MS 1500 (1)

At recertification, all technical and financial requirements are reviewed to ensure the recipient continues to be eligible for Medicaid (MA). All MA cases require a recertification every 12 months, including non-modified adjusted gross income (Non-MAGI) Medicaid. The renewal process starts on the 1st day of the month prior to the renewal month. For example, the renewal process will begin July 1 for Medicaid cases with an August recertification date.

Renewals are completed annually through the passive or active renewal process. A passive renewal does not require an individual to interview, complete a form, or take any action to initiate recertification of their Medicaid benefits. Worker Portal will determine if MA cases meet the criteria to be passively renewed. If not, Worker Portal issues form EDB-087, Renewal for Medical Coverage, to initiate the active renewal process. This applies to all Non-MAGI Medicaid, including Medicare Savings Programs.

NOTE: State Supplementation will not use the passive/active renewal process and interviews arestill required for State Supplementation recertifications.

An individual also has the option to complete their Medicaid recertification in-person, via telephone, or via the self-service portal (SSP).An interview is not required for passive/active renewals or for a renewal completed on SSP. However, an interview is required if the renewal is completed in-person or by phone.

A.Worker Portal begins the renewal process on the first of the month prior to the renewal month andcases will be passively renewed if:

  1. The head of household has not opted-out of ongoing data checks;
  2. All income and resources in the case meet the reverification requirements for passive renewal (see D below);
  3. Everyone in the case can be passively renewed. If any individual does not meet passive renewal criteria, the entire case must be actively renewed;
  4. The case is not a three month Pass Through renewal; and
  5. The case is not in change, intake, or reinstate mode.

B. Passive Renewal Process:

Worker Portal interfaces with Eligibility Advisor (EA)to verify liquid resources.If resources require verification, a request for information(RFI)isissuedgiving the individual until the end of the renewal month to provide the required verification. MA benefits will discontinue at the end of the renewal month if verification is not provided.

C. Active Renewal Process:

If a case cannot be passively renewed, Worker Portal issues form EDB-087 on the 1stday of the month prior to therenewal month. The completed form EDB-087 is due the last workday of the recertification month.When the renewal form is uploaded to the Electronic Case File (ECF), a document processing task is generated.Any forms received on or before the 15th of the recertification month must be entered by the 15th. If a recertification is not initiated on Worker Portal by the 15th of the renewal month, form EDB-088, Renewal Reminder Form for Medical Coverage, will be issued.

  1. If all verification is provided, run eligibility and dispose the case.Worker Portal will automatically update the certification period.
  2. If verification is not provided with the renewal form anRFI is system generated giving the individual until the end of the renewal month to provide the required verification.
  3. MA benefits will automatically discontinue at the end of the renewal month if verification is not provided.
  4. If the case discontinues correctly, a new application is required.
  5. Never use the Reinstate or Reactivate function for cases that discontinue at recertification regardless if the discontinuance is correct or due to agency error. Workers must always use the Add/Reapply function on the Case Summary screen for cases that discontinue at recertification.

D.Reverification Requirements for Income and Resources

1.The following types of income require verification at recertification;any cases with these types of income will not be passively renewed:

a.Pension/Retirement

b.Earned income (wages, self-employment, etc.)

c.Worker’s Compensation

d.Unemployment Insurance Benefits

e.Mineral Rights/Royalties

f.IRA Distribution

g.Dividends

h.Alimony/Spousal Support

i.Child Support

j.Friends or Family Contribution

k.Military Retirement

l.Loans

m.Oil Leases

n.Consumer Direct Option (CDO) Payments

o.Trust Income

p.Interest

q.Capital Gains

r.Other

2. The following types of income do not require verification at recertification. If these are the only types of income in the case, the case may be passively renewed if it meets all other criteria:

a. RSDI

b. Railroad Retirement

c.VA Pension or Compensation

d.Black Lung

e.LTC Insurance Payments (regardless who receives payment)

f.Annuity Payments

g.Indemnity Policy

h.Reverse Mortgage Payments

i.In-kind Income

j.Taxable State Tax Refund

k.Lottery Payments

l.Insurance Settlement Payments

m.U.S. Refugee Program

n.AmeriCorps

3.The following resources require verification at recertification.Cases with these types of resources will not be selected for passive renewal:

a.Whole Life Insurance

b.Modified Term Life Insurance

c.Nursing Facility Resident Account

d.Direct Express Card

e.Reloadable Money Card

f.Individual Development Account

g.Stocks

h.Bonds

i.Mutual Funds

j.Oil Rights

k.Mineral Rights

l.Other

m.Liquid Asset Type of Other

n.Other Investments

4.The following resources do not require verification at recertification. If these are the only types of resources in the case, other than liquid assets, the case may be passively renewed if it meets all other criteria:

a.Vehicles

b.Non-home real property

c.Reverse Mortgage

d.Term Life Insurance

e.Pre-arranged Funeral Contract

f.Burial Reserves

g.Life Estate

h.Annuity

i.Trust

j.Promissory Note

k.Land Contract

l.Deferred Payment Loan

m.Home Equity Line of Credit

n.Lifetime Care Agreement

o.Life Settlement Contract]