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Chapter 4 - Recertification

Introduction 4.1

The time between initial eligibility and the date the SSR must review the case, or the time between required reviews is the certification period. The recertification process involves recipients providing updated information to have their program eligibility recertified or redetermined by ESA for additional periods of time which vary by program. The recertification process must be completed within set time frames. No FS group may participate in the FS program beyond the end of their certification period unless they submit a signed recertification and complete the recertification process. If they do not complete this process within thirty days of the end of their certification period, they must re-apply, unless the delay is due to agency failure to provide the group with an opportunity to recertify. For MA groups, the group may not participate beyond the end of their certification period without a recertification of eligibility unless the agency either fails to provide the group with an opportunity to recertify or is seeking additional information to complete a recertification.

MA recertifications are done by mail. However, if a customer meets with his/her SSR for another purpose, the SSR should encourage the customer to recertify MA eligibility at that time if the MA certification period ends within ninety days. Groups categorically eligible for Medicaid do not need to recertify MA eligibility (see Section 12.6: Termination of Categorical Eligibility in Part IV for policy on handling groups who have lost their categorical eligibility).

GC cases must be reviewed once every twelve months. However, benefits in this program does not expire if a redetermination is not scheduled prior to the end of the twelve-month period.

 DHS has developed a phased implementation plan for the mandatory assessment and orientation of work eligible TANF customers,  During the first phase, customers were permitted to voluntarily submit to the orientation and assessment.  During the second phase, TANF customers who have not received an TANF orientation and assessment will be required to have a TANF review in order to maintain eligibility. Effective February 1, 2013, TANF reviews will consist of the completion of an Online Work Readiness Assessment, orientation, and Individual Responsibility Plan. Therefore, until further notice, TANF reviews will only be scheduled for TANF recipients who have not completed their  in-depth assessment,  orientation, and plan.  DHS will provide instructions on the subsequent phases at the appropriate time.

Legal Authority 4.2

Area/Topic District Federal

Recertification

TANF: D.C. Code 4-205.19a-19b; 4-205.53

GC: See TANF and D.C.

Code 4-205.5a

MA: 42 CFR 435.916

FS: 7 USC 2012(c); 7 USC 2020(e) (4); 7 CFR 273.2 (f) (8); 273.14

Notification of Recertification/Review Date 4.3

MA

ACEDS will automatically generate a notice 90 days prior to the end of the current certification period. The notice includes the actual recertification form and informs the recipient that it is time to have his case recertified in order to determine continuing MA eligibility. MA recertifications are done by mail. However, if a customer meets with his/her SSR for another purpose during this 90-day period, the customer can (and should be encouraged to) recertify MA eligibility during the office visit. MA cases that are not recertified prior to the end of the current certification period will automatically be terminated by ACEDS.

TANF

 

Effective February 1, 2013, ESA shall generate and mail a review scheduling notice, at least 10 days prior to the scheduled date of assessment and orientation. The notice shall tell the recipient:

  • It is time to have his/her case reviewed and that this will consist of an assessment and orientation and development and signature of an Individual Responsibility Plan;
  • The scheduled date of the assessment/orientation;
  • The location of the assessment/orientation;
  • Deadline for completing the assessment and orientation if the TANF recipient is unable to make the original appointment;
  • Information regarding how to reschedule an assessment appointment; and
  • Information regarding the requirement to complete the assessment/orientation in order to maintain TANF eligibility.

Failure to complete the assessment, group orientation, and Individual Responsibility Plan by the deadline specified in the review scheduling notice shall result in termination of TANF benefits.

 

GC

 

The SSR should generate Form A600, the Review Due Notice, at least 10 days prior to the appointment date to inform the recipient that it is time to have his/her case reviewed. Form A600 should indicate the following:

  • time and date his/her review has been scheduled
  • list of needed verifications
  • any adverse action that may be taken if the appointment is not kept.

Failure to attend the scheduled meeting and failure to provide requested information will result in GC benefits being terminated.

