination,
locate the field in MAPS that captures the estimated effective date, see MS 03206.002E.[21-D].To
locate the coverage state date field in MAPS, see MS 03301.008C. [11-D]. For information
about MAPS determination dates, see MS 03206.021.
SSA excludes anyone who CMS deems eligible for Extra Help, previously reported an
SCE, or had a no-error OQR result.