Department of Human Services: Chapter 4: Section 4.5

ALL
Disposition of a recertification must not be delayed when verification requirements can be met by material already available to the SSR.

Information already included in the case record (e.g., copy of birth certificate or social security card, etc.) or verifiable through ACEDS should be used. The recipient is not required to produce documentation again for eligibility factors that do not change and have already been verified. Residency must be verified for TANF recipients at each recertification.

During any recertification, the SSR shall screen the group for possible participation by members previously excluded due to citizenship requirements that have changed.

MA
When processing any MA Recertification form, follow closely the procedures outlined on the Form 1210: "Processing Medicaid Recertifications."

All terminations of MA due to a redetermination of eligibility must be authorized by a supervisor. In general, for recertification forms to be processed, they must be signed and they must be received no later than 30 days after the end of the certification period (except for extended recertifications as described below.)

For the purposes of this section:

A "timely recertification" is any recertification that is

signed and

received during the recertification period.

A "delayed recertification" is a recertification form that is

signed and

received during the 30 days following the end of the certification period.

An "extended recertification" is a recertification form that is sent to the recipient as the result of an extension of eligibility. The extension must have been granted in order to obtain information needed to complete a timely recertification. Information provided with an extended recertification is used to complete the previous timely recertification.

Registering MA Recertification forms

The following recertification forms must be registered immediately:

any timely recertification

a delayed recertification, as long as it has all needed information, or all needed information can be obtained by collateral contact immediately upon receipt

Example

Mrs. Jones receives a MA recertification form on January 5. She has just started a new job. The certification period ends March 31. She signs the form and mails it back in but does not include any paystubs. It is received on January 10. Even though she has not included enough information to redetermine eligibility, the form is timely and must be registered immediately.

Example

Mr. Thomas receives a MA recertification form on April 3. His only income is Social Security retirement, and he reports no resources and no changes. The certification period ends June 30. He returns the form on July 5, after the case closes. He signs it and reports no changes and no resources. Since it is received within 30 days after the end of the certification period and the income can be verified through the ACEDS BENDEX interface, it is a delayed recertification and must be registered immediately.

Any recertification form that is received but does not meet either of these criteria will be filed in the case record without further action, except that any information contained with an extended recertification should be examined to see if there is now enough information to process the outstanding timely recertification.

Example

Ms. Winter is sent a recertification form on August 31. The certification period ends September 30. Ms. Winter returns the form November 10. Since it was received more than 30 days after the end of the certification period, it will not be registered or processed, regardless of whether or not it has a signature or all needed information.

Eligibility for MA will be continued in ACEDS once the recertification form is registered until a redetermination of eligibility is completed. Notice X727, “Receipt of Medical Recertification Form,” will be automatically generated by ACEDS when the recertification is registered. This notice informs the recipient of his continuing eligibility pending a final determination. No further Notices of Eligibility should be sent until a full redetermination is made.

Examining Recertification Forms for Eligibility

When processing a recertification, the SSR shall look at all information available on the form, in the case record and in ACEDS.

The SSR should follow these steps for processing all timely, delayed and extended recertifications:

Look for indicators of ineligibility (other than excess income) by looking at the recertification form and at information in ACEDS (such as reporting on the recertification form that the group has moved outside the District). If obvious ineligibility exists for everyone in the group, complete Form 1210: “Processing Medicaid Recertifications” and terminate benefits for the first available month after timely and adequate notice is sent. Supervisory authorization of the termination is required.

Example

Mr. Giles applied for Medicaid for his twenty year old grandson Eric and benefits were approved. The certification period ends April 30. Mr. Giles completes and signs the recertification form, indicating that there are no changes. The form is received by the Agency April 2. The SSR checks and finds that Eric turns 21 this month. Unless Eric is the caretaker relative for a child or is disabled, the SSR should terminate benefits after supervisory authorization.