For GC recipients who do receive FS, the Food Stamp Recertification Notice sent by ACEDS informs recipients that their GC benefits will be reviewed at the same time. When the recipient comes in for the FS recertification, the SSR will also initiate a GC review. The SSR must give the recipient written notification of any additional information needed. In this situation, the SSR must give the recipient 10 days to return additional information before initiating any adverse action. If the recipient does not come for the FS recertification appointment and does not reschedule, the SSR will initiate action to terminate the GC benefits after timely and adequate notice.

 

FS

ACEDS will automatically generate a notice 60 days prior to the end of the certification period that will inform the recipient of the need to have her case recertified in order to determine ongoing eligibility. The notice gives the recipient a recertification appointment date and indicates that he/she can call to reschedule. The original appointment must be scheduled for a date at least 10 days prior to the end of the certification period. If a customer misses their appointment and calls to reschedule, they must be given a second appointment. This must be documented in the case record. FS cases that are not recertified prior to the end of the current certification period will automatically be terminated by ACEDS. An FS recipient may come in any time within 30 days after the termination of his/her certification period and still be treated as a recertification. However, if she does come in after the effective date of the termination, the benefits for the first month will be prorated from the date she recertifies, unless the failure to recertify is due to agency error. In that case, benefits will be given for the entire month once eligibility is recertified.

Mid-Certification Reports

In addition to the requirement for recertification, FS households certified for twelve months will be mailed a "Mid-Certification Report" form at the end of the fourth month of their twelve month certification period. Recipients must complete and return the form, along with verifications of changes in household circumstances. if the household fails to comply with this requirement by the end of the fifth month, FS benefits will be terminated effective the end of the sixth month of eligibility. Households who comply will continue to receive benefits, although the Agency will process changes reported by the household and will redetermine the level of benefits.

Interim Contact

In addition to the requirement for recertification, FS households certified for twenty-four months will be mailed an "interim Contact" notice at the end of the tenth month of their twenty-four month certification period. They must call or contact the Agency and must report any changes in their circumstances. If the household fails to comply with this requirement, FS benefits will be terminated. Households who comply will continue to receive benefits, although the Agency will process changes reported by the household and will redetermine the level of benefits.

Recertification Interview 4.4

ALL

With the exception of Medicaid recertifications which are done by mail, and TANF reviews effective February 1, 2013, the purposes of the recertification interview include the following:

  • to clarify information received by Department interfaces, such as wages, Unemployment
  • Compensation, and Social Security benefits;
  • to inform recipients that information they provide regarding eligibility and benefits will be matched regularly against information from the Department of Employment Services, U.S. Internal Revenue Service, Social Security Administration, and other states;
  • to advise adult recipients of the opportunity to register to vote if they desire;
  • to explore and resolve unclear and incomplete information; and
  • to explain change reporting requirements to recipients.

Recipients (or their authorized representatives) must submit the appropriate form for recertification. For Medicaid, it is preferred that they use Form DHS-1209 “Recertification for Medical Assistance.” For FS, recipients may use the “Food Stamp-Only Application.” All recipients may use the combined “Recertification Form” or the combined “Application for Benefits.”

MA

Medicaid recertifications are normally done by mail. However, if a customer meets with his/her SSR for another purpose, the SSR shall encourage the customer to recertify MA eligibility at that time if the MA certification period ends within ninety days.

The “Recertification for Medical Assistance” form, DHS-1209, that is mailed out to clients includes information regarding EPSDT services and their availability.

TANF

 

Effective February 1, 2013, the TANF review interview shall consist of a detailed assessment of the TANF recipient’s education, work experience, skills, employability and a screening for potential barriers to employment.  The TANF recipient shall also complete an orientation covering TANF program rules and regulations. In addition, the TANF recipient shall participate in the development of an initial Individual  Responsibility Plan and shall sign the plan.


As part of the assessment, the staff person administering the work assessment shall provide the following to the TANF recipient:

  • information regarding child support requirements and benefits,
  • a description of the POWER program, and
  • information regarding  Early Periodic Screening Diagnosis and Treatment (EPSDT) services provided now by the D.C. Department of Health “Health Check” program, formerly known as the D.C. Healthy Teens and Tots Program (see requirements in Section 2.2.8 of Part I: “EPSDT/D.C Healthy Tots and Teens).

