Why is Medicaid recertification important and how do you navigate the process?

After a lengthy application and approval process, your aging loved one has finally been approved for Medicaid. A huge financial burden is lifted, and you are now free to focus on other vital aspects of their elderly, such as hiring a caregiver, Implementing safety precautions, and deciding what level of care is best for their specific needs.

You can stop submitting endless amounts of paperwork to your application. You should heave a sigh of relief. But, you should not discard any communication you receive from Medicaid.
Eligibility for Medicaid is recertified periodically. And although it is usually a simple process, Medicaid recertification is important to take care of in a timely manner to ensure there is no gap in coverage.

Reasons for Renewal//What should you know?

Medicaid beneficiaries are normally evaluated once during every 12 months to confirm that they remain eligible – based on the set income and asset brackets in the applicable State.

Of course, if there is any change to the income or assets of an eligible individual at any point, Medicaid requires beneficiaries to report them within 10-30 days of the change. In some states, this is a less stringent requirement.

If these changes aren’t reported, consequences may include:

• ⚠️ Loss of benefits
• ⚠️ Repayment of benefits received
• ⚠️ Medicaid fines
• ⚠️ Jail time

Therefore, you should make sure to report changes even when it is not yet time for renewal so Medicaid can evaluate the case based on the updated circumstances.

The Recertification Process//What can you expect?

At the time of renewal, the Medicaid agency confirms that any information that may have changed during the time since the last certification is up to date.

• ✔️Income amounts are reviewed to ensure they are still within the threshold limits.
• ✔️Countable assets are checked to confirm they have not exceeded the asset limit at any point during the previous year.
• ✔️Financial documents and contact information are reviewed and confirmed along with any financial documents submitted during the original application.
• ✔️Age, social security numbers, and citizenship are not reviewed.

Renewal Process Types//What is the process?

In the same way that technology has streamlined many bureaucratic processes, Medicaid recertification, too, has been streamlined to make the process somewhat easier for all parties.

• ☛ Automatic Renewal
  When possible for the applicable state, the Medicaid recipient’s income and assets must be verified electronically. This is also known as Ex Parte Renewal or Administrative Renewal.
  If an individual’s eligibility status can be determined in this way, no request for documentation will be sent and the coverage will renew automatically.
  • Here are some cases where automatic renewal is not possible:
    • The individual has income or assets (such as rental or self-employment income,) which cannot be found in online databases.
    • The recipient does not have a social security number, which makes it impossible for electronic databases to verify eligibility criteria.

In such situations, paper documentation will be sent to request the data.

• ☛ Pre-Populated Renewal Form
  Even in cases where a recipient cannot be renewed by automatic renewal, the state can process the renewal using a pre-populated form. This means that only the information that has changed must be entered or updated in the paperwork received. However, they are only required to use this method for specific groups of people, including parents/caretaker relatives.
  • Since the pre-populated form is not a requirement for the senior age group of 65+ years,  you may receive an empty renewal form to complete. Take care to complete and return whichever form is sent to you within the specified date window.
• ☛ Online, Phone, and In-Person Recertification
  These are all alternate options available for your convenience, as well.

You don’t have to do it alone.

Though not nearly as thorough as the original approval process, Medicaid agencies will often request financial documentation for dates within the previous coverage period to determine eligibility. You will likely be asked to provide proof of income, or other fiscal statements.
Also, as with any Medicaid process, the manner in which recertification is handled as well as the information and documents required differs across different states in the US.

Are you overwhelmed by the many aspects of caregiving and want to get this right and prevent coverage gaps? Our Medicaid experts are here to help you navigate the process. Reach out to us at: info@seniorplanning.com