A. Certification Period
1. The certification period is the time frame an individual is eligible for assistance based on an approved application or review.
2. For applications, the certification period begins the first day for which assistance is approved. Any retroactive months approved with the application will not be included in the certification period.
3. For reviews, the certification period begins on the first day of the month after the review month, or the first of the month in which the review is completed if the review is not completed timely (721-1).
4. The benefit effective date is usually the first day of the month for which assistance is approved. In a few cases, the benefit effective date will not be the first day of a month (711).
5. Members must report changes during the certification period that may affect their eligibility (107-4).
B. Length of Certification Period
1. The certification period for MAGI and Medicare Cost-Sharing programs is 12 months. For all other medical programs, assign a 12-month certification period, unless there is evidence that household circumstances are likely to change, such as:
a. A recipient has fluctuating income;
b. The agency has information about anticipated changes that may affect eligibility; or
c. Changes are needed to meet workload demands.
2. The certification period cannot be longer than 12 months for any Medicaid program.
a. In most circumstances a pregnant member will not need to complete a review until the end of the postpartum period. See policy 349
3. Any child under 19 that has been determined eligible at application or review for any medical program shall receive 12 months of continuous coverage. See policy 343-4 on how to handle certification for children on 4 Month Extended or 12 Month Transitional benefits. Any retroactive months will not count as part of the certification period. The approved coverage should not end during the certification period unless the child:
a. Is no longer a Utah resident
b. Dies
c. Reaches age 19.
d. Requests the case be closed.
e. The agency determines that eligibility was granted during the most recent determination of eligibility in error or due to fraud, abuse, or perjury attributed to the child or the child’s representative.
f. Spenddown is not met
4. For individuals eligible for the Targeted Adult Medicaid (TAM) program, assign a 12-month continuous certification period, starting with the application month. Any retroactive TAM months authorized will not count as part of the certification period.