GC

A face-to-face interview is generally required. For situations in which this requirement can be waived, see Section 1.8.2: Waiver of Face-to-Face Interview in Part III. The SSR shall explore the following with the caretaker during a GC review:

  • Any custody proceedings, FSA involvement, or parental contact since the application or last review that could affect the child’s continued presence in the home;
  • Any putative, but unestablished relationship between the child and the caretaker, and whether or not any progress has been made since the application or last review in determining relationship that could make the child ineligible for GC;
  • If the caretaker has taken any action to adopt the child; and
  • Any changes in the household that bring a parent or relative of the child into the home.

The SSR shall inform the client orally and in writing of Early Periodic Screening Diagnosis and Treatment (EPSDT) services provided now by the D.C. Department of Health “Health Check” program, formerly known as the Healthy Teens and Tots Program (see requirements in Section 2.2.8 of Part I: “EPSDT/D.C. Healthy Tots and Teens).

 

FS

A face-to-face interview is generally required. For situations in which this requirement can be waived, see Section 1.8.2: Waiver of Face-to-Face Interview in Part III.

The SSR shall screen for expedited service, using the Expedited Screening Form. Households who are timely recertifying are generally not eligible for expedited service.

The SSR shall review the FSET status of the household. New referrals must be done every twelve months on FS participants who are not exempt from FSET.

The SSR shall inform the household of their change reporting responsibilities.

During the interview, the SSR shall give the customer a Change Report Form.

 

Processing of Recertification Forms 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.

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:

1. 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.

 
TANF

Effective February 1, 2013, completion of the work assessment, orientation, and Individual Responsibility Plan shall fulfill the requirements of the TANF review.

 

 

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.

Effective February 1, 2013, for FS households who also receive TANF, changes reported at the time of FS recertification that effect TANF eligibility will be considered as a reported change, and handled in accordance with Part VIII, Chapter 5: Reporting and Processing Changes.

 

Certification Period 4.6

MA

Any signed recertification form which is completed prior to the last day of the certification period is considered timely, and every reasonable effort must be made by eligibility staff to complete the redetermination prior to the end of eligibility. If it is not possible for the agency to complete the recertification process prior to the end of the certification period, eligibility should be extended to give time to pursue all reasonable means to determine eligibility.

The next certification period is set 12 months from the last effective date of eligibility. Groups determined ineligible due to excess income from earnings or child support may be eligible for up to a six-month certification period for TMA (if the group is an AR or AX case) or may be eligible for MA based on the spend-down process (see Section 1.3: Transitional Medicaid Assistance (TMA) in Part VII and Chapter 7: Spend-Down in Part VI).

If the recipient has already received a Notice of Termination, Form A714, for failure to return a complete recertification form and it is subsequently determined that ineligibility exists for one or all members of the assistance unit, an appropriate Notice of Ineligibility must be issued. If the assistance unit is determined to be eligible based on the recertification form, an appropriate Notice of Eligibility must be issued indicating that it supercedes the previously issued termination notice. If any eligible person is terminated from an assistance unit, the eligibility for the remaining persons in the unit must be redetermined.

When a TANF case is closed, the family’s ongoing eligibility for Medicaid must be evaluated.

IF TANF is closed for reasons that affect Medicaid eligibility, such as an increase in income, the family’s eligibility for Medicaid must be evaluated under standard AR and AX program types. If the group is found eligible for Medicaid under standard AR or AX programs, the group should be given a 12-month certification period. If the group’s income from earnings or child support exceeds the standards for AR/AX coverage, Transitional Medicaid is triggered. A six-month certification period would be given in the case of earnings, and a four-month certification period would be given in the case of child support. The certification period would begin on the effective date of the TANF case closure.