    2.   If ineligibility is not immediately apparent, check to see if the customer did any of the following to

        provide sufficient information to redetermine eligibility

The customer recertified for food stamps within the last three months and reported no change on the MA recertification form (in this case the SSR should use the information from the food stamp recertification).

The customer submitted two or more paystubs for the last 60 days.

The customer submitted a benefits statement for his only income that is dated within the last 12 months, and the statement reflects the most recent COLA.

The customer stated that she only receives income from Social Security and/or Unemployment Benefits and current information is available through the ACEDS interface.

For an AR/AX customer, the customer reported income in excess of the AR/AX standard and the customer has been enrolled in the AR/AX program (but not Transitional Medical Assistance [TMA]) for at least three of the last six months (in this last case the SSR should approve TMA).

For an SR customer with reported resources, the customer has provided a checking or banking statement dated within the last three months, or any other proof of resources, consistent with the information reported on the recertification form.

The customer indicates that she is now receiving SSI, and verification is either attached or available through the ACEDS interface; and the case is not subject to recertification. The eligibility should be extended with an indefinite certification period in ACEDS, and proper notice should be sent to the customer.

   3. If the customer did provide sufficient information, or if the SSR can verify missing information through collateral contact, the SSR should redetermine eligibility. The effective date will be the earliest month after the end of the certification period that can be effected after timely and adequate notice is sent.

Example

The SSR receives a timely MA recertification form from Ms. Standard. Ms. Standard works and does report it on the form, but does not attach any paystubs. The SSR sees in the case record that Ms. Standard recertified for food stamps last month and provided paystubs. The SSR should use this information to process the current MA recertification.

Recertifications Without Needed Information

If sufficient information is not available, the SSR will take the following actions, depending on the type of recertification form:

For a timely recertification the SSR shall:

complete Form 1210: “Processing Medicaid Recertifications”
consult with the unit supervisor and obtain his/her approval to request further information from the customer
make telephone contact with the customer to request the missing information unless there is no telephone contact number known to the Department
issue a General Communication notice requesting the missing information, regardless of whether or not the SSR succeeds in making telephone contact
document the case record, clearly stating what information is missing, and file the Form 1210 with the supervisor's authorization
approve eligibility with a four month certification period (this will automatically generate an extended recertification form at the beginning of the extension period)
if the missing information is received within the extension period, either by itself or with the extended recertification form, redetermine eligibility (if eligibility is being terminated, timely and adequate notice must be sent. The new certification period will end 12 months after the end date of the last regular certification period.)
if the information is not received, allow the case to be automatically closed by ACEDS at the end of the extension period.

For a delayed recertification, if there is missing information and the missing information cannot be immediately furnished by collateral contact, no action will be taken by the SSR except to file the form in the case record and document exactly what was missing. The case will remain closed.

For an extended recertification, if the information originally requested in the General Communication notice above is not with the returned extended recertification, take no action except to file the form in the case record. Any information that is included with an extended recertification can be used to process the outstanding timely recertification. If sufficient information is not received, benefits will automatically be terminated by ACEDS at the end of the extension period.

Example

Mrs. Bailey’s certification period ends November 30. She sends in her recertification form on October 10. She reports that she has begun to receive Veteran’s Benefits but does not attach verification. The form is signed and is timely, so the SSR does register it. After consulting with his/her supervisor, the SSR calls Ms. Bailey and sends her a General Communication Notice requesting verification of the income and extends eligibility through March 31. On November 30, an extended recertification form is automatically mailed to Ms. Bailey. She sends it back on December 10, and attaches verification of the income. The SSR will not register the extended recertification form. However, on December 12, the SSR uses the verification of the income to process the timely recertification and redetermines eligibility effective January. A certification period through November 30 will be assigned.



FS

Households that have met all application requirements shall be notified of their eligibility or ineligibility by the end of their current certification period. Eligible households who have met all application requirements shall be given an opportunity to participate by the household’s normal issuance date in the month following the end of their current certification period.