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IMA POLICY MANUAL
PART VIII: CASE MAINTENANCE
CHAPTER 4: RECERTIFICATION
BENEFIT PRORATION RELATED TO RECERTIFICATION 4.8
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MA |
If the Department caused a delay in recertification which leads to a delay in issuing benefits, benefits will be restored from the beginning of the new certification period. The reason for the delay must be noted on the case record.
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| TANF |
Benefit proration is not required because benefits do not automatically terminate at the end of the review period.
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| GC |
See TANF.
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| FS |
See MA. When there is a break in certification that is not due to agency delay (i.e., client’s benefits expired August 31, 2003 and client reapplies September 18, 2003), the benefits will be prorated from the date of reapplication. (i.e., September 18, 2003). Proration due to a break in certification does not apply to migrant and seasonal households in certain circumstances. If such a case presents itself to a service center, the Administrator’s office should be contacted. |
ELIGIBILITY DETERMINATIONS AT RECERTIFICATION 4.9
| ALL |
Clients must be notified in writing of determinations regarding continuing eligibility.
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| MA |
Once redetermination of eligibility or ineligibility is made, notice must be sent to the group. Each member of the existing group must be included in a notice of eligibility or ineligibility. Timely notice must be sent for any member who is being determined ineligible for Medical Assistance.
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| TANF |
If there are no changes in the grant following recertification, the SSR shall send Notice A608, “Continuing Eligibility-TANF”. If there are changes in the grant, timely and adequate notice for any adverse action shall be given using the appropriate notice.
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| FS |
Households that have met all application requirements shall be notified in writing of their eligibility or ineligibility by the end of their current certification period.
FS recertifications do not determine continuing eligibility, but rather determine eligibility for a new certification period. Therefore, the client will be notified of recertification decisions by the SSR using notices of approval or denial, rather than notices of increase, reduction, or termination of benefits. Timely advance notice is not required.
If the household is determined to be eligible for a new certification period, the agency shall mail a notice of reporting requirements to the household. If the household is subject to Simplified Reporting, Notice F722: "Notice of Simplified Reporting" shall be mailed to the customer. If the household is subject to Standard Reporting, Notice F723: "Standard Reporting Notice" shall be mailed to the customer.
If a household files an application prior to the end of the certification period but the recertification cannot be completed within 30 days due to agency error, the agency must continue to process the application and provide benefits from the first day of the month.
If a household files an application before the end of the certification period but fails to complete a required action, the agency will deny benefits. However, if the household then completes the required action within thirty days of the end of the certification period, the application will still be treated as a recertification. In this situation, benefits will be prorated from the date the client completes the required actions.
Automatic Denial of Recertification
The ACEDS system schedules all FS recertifications on or prior to the 15th day of the last month of the certification period. ACEDS automatically denies recertifications if customers do not complete the process. The date of termination depends on the situation:
- If a customer does not come in for their recertification at all during the certification period, ACEDS will send the customer a denial notice at the end of the last working day of the certification period. The customer can come in within the next thirty days and be treated as a recertification with regard to the items they must verify, but benefits will be prorated from the date they come in to reapply. See Example 1 below.
- If a customer comes in for their recertification before the last 10 days of the last month of the certification period, their recertification will be automatically denied if it remains incomplete at the end of the first working day of the month after benefits expired. ACEDS will automatically send the customer a denial notice at that time unless the worker has entered a PCN on the FSAD screen. See Example 2 below.
- If a customer comes in during the last ten days of the month, the recertification will automatically deny if it is still incomplete ten days later. ACEDS will automatically send the customer a denial notice at that time unless the worker has entered a PCN on the FSAD screen. If the customer provides all needed information within ten days, the recertification is timely and the effective date for the new certification period will be the 1st of the month. Benefits must be made available within 5 working days of the date the household provided all verification. See Example 3 below.
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April Ashton's Food Stamp eligibility expires on June 30. She is sent a Recertification Notice on April 28 (the last working day of April) giving her a recertification appointment for June 8. She does not keep the appointment and does not contact her worker to reschedule. Unless she comes in before the end of June, her benefits will automatically expire on June 30. ACEDS will send a termination notice to her the night of June 30.