Example
Ms. Smith and her two children receive TANF. On May 17, Ms. Smith notifies her SSR that she has found a job. Ms. Smith provides documentation of her earnings and the SSR determines that she is over-income for TANF. The SSR issues an adverse action notice on May 28—thus, the effective date of the TANF case closure is July 1. The SSR determines that Ms. Smith remains eligible for Medicaid under the AX program type while her two children are eligible under the AR poverty level categories. Ms. Smith should be given a 12-month MA certification period beginning on July 1st.

If the TANF closing is due to administrative reasons such as failure to complete a TANF assessment, the group’s Medicaid case is NOT closed. Instead, the SSR must enter a Medicaid recertification period end date in ACEDS so that ACEDS will generate a Medicaid recertification notice for the group. The group’s Medicaid case will only close if the group fails to return the completed Medicaid recertification form or if the returned form indicates ineligibility. The SSR should set the certification end date for the earliest month that will enable ACEDS to send out a recertification notice 90 days prior to the end of the certification period.

Example
Ms. Jones fails to complete a TANF assessment scheduled for May 15. The SSR issues an adverse action notice on May 19th indicating that her TANF case will close effective July 1st. The SSR establishes a Medicaid certification period end date of September.

There are circumstances under which a Medicaid case should be closed at the same time as a TANF case closure, such as when the family reports a change in circumstances that affects both TANF and Medicaid eligibility. For example, if a family reports that the children in the family no longer reside in the home and the remaining group members are ineligible for TANF and Medicaid (under all program types), then both programs could close at the same time.

TANF

If a client reports changes during the assessment that affects TANF eligibility or level of TANF benefits, the staff person administering the assessment will direct the recipient to staff in the Division of Program Operations, who will take appropriate action after timely and adequate notice (See Part VIII, Chapter 5: Reporting and Processing Changes.)

 

GC

SSRs are required to conduct a face-to-face eligibility review every twelve months. The SSR must issue an appointment notice at least 10 days prior to the GC review appointment. The notice must indicate a date and time for the review and the information the customer must bring to the appointment.

 

FS

The certification period shall not exceed six months unless all adult members in the household are elderly or disabled. Households in which all adults are either elderly or disabled should be certified for 24 months. Such households will be notified every 12 months that they must report changes in their circumstances. The case record must be annotated to reflect the contact.

Synchronizing Payment Program Reviews With Recertification 4.7

ALL

Case reviews, when possible, should be synchronized if a household is receiving multiple benefits. However, existing FS certification periods may not be shortened in order to synchronize with another program. If a group comes in for another program and the group has been sent a MA recertification form that has not been returned, the worker should encourage the group to recertify its MA eligibility during the office visit. This would eliminate the need for the group to return the mailed MA recertification form.

Benefit Proration Related to Recertification 4.8

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.

TANF

Benefit proration is not required because benefits do not automatically terminate at the end of the review period.

GC

See TANF.

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.

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.

TANF

Effective February 1, 2013, once  the recipient completes the required work assessment, orientation, and initial Individual Responsibility Plan , ESA shall generate and mail notice to the recipient that s/he has fulfilled the assessment requirement.  If there are changes to the grant, timely and adequate notice for any adverse action shall be given using the appropriate notice.

 

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.
Example 1

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.

Example 2

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.

Example 3

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.

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.

.

Verifications During Recertification 4.10

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.

TANF

Effective February 1, 2013, and until the completion of the project of assessing TANF recipients who have not participated in an assessment other than the Preliminary Self-Assessment, the verification requirement at TANF review consists of the completion of an assessment and orientation, and the signing of an initial Individual Responsibility Plan. If a client reports changes during the assessment that affects TANF eligibility or level of TANF benefits, the staff person administering the assessment shall report the change to the staff of the Division of Program Operations, who will take appropriate action after timely and adequate notice (See Part VIII, Chapter 5: Reporting and Processing Changes.) Further instructions will be given following the completion of the project of assessing TANF recipients who have not participated in an assessment other than the Preliminary Self-Assessment.

 

GC

 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).

However, income and assets should only be verified for the child/ren in the GC grant.

 

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.