Medical Assistance Certification Periods Minnesota Financial Workers & Case Aides Association Conference September 28-30, 2011 DHS – Health Care Training Presenter: Ge Her Note: Unresolved questions asked during the presentations are being reviewed and will be posted soon.

Table of Contents What is a Certification Period How a Certification Period is Created When to Interrupt a Certification Period When Not to Interrupt a Certification Period Adding a New Household Member Overlapping Certification Periods Spenddowns and Changes to Certification Periods 2

Definition of a Certification Period 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 in which income is calculated to determine income eligibility, as well as the premium or spenddown amount. 3

Initial Certification Period 4 JanJan FebFeb MarMar AprApr MayMay JunJun Retro = Actual Income Anticipated Income

How a Certification Period is Created MAXIS sets up the initial certification period when: A new case is created and health care is requested. A closed case is put into PND2 status through APPL. Health care is requested through STAT/HCRE on an active case. 5

STAT/HCRE 6 Note:All case names and numbers used in this presentation are fictional and were created for learning purposes only.

STAT/BUDG 7

STAT/BUDG Continued… 8

When to Interrupt a Certification Period A previously scheduled cash, or Food Support (FS), annual recertification, six-month report or MA renewal is due during a current certification period. A MCRE renewal is due during an existing MA certification for other household members. Exceptions exist for cases that have active Food Support or cash programs. Adding a household member who increases the household size. Exception: Do not interrupt the certification period when adding a newborn already included in the household size as an unborn. 9

When to Interrupt a Cert Period Continued… 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. A client’s automatic MA eligibility ends (MSA). 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. 10

Aligning Cert Periods 11

STAT/BUDG - Aligning 12

STAT/REVW Updated 13

STAT/BUDG Updated 14

ELIG/HC – Updated 15

MinnesotaCare Redetermination Date 16

Automated Cert Period Creation MAXIS creates a new certification period in most instances when a certification period must be interrupted. 17

Automated Cert Period Creation Example 18

Automated Cert Period Example Continued 19

New Certification Period 20 If a PF11 system patch is needed, see TE – HCRW SHORTENED SPENDDOWN FIXES – PHASE 1.

Notes for Interrupted Certification Periods When a new certification period is created, adjustments must be made to the old certification period, such as a shortened spenddown calculation. If the new certification period has a spenddown, all household members must use the same spenddown type unless an exception is met. Update MMIS according to the MAXIS changes. 21

When Not to Interrupt a Certification Period A person on stand-alone MA becomes eligible for automatic MA with cash assistance, or the MSA and RCA programs. A client enters or leaves an LTCF. QMB, SLMB or QI eligibility is added to MA. MA eligibility is added to QMB, SLMB or QI. The household size decreases because a person dies or leaves a current MA household. A client’s income changes. 22

When Not to Interrupt a Cert Period Continued… 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. A client’s eligibility changes from MA-EPD to basic MA, resulting in a lower income standard. Redetermine eligibility for the remaining months of the certification period using a monthly spenddown. People on basic MA become eligible for TMA or TYMA. People on TMA or TYMA become eligible for basic MA. 23

Notes on When a Cert Period is Not Interrupted On a six-month spenddown, you cannot decrease benefits as eligibility has already been approved through the six-month certification period. (HCPM ) If the six-month spenddown adjustment results in a lower spenddown amount or earlier satisfaction date, make the adjustment in MMIS and notify the client of the changes so they can submit additional bills that may now be covered by MA. (HCPM 24.25) If the client has a monthly spenddown, you must allow for 10-day notice before taking adverse actions on the case. (HCPM 24.25) Update MMIS according to the MAXIS changes. 24

Adding a New HH MEMB Eligibility is determined based on his/her living arrangement before entering the home. If the new member lived with other mandatory members, deeming and HH composition rules apply from the previous HH. The new member may gain a basis of eligibility but HH size rules do not apply in the month of entry or retro months. New member must be determined under old HH factors for those months. A new HH member cannot be eligible with existing members until the first full month they have lived in the home, except for auto-newborns. 25

Adding a New HH MEMB 26

Adding a New HH Member Continued 27 MAXIS creates a new certification period.

Overlapping Cert Periods New health care requests that overlap with previous certification periods with eligible or ineligible months. 28

Overlapping Cert Periods 29

Overlapping Cert Period September Application 30

FIAT Required 31 Reason Code 05 – System Override

Overlapping Cert Period 32 Update month of August with new application information. POLI/TEMP TE

Which type of spenddown can be shortened? A six-month spenddown can be shortened. Monthly spenddowns are determined one month at a time so changes take effect the next available month allowing for 10- day notice. 33

Recalculating a SPDN Step 1: Update the information that interrupts the certification period in the month the change occurred. Step 2: Once the update is made, change the footer month to the beginning of the certification period. Step 3: Use the BGTX command in STAT to request new background transactions. 34

When a SPDN Decreases Act on a change when the client reports it but do not verify the change until the next certification period. Changes may result in earlier satisfaction dates or changes to the recipient amounts. 35

SPDN Decrease - Example 36

Spenddown Decrease Example Continued… 37

SPDN Decrease - SPDN 38

SPDN Decrease – Shortened Cert Period 39

STAT/BUDG Alignment Don’t forget to update STAT/REVW! 40

SPDN Decrease Shortened SPDN 41

SPDN Decrease - MMIS 42

Spenddown Increases Increase in income beyond normal projected amounts – e.g. new job. A household member enters or leaves the home. Client reports income that was not anticipated when the original income calculation was determined. The months before the change were high income months in shortened spenddown situations. 43

SPDN Increases - Example Richard and Jane receive an unexpected lump sum payment of $4, in July. Update income in the month of the change. Recalculate spenddown. 44

SPDN – Increased SPDN 45 Do not send notice due to increased six-month SPDN amount.

Other Changes Review HCPM – Certification Period Review case to see if interruption of certification period is needed. Update spenddown amounts and make updates if changes are beneficial to client. If case is set up as monthly spenddown, allow 10-day notice if taking adverse action. 46

Questions? 47

Thank you! 48