Adult Medicaid Manual MA-2350 CERTIFICATION AND AUTHORIZATION

II. LENGTH OF CERTIFICATION PERIODS

A. Retroactive Period

1. A retroactive c.p. for MAABD, MQB-B and MQB-E cases may be either 1, 2, or 3 months prior to the month of Medicaid application. Refer to MA-2370, Retroactive Coverage.

2. The retro c.p. for an SSI a/r may be either the 1, 2, or 3 months prior to the month of SSI application. Refer to MA-1100, SSI Medicaid – County DSS Responsibility.

3. There is no retroactive coverage for MQB-Q cases.

4. Certification periods for ongoing MQB-Q, MQB-B, MQB-E and retroactive M-AABD may not overlap.

EXAMPLE: An MQB-B applies in March for ongoing coverage and the case is approved in April. The certification period begins in March; authorization begins in March. The applicant may not later apply for M-AABD retroactively for March and April. He must meet a six month deductible (March-August).

5. Eligibility for the retroactive period is determined separately from the ongoing period.

B. Prospective Period

1. The prospective c.p. is 12 months for:

a. Categorically Needy No Money Payment (N)

(1) The applicant/recipient (a/r):

(a) Lives in a private living arrangement (pla), and

REVISED 04/01/11 – CHANGE NO. 01-11

(II.B.1.(1)

(b) Has stable income i.e., predictable in amount and expected receipt, such as RSDI, VA, other pension, etc., and

(c) Has no deductible.

NOTE: Cases having no income or a pending application for benefits is not stable income. Such persons do not meet this requirement and must have a 6 months c.p.

(2) The a/r receives Special Assistance for the Blind (MSB) and does not receive SSI.

b. MQB-Q or B cases.

2. The prospective c.p. is 6 months for:

a. All Medically Needy (MN) cases, including CAP cases,

b. All cases in long-term care (ltc),

3. MQB-E (s) do not have a standard six or 12 month c.p. The prospective c.p. begins with the month of application for MQB-E.

If a MQB-E a/r becomes eligible under MAABD (or other aid program/category), the c.p. is not based on the ongoing MQB-E certification period. The c.p. begins with the month the a/r requests assistance under the new aid program/category.

C. Beginning Certification

1. Begin the c.p. in all cases except certain applications and terminated cases as noted in II.E., below:

a. Either 1, 2, or 3 months prior to the month of application for a retroactive c.p., or

b. The month of application for a prospective c.p.

2. For certain applications, the c.p. begins the month the categorical requirement of age or state residence is met. See III.B., below.

3. The c.p. of a previously denied disability case subsequently approved by SSA is based on the application date of the denied application. Refer to MA-2525, Disability, for authorization instructions.

D. Ending Certification

1. Certification ends on the last day of the month in which a timely notice has expired or the month in which death occurs.

2. Recompute a deductible for the c.p. if it is shortened because the a/r:

a. Begins receiving SSI; or

REISSUED 04/01/11 – CHANGE NO. 01-11

(II.D.2)

b. Dies.

3. Do NOT recompute a deductible for the c.p. if there are no other changes prior to the termination. Changes occurring prior to termination must be evaluated to determine their effect on the deductible.

E. Overlapping C.P.'s

1. Denied or Withdrawn Applications

If a previous application is denied or withdrawn, the c.p. of a new application, including retroactive months, may overlap months that would have been covered in the previous application.

2. Terminated Cases

a. When an ongoing non-SSI Medicaid case is terminated and the individual reapplies, even if the case was not authorized, the retroactive or ongoing c.p. can begin no earlier than the month following the month of termination.

NOTE: This is an exception to the rule that the c.p. must begin with the month of application.

b. Months in the original c.p. after the termination date may be included in subsequent c.p.'s. because certification ends with termination. See II.D., above.

F. Changes from 12 Months to 6 Months C.P

If a recipient with a 12 month c.p. has a change in situation which results in a deductible, unstable income, or placement in long-term care, adjust the c.p. to 6 months.

1. If the change occurs during the first 6 months, adjust the c.p. to begin with the first month and end with the 6th month.

2. If the change occurs during the second 6 months, adjust to begin the subsequent c.p. with the 7th month and end with the 12th month.