Last Updated: July 2007

HOW TO RECERTIFY IN MANAGED CARE

Q. What is recertification?

A. Every year your client has to document that he/she is still eligible for Medicaid. This is called "recertification".

Q. How does your client recertify?

A. It depends on how he/she originally applied for Medicaid.

• If the client is receiving home care services, the worker will recertify him/her during one of the home care visits.
• If the client is residing in an institution, the institution will recertify him/her.
• Pregnant women (who applied through PCAP) will receive a notice of recertification in the mail and must recertify their Medicaid eligibility within 2 months after delivering their baby.
• Everyone else will receive a recertification package in the mail. The client must complete the paperwork and mail it back to Medicaid in the envelope provided before the "respond by" date on the front of the Mail Recertification form. The application must be received by Medicaid by the date on the front of the form; it is a received by date not a mailed by date. For assistance in completing the Mail Recertification forms, call the HRA Medicaid Helpline at 1-888-692-6116, or take the Mail Recertification package to one of the enrollment facilitators on the list that comes in each Mail Recertification package.

Q. What happens if your client doesn't recertify his/her Medicaid?

If the client doesn't recertify, he/she will lose Medicaid coverage. Medicaid will send a Notice of Discontinuance. If this happens, your client should request a Fair Hearing and Aid-to-Continue within 10 days so his/ her Medicaid case does not close (see Chapter 5J for information on how to do this). If the client reapplies for Medicaid within 30 days of the case closing, the case will be reconsidered, and he/she may not be required to go through the entire application process again. If the client still has the recertification packet, he/she should fill out the recertification packet and take it to the Medicaid office before the 30 days are up.