Department of Human Services: Chapter 4: Sections 4.6 thru 4.7

Any signed recertification form which is completed prior to the last day of the certification period is considered timely, and every reasonable effort must be made by eligibility staff to complete the redetermination prior to the end of eligibility. If it is not possible for the agency to complete the recertification process prior to the end of the certification period, eligibility should be extended to give time to pursue all reasonable means to determine eligibility.

The next certification period is set 12 months from the last effective date of eligibility. Groups determined ineligible due to excess income from earnings or child support may be eligible for up to a six-month certification period for TMA (if the group is an AR or AX case) or may be eligible for MA based on the spend-down process (see Section 1.3: Transitional Medicaid Assistance (TMA) in Part VII and Chapter 7: Spend-Down in Part VI).

If the recipient has already received a Notice of Termination, Form A714, for failure to return a complete recertification form and it is subsequently determined that ineligibility exists for one or all members of the assistance unit, an appropriate Notice of Ineligibility must be issued. If the assistance unit is determined to be eligible based on the recertification form, an appropriate Notice of Eligibility must be issued indicating that it supercedes the previously issued termination notice. If any eligible person is terminated from an assistance unit, the eligibility for the remaining persons in the unit must be redetermined.

When a TANF case is closed, the family’s ongoing eligibility for Medicaid must be evaluated.

IF TANF is closed for reasons that affect Medicaid eligibility, such as an increase in income, the family’s eligibility for Medicaid must be evaluated under standard AR and AX program types. If the group is found eligible for Medicaid under standard AR or AX programs, the group should be given a 12-month certification period. If the group’s income from earnings or child support exceeds the standards for AR/AX coverage, Transitional Medicaid is triggered. A six-month certification period would be given in the case of earnings, and a four-month certification period would be given in the case of child support. The certification period would begin on the effective date of the TANF case closure.

Exapmle

Ms. Smith and her two children receive TANF. On May 17, Ms. Smith notifies her SSR that she has found a job. Ms. Smith provides documentation of her earnings and the SSR determines that she is over-income for TANF. The SSR issues an adverse action notice on May 28—thus, the effective date of the TANF case closure is July 1. The SSR determines that Ms. Smith remains eligible for Medicaid under the AX program type while her two children are eligible under the AR poverty level categories. Ms. Smith should be given a 12-month MA certification period beginning on July 1st.

If the TANF closing is due to administrative reasons such as failure to attend a review or failure to provide information needed to complete the TANF review, the group’s Medicaid case is NOT closed. Instead, the SSR must enter a Medicaid recertification period end date in ACEDS so that ACEDS will generate a Medicaid recertification notice for the group. The group’s Medicaid case will only close if the group fails to return the completed Medicaid recertification form or if the returned form indicates ineligibility. The SSR should set the certification end date for the earliest month that will enable ACEDS to send out a recertification notice 90 days prior to the end of the certification period.

Exapmle

Ms. Jones fails to attend a TANF review appointment for May 5th. The SSR issues an adverse action notice on May 19th indicating that her TANF case will close effective July 1st. The SSR establishes a Medicaid certification period end date of September.

There are circumstances under which a Medicaid case should be closed at the same time as a TANF case closure, such as when the family reports a change in circumstances that affects both TANF and Medicaid eligibility. For example, if a family reports that the children in the family no longer reside in the home and the remaining group members are ineligible for TANF and Medicaid (under all program types), then both programs could close at the same time.

TANF

SSRs are required to conduct a face-to-face eligibility review every six months. The SSR must issue an appointment notice at least 10 days prior to the TANF review appointment. The notice must indicate a date and time for the review and the information the customer must bring to the appointment. A TANF appointment notice should be issued even if the customer is also scheduled for a FS recertification appointment on the same day.

See TANF.

The certification period shall not exceed six months unless all adult members in the household are elderly or disabled. Households in which all adults are either elderly or disabled should be certified for 24 months. Such households will be notified every 12 months that they must report changes in their circumstances. The case record must be annotated to reflect the contact.