Attorney At Law: Medicaid recertification process now underway

By Nancy Burner, Esq.

As a part of Medicaid eligibility, existing members must recertify with the local Department of Social Services (“DSS”). This is a mini application wherein your will have to provide current financial statements, monthly income verification and pooled income trust deposits if using one. This has always been the case for recipients of Community Medicaid and Chronic Medicaid; however, this may be a new concept for those that started with the program post-March 2020.

Due to the COVID pandemic, DSS was extending benefits without the requirement of submitting the necessary documents. You may have even received a notice from your local department stating that “we will extend Medicaid coverage” and “based on the federal legislation signed into law on Wednesday, March 18, 2020, no person who currently has Medicaid coverage will lose their coverage during this time of the COVID-19 pandemic.” For some people, this meant no recertification for three years. But that time is over and as the new notices from DSS say it is time to “ACT NOW.”

Since this is the first time in three years that benefits have been adjusted, you could see a dramatic change in the income budgeting for the Medicaid recipient. One of the main reasons for recertification (other than confirming continued eligibility) would be to assess the monthly income budgeting. This would be the net available monthly income (“NAMI”) for Chronic Medicaid recipients which needs to be the amount paid over the nursing home each month. For Community Medicaid recipients it would mean adjustments to the funding of the pooled income trust. This is usually adjusted annually, and the change is barely noticeable. 

But now, after three years, the adjustment may seem dramatic, especially if there has been a major change with the Medicaid recipient, including the death of a spouse, change in value of a retirement account, or an increase in social security benefits. All of these circumstances can impact the monthly benefits.

Retaining an attorney to prepare and submit the recertification is typically advisable. If the application is not filled out correctly, or documentation is missing, the recertification could be denied for failure to provide information