PM 19-02-07

new textResetting Certification Periods at REDE Examples

  • Example 1: The Teague family receives FamilyCare, All Kids Assist and SNAP benefits. All EDGs have the same certification period of Oct 2015 through Sept 2016. A REDE is completed and certified on Sept 6, 2016 for medical and SNAP. The new medical and SNAP certification periods are Oct 2016 through Sept 2017.
  • Example 2: The Ianni family has an All Kids Share EDG with a cert period of Oct 2015 through Sept 2016, and a SNAP EDG with a cert period of May 2016 through April 2017. A medical REDE is completed and certified on Sept 6, 2016. The new certification period for the Share EDG is Oct 2016 through Sept 2017. The cert period for the SNAP EDG is not changed.
  • Example 3: The Reed family has a SNAP EDG with a cert period of Oct 2015 through Sept 2016. Mr. Reed receives AABD medical and Mrs. Reed gets ACA Adult benefits. Both medical EDGs have a cert period of Jan 2016 through Dec 2016. A SNAP REDE is completed on Sept 6, 2016. Since the worker has enough information to REDE the medical EDGs as well, a REDE is processed for all EDGs. The medical cert periods are aligned with SNAP, and the new certification period for all EDGs is Oct 2016 through Sept 2017.
  • Example 4: The Eaton family receives All Kids Assist for Nick with a cert period of Oct 2015 through Sept 2016. They also receive All Kids Share for Nelly with a cert period of Nov 2015 through Oct 2016. On Sept 6th a REDE is completed for Nick who will be certified for All Kids Share. Using the same information, a REDE is also completed for Nelly who continues to qualify for All Kids Share. The EDGs are aligned and the new cert period for both children is Oct 2016 through Sept 2017.
  • Example 5: The Diaz family receives All Kids Assist for Stevie with a cert period of Oct 2015 through Sept 2016, and All Kids Premium Level 1 for Sally with a cert period of Dec 2015 through Nov 2016. On Sept 6th a REDE is completed for Stevie who will be certified for All Kids Premium Level 2. His new cert period is Oct 2016 through Sept 2017. Based on Stevie's REDE, Sally would also move to Premium Level 2. However, due to continuous eligibility policy, a REDE cannot be completed for Sally at this time.
  • When Sally is due for a REDE in November, both children continue to be eligible for All Kids Premium Level 2, and the worker completes a REDE for Stevie as well. Both Stevie and Sally will have a new cert period of Dec 2016 through November 2017.

new textHard Stop Message for Certain Early REDEs

IES will not permit a REDE to be certified early for a medical EDG in certain situations. A REDE cannot be processed early for Medical Extension EDGs. The second situation where the REDE cannot be processed early is when a change would result in a child under age 19 being canceled or moved to a higher cost medical program before the current certification period ends. In these situations the following 'hard stop' message will appear on the certification page: "Early redetermination cannot be processed for one or more EDGs. Please process redetermination after cutoff in the month prior to the certification end date."

  • Example 1: The Wong family receives All Kids Assist for Jill and John with a certification period of January through December 2016. A REDE form is mailed to the family on November 1st with a response due by December 1, 2016. The customer responds through the ABE member portal on 11/03/16 and uploads all required verifications. The income has increased and the children now qualify for All Kids Premium level 1.
  • On 11/05/16, the worker attempts to certify the REDE. Since IES is still processing for the ongoing month of December, the last month of the current certification period, the 'hard stop' message will appear on the certification page. The worker cannot certify the REDE until after cutoff (11/16/16). On 11/16/16, the worker certifies the REDE for the effective month of January. The new All Kids Premium Level 1 certification period is January through December 2017.
  • Example 2: The O'Brian family receives FamilyCare for Mr. and Mrs. O'Brian and All Kids Assist for Pat and Meghan with a certification period of January through December 2016. A REDE form is mailed to the family on November 1st with a response due by December 1, 2016. The customer responds through the ABE member portal on 11/03/16 and uploads all required verifications. The income has increased slightly and the children will continue to qualify for All Kids Assist, however the parents are now over the FamilyCare income level.
  • On 11/05/16, the worker certifies the REDE. Since the children will not move to a higher cost program, the system will allow the REDE to be processed early and will set a new All Kids Assist certification period of January through December 2017. However, since IES is still processing for the ongoing month of December, the adults will be canceled effective December 2016. IES will transmit their case information to the Marketplace.

new textAligning Medical Certification Periods on Active Cases Examples

  • Example 1: The Aguilar family receives FamilyCare and All Kids Assist benefits with certification periods of July 2016 through June 2017. Mr. Aguilar begins receiving Medicare benefits and qualifies for QMB effective Jan 2017. The new QMB/MSP certification period is aligned with the FamilyCare EDG and will end June 2017.
  • Example 2: Mr. Zack, age 66, receives AABD medical and has a certification period of July 2016 through June 2017. His 14 year old grandson, George, moves in with him in September and Mr. Zack requests medical benefits for George. George is approved for All Kids Assist starting in September and his certification period is aligned with Mr. Zack's with an end date of 06/30/17. When George is added to the IES case, Mr. Zack is certified under the FamilyCare program because he is George's caretaker relative. Mr. Zack's certification period is not changed.
  • Example 3: Ms. Tower receives All Kids Share benefits for her two children. Her certification period is August 2016 through July 2017. In November she loses her job and requests TANF assistance. She is approved for TANF for herself and her two children. Due to the receipt of TANF benefits, the family is deemed eligible for FamilyCare and All Kids Assist. The medical benefits are aligned with the new TANF certification period. Since the children are moving from All Kids Share to a lessor cost program, All Kids Assist, setting a new certification period for the children is not a violation of continuous eligibility policy.
  • Example 4: The Cruz family receives FamilyCare and All Kids Assist benefits with a certification period of July 2016 through June 2017. In October the family requests SNAP benefits. The income verification provided with the SNAP application shows that family income is increased to the All Kids Share level. The family is approved for SNAP with a certification period of October 2016 through September 2017. Mr. and Mrs. Cruz' medical benefits are canceled and they are referred to the Marketplace. Due to continuous eligibility policy, the children continue to receive All Kids Assist through June 2017.