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Example 2 |
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John Jacobs' Food Stamp eligibility expires on December 31. He comes to this ACEDS-scheduled recertification appointment on December 10, but does not provide all needed verification. His caseworker registers his recertification and issues a checklist to him for the missing verifications. Mr. Jacobs' Food Stamp recertification will automatically deny if his recertification is not completed by the first working day in January. A recertification denial notice will be issued that night.
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Jane Reynolds' Food Stamp eligibility expires on January 31. She completed her recertification interview on January 28, but does not have all her required verifications. Her caseworker registers her recertification and issues a checklist and also sends her a Request for Additional Information. If her recertification is not completed by February 7, Ms. Reynolds will be sent a recertification denial notice.
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To ensure the correct processing of recertifications, the SSR must take the following actions:
- Register recertifications in ACEDS when they are received,
- Issue written requests for additional information to customers, and
- Complete eligibility determinations in ACEDS within agency timeframes. Receipting all information on a checklist in ACEDS has not effect on how ACEDS treats a recertification. Food Stamp recertifications will automatically deny even if the checklist is closed, unless they PCN is entered on the FSAD screen.
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VERIFICATIONS DURING RECERTIFICATION 4.10
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ALL |
If a client comes in for a recertification (or mails in their Medicaid recertification form), and it is determined that further information is needed to redetermine eligibility, written notice must be given to the client. This notice should include the information needed, and the amount of time the client has to provide the information. At least 10 days must be given to the client to return needed information. |
| MA |
Requests for further information from a client during a MA review should be kept to a minimum. In general, when no changes are reported, or reported changes are minimal, or reported changes would not result in a change in eligibility for anyone in the group, no further verification should be requested. Information available in ACEDS should be utilized whenever possible to verify regular income, such as Social Security benefits.
AR and AX: Recipients reporting earnings for the first time should present at least one paystub (if the information on the paystub is not representative of expected future earnings, collateral contact with the employer or a second paystub may be needed.) Also, if paystubs are not submitted, an attempt must be made by the SSR to obtain verification by collateral contact with the employer by telephone. Collateral contacts must be documented in the case record. Customers with previously verified income who report minimal or no changes in their income should not be required to present new documentation.
SR: See AR and AX. Also, resources of SR groups need to be verified. Verification should be dated within the past three months. However, if the group reports resources above allowed levels, their eligibility can be terminated based on their report if they are not eligible under any other Medicaid program.
If the Department needs a new determination of disability for an SSR client, and that is the only information needed to complete a recertification, eligibility should be extended until the Medical Review Team makes a determination that the client is not disabled (see Section 9.4 in Part IV: Disability/Blindness Determinations for information regarding which clients need to be evaluated by the Medical Review Team). It is the responsibility of the Department to ask the client for current medical data. The client will be given 90 days to provide current medical information.
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| TANF |
Residency must be verified at every review. Reported income and assets must be verified at every review. The Department should utilize information available in ACEDS whenever possible to verify unearned income. Families must verify that children who are sixteen or older in the grant meet school requirements (see Section 4.4 in Part IV: School Attendance and Student Status).
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| GC |
See TANF. However, income and assets should only be verified for the child/ren in the GC grant.
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| FS |
The following items are subject to verification at recertification:
- residency, except for categorically eligible households;
- previously unreported income, except for categorically eligible households;
- resources except for categorically eligible households, only if the information provided would affect group eligibility and is questionable (i.e., unclear, inconsistent, or incomplete);
- income that has changed by more than $50, except for categorically eligible households
- previously unreported medical expenses;
- actual utility expenses that have changed by more than $25 unless the household is using the SUA;
- rent, mortgage, or other housing costs that have changed by more than $25, unless the change will not affect the excess shelter deduction (i.e., if the change does not increase shelter costs enough to trigger the excess shelter deduction);
- previously reported medical expenses that have changed by more than $25;
- for households eligible for the child support deduction, any changes in the legal obligation to pay child support, the obligated amount, and the amount of legally obligated child support a household pays to a nonhousehold member; and
- unless good cause is determined, proof of an application for a social security number for any household member who has not previously presented a social security number or proof of application and who does not have a social security number at the time or recertification, except that this requirement does not apply to newborns until six months after birth nor to categorically eligible households.
If the household does not provide needed verification of shelter, medical, child support, or child care expenses, but has otherwise provided all needed verification, their eligibility shall be determined without deducting the unverified expenses.
Clients must be given at least 10 days to provide needed information. |
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