WAG 19-02-07: Medical Certification Periods at REDE & Active Cases

Resetting 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 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.]

Hard 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 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.

Aligning 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.