All Medicaid Programs |
Obsolete Policy |
Special Notice: Effective March 18, 2020 until the end of the Health Emergency due to COVID-19, refer to the Q&As in this manual for special instructions about certification periods. During the emergency period, eligibility cannot be terminated except for a few exceptions noted in the Q&A document being added to the manual.
Certification Period
The certification period is the time frame an individual is eligible for assistance based on an approved application or review.
For applications, the certification period begins the first day for which assistance is approved, this may include retroactive months.
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).
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).
Clients must report changes during the certification period that may affect their eligibility (107-4).
Length of Certification Period
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 recipient has fluctuating income;
The agency has information about anticipated changes that may affect eligibility; or
Change are needed to meet workload demands.
The certification period cannot be longer than 12 months for any Medicaid program.
Assign a 12-month continuous certification period for individuals eligible for the Targeted Adult Medicaid (TAM) program. Medicaid coverage will end prior to the 12-month certification period if the individual:
Turns age 65;
Moves out of state;
Fails to apply for other benefits;
Becomes institutionalized (See 604 for suspending coverage); or
Is determined eligible for another Medicaid program, with the exception of Adult Expansion, Refugee or Medically Needy.