*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: October 1, 2014 |
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21.05 - Certification Period |
Archived: June 1, 2016 (Previous Versions) |
"Certification period" has two meanings. A certification period is the period of time a client can be active before the next renewal is due. For income purposes, the certification period, sometimes referred to as a budget period, is the time period for which income is calculated to determine income eligibility, as well as the premium or spenddown amount.
Length of the Certification Period.
Interrupting a Certification Period.
Do Not Interrupt a Certification Period.
Length of the Certification Period
The length of the certification period depends on the health care program.
l MinnesotaCare (MCRE) has a 12-month certification period.
The certification starts from the first month following the month in which the household was initially pended awaiting payment of the premium.
l MA has a six-month certification period.
The certification period begins either:
n The first month of eligibility.
n In a retroactive month. Clients requesting retroactive eligibility may have the certification period start in a month in which there is no eligibility but for which income and bills were considered.
Interrupting a Certification Period
There are specific times when a certification period must be interrupted and changed to a new certification period for MA.
Note: Determine a shortened spenddown period any time a certification period with a six-month spenddown is interrupted.
Inform a client who chooses to enroll in MCRE during a certification period with a six-month spenddown that MA eligibility exists for the entire six-month period. The client may choose to enroll in MCRE or remain on MA.
Interrupt a certification period in the following situations:
l A previously scheduled cash, or Food Support (FS) annual recertification, six-month report or MA renewal is due during a current income certification period. Complete the recertification and begin a new income certification period with the recertification month.
Example:
William and Patsy and their three children receive Food Support (FS) and MA. They were approved for FS effective June 13. The Food Support recertification is scheduled for June. They then applied and were approved for MA the following March. The MA income certification period is March - August.
Action:
Redetermine eligibility for both FS and MA for June using the FS recertification. Interrupt the existing MA certification period and begin a new income certification period for June - November. The next FS and MA annual recertification will be due at the same time in the following June.
l A MCRE renewal is due during an existing MA certification period for other household members. Align the MA certification period with MCRE.
Exception: Do not adjust the MA certification period if some or all household members receive cash or FS with a different recertification date.
Example:
Leo and Prudence apply for FS for themselves and their two children. They apply for MA at the same time for the children. The renewal and recertification dates are set for July. Leo and Prudence apply for MCRE for themselves the following March and the renewal month is April.
Action:
Do not adjust the MA certification period to align with the MinnesotaCare renewal because the household receives FS.
Note: Do not adjust a MCRE renewal date to align with any other programs.
Example:
Larry and Liz apply for MCRE for their three children. MCRE is approved and with a renewal due for October. Larry and Liz apply for MA for themselves in August and have a certification period of August - January.
Action:
Interrupt Larry and Liz’s August - January certification period at the time of the children’s MCRE renewal for October. Begin a new MA certification period for October - March. The renewals are now aligned for the following October.
l Adding a household member who increases the household size. End the current certification period for the existing household members on the last day of the month before the month the new member is added.
Exception: Do not interrupt the certification period or recalculate the spenddown when adding a newborn who was already included in the household size as an unborn.
Note: See Household Composition for more information on when to add a household member and how to calculate the household size.
Example:
Rita applies for MA for herself and her three children. They are found eligible and have a certification period of July - December. Rita's husband, Ron, who was not previously counted in the household size, returns home on September 15 and requests MA for October.
Action:
Interrupt the income certification period for Rita and the children because Ron is being added to the household. The certification period for everyone, including Ron, is October - March.
l A person who is included in the household size but did not request MA with other household members, now requests MA for a period before the household's original certification period.
n The new income certification period will begin on the first day of the earliest requested retroactive month for all household members.
n Redetermine the entire household's eligibility using an income certification period starting with the new member's earliest eligible retroactive month.
Example:
Mike applied for MA for his two children in April. He did not request MA for himself because he had other coverage. The children are eligible with a certification period of April - September.
On June 5, Mike requests MA retroactive to March for some bills not covered by his other insurance.
Action:
Redetermine eligibility using a new certification period for the entire household of March - August.
l A client's automatic MA eligibility ends.
Example:
Suzanne’s MSA eligibility ends as of December 30. Her certification period
for MA is September through February.
Action:
Interrupt the certification period due to MSA ending. Redetermine eligibility
with January the first month of the new certification period.
l When a client in a single person household dies, end the current certification period on the last day of the month in which the death occurred. Redetermine eligibility for the months in the certification period through the month of death.
Example:
Roger died on September 12 and was receiving MA with a certification period of May - October.
Action:
Terminate MA on the date of death. Recalculate Roger's eligibility for a five-month period using his income from May 1 through September 12.
Do Not Interrupt a Certification Period
Do not interrupt an income certification period for MA in the following situations:
l A person on stand-alone MA becomes eligible for automatic MA with cash assistance (MSA).
n The certification period will include stand-alone MA months and automatic months.
n For client’s with a spenddown, redetermine the spenddown for the stand-alone MA months using the applicable MA standard and income. See Shortened Spenddown.
Example:
Patrick is disabled and eligible for MA with a six-month spenddown. He has a certification period of April - September. He becomes eligible for MSA and automatic MA on June 1.
Action:
Do not interrupt the certification period. Calculate a new spenddown amount and satisfaction date for March, April, and May.
n When applicants for a type of cash assistance that includes automatic MA also request retroactive MA, begin the certification period with the retroactive month in which eligibility began.
Note: For the cash assistance months of the certification period, enter income of $0 (use the "X" income standard) and the appropriate MSA eligibility type.
l A client enters or leaves an LTCF. See MA Payment of Long-Term Care (LTC) Services for more information.
l , or eligibility is added to MA.
l MA eligibility is added to QMB, SLMB or QI.
l The household size decreases because a person dies or leaves a current MA household. Recalculate the current certification period with the decreased household size in the appropriate months.
Example:
Luke and Laura and their two children are active on MA. Luke and Laura have an automated monthly spenddown and the children have no spenddown. Their current income certification period is March - August. Luke leaves the home on June 4.
Action:
Recalculate Laura and the children's eligibility for July (the month after Luke left the home) and August. Decrease the household size to three and do not count Luke's income for those two months.
l A client's income changes. Redetermine eligibility for the current six-month certification period.
l A person who was included in the existing household size but did not request MA is now requesting coverage within the same income certification period.
Example:
Theresa and David apply for MA for their two children on July 8. The children are approved with a certification period of July - December. In September, Theresa requests MA for herself and David because of bills they incurred starting in late July.
Action:
Determine eligibility for Theresa and David using the original certification period. If they have a spenddown under the income standard that applies to them, they may have a later opening date than the children.
l A client’s eligibility changes from MA-EPD to regular MA, resulting in a lower income standard. Redetermine eligibility for the remaining months of the certification period using a monthly spenddown.
Example:
Mark is enrolled in MA-EPD with a certification period of September - February. He stops working for non-medical reasons and receives his last pay check in December. He continues to receive RSDI in excess of the income standard for regular MA.
Action:
Use a monthly spenddown for January and February.
l People on regular MA become eligible for TMA or TYMA.
l People on TMA or TYMA become eligible for regular MA.