Adult Medicaid Manual MA-2350 CERTIFICATION AND AUTHORIZATION

REISSUED 04/01/11 – CHANGE NO. 01-11

I. POLICY PRINCIPLES

A. Certification Periods

1. A certification period (c.p.) is a period of time for which eligibility is determined. In cases with deductibles, the deductible is determined for the entire c.p. of six months.

2. During the c.p, all eligibility factors must be continuously met, except:

a. Income: Excess income may be reduced or "spent down" by incurred medical expenses. Refer to MA-2360, Medicaid Deductible.

b. Reserve: For prospective c.p.’s, excess reserve may be reduced to allowable limits during the 45/90 day application processing time.

NOTE: Refer to MA-2230, Financial Resources, for instructions for rebutting property value and applying the burial exclusion. This is not reducing reserve, but will have bearing on determining countable reserve. Refer to MA-2303 Verification Requirements For Applications, for procedures regarding the use of a/r’s statement.

3. A case which is dually eligible for MQB-Q or B and M-AABD has a 12 month c.p. for M-QB, but will transfer to a 6 month c.p. when the M-AABD deductible is met.

a. If the deductible is met in the first 6 months of the MQB-Q or B c.p., the MAABD c.p. is the first 6 months of that M-QB c.p.

b. If the deductible is met in the second 6 months of the MQB-Q or B c.p., the M-AABD c.p. is the second 6 months of that M-QB c.p.

4. When the c.p. ends:

a. Eligibility is redetermined for a new c.p., or

b. The case is terminated with timely notice.

NOTE: If eligibility for M-AABD with Q or B classification no longer exists, transfer the case to M-QB with timely notice. Refer to MA-2355, MAABD/MQB Program Transfers, for transfer procedures.

REVISED 04/01/11 – CHANGE NO. 01-11

(I.A.)

5. The certification period for an SSI CAP case is controlled by the Social Security Administration (SSA). A yearly review is done by the CAP lead agency to update the plan of care. The county can not change the certification period for an SSI CAP case.

B. Authorization

The period authorized is the portion of the c.p. when all factors of eligibility are met and the individual receives Medicaid benefits.