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

Resetting Certification Periods at REDE

At redetermination, a new medical certification period usually starts with the first month after the current certification period ends, however it may start earlier when enough information is available to renew medical eligibility without violating continuous eligibility policy for children.

Programs	Medical Cert Periods
Medical only (1 EDG or all medical EDGs due same time)	The new 12-month period starts with first month after the current certification period ends.
Medical & SNAP (REDE due at same time)	The new 12-month period starts with first month after the current certification period ends.
Medical & SNAP (Medical REDE due before SNAP REDE)	The new 12-month period starts with first month after the current certification period ends.
Medical & SNAP (SNAP REDE due before Medical REDE)	Use SNAP data to REDE the medical EDGs and align the cert period with SNAP, unless a child subject to continuous eligibility would move to a higher cost program or would become ineligible. If aligned, the new 12-month period starts with first month after the current SNAP certification period ends.
Medical only (Multiple Medical EDGs, with different REDE due dates)	When first EDG comes due, use data to REDE all medical EDGs and align the cert periods unless a child subject to continuous eligibility would move to a higher cost program or would become ineligible. If aligned, the new 12-month period starts with first month after the current certification period ends for the EDG that is due, and for any other medical EDGs that are aligned with the medical EDG that is due.

Programs

Medical Cert Periods

Medical only

(1 EDG or all medical EDGs due same time)

The new 12-month period starts with first month after the current certification period ends.

Medical & SNAP

(REDE due at same time)

The new 12-month period starts with first month after the current certification period ends.

Medical & SNAP

(Medical REDE due before SNAP REDE)

The new 12-month period starts with first month after the current certification period ends.

Medical & SNAP

(SNAP REDE due before Medical REDE)

Use SNAP data to REDE the medical EDGs and align the cert period with SNAP, unless a child subject to continuous eligibility would move to a higher cost program or would become ineligible.

If aligned, the new 12-month period starts with first month after the current SNAP certification period ends.

Medical only

(Multiple Medical EDGs, with different REDE due dates)

When first EDG comes due, use data to REDE all medical EDGs and align the cert periods unless a child subject to continuous eligibility would move to a higher cost program or would become ineligible.

If aligned, the new 12-month period starts with first month after the current certification period ends for the EDG that is due, and for any other medical EDGs that are aligned with the medical EDG that is due.

Deemed Newborns and Pregnant Women

Deemed newborns and pregnant women receive a period of continuous eligibility under policy that is separate from the policy regarding continuous eligibility for children under age 19 that is described in PM 18-05-01.

Deemed Newborns

Newborns whose mother was covered for HFS medical benefits for the newborn's birth are deemed eligible and are continuously eligible for medical benefits until they are a year old regardless of changes in income. Rather than aligning a deemed newborn's certification period with the other medical EDGs on a case, the newborn's cert period will be set to end after they turn 1 year old.

For an example of a deemed newborn who turns a year old during the certification period, see WAG 18-05-01-b.

Pregnant Women

Under the Moms & Babies program, pregnant women are eligible through their postpartum period (see PM 06-09-05-a for postpartum coverage) regardless of income changes.

When a woman, receiving medical coverage, is reported to be pregnant, she is assigned a new 12-month certification period and transitioned to the Moms and Babies program.
When a woman who is pregnant is being added to a case, she may receive a separate certification period , rather than aligning her cert period with the other medical EDGs on the case.
Pregnant women continue to receive medical coverage during their postpartum period (see PM 06-09-05-a for postpartum coverage). The postpartum period begins with the 1st day of the month following the month in which the pregnancy ended.
These women are redetermined at the end of their postpartum certification period.

Aligning Medical Certification Periods on Active Cases

When a person (other than a deemed newborn or pregnant woman) is added for medical benefits to an IES case with existing medical benefits, IES will align the added individuals' certification period with the certification period of the existing medical EDG.

When a new program is added to an active IES case, the system aligns the certification periods in the following order:

Program added	Existing Program	Result
MSP EDG	Active Medical	align Medicare Savings Plan (MSP) with existing medical cert period
Medical EDG	Active Medical	align new medical EDG with existing medical cert period
Cash EDG	Active Medical	align medical EDG with new cash EDG (REDE done)
Medical EDG	SNAP	align medical EDG with existing SNAP EDG (REDE done)
SNAP	Medical	align medical EDG with new SNAP EDG (REDE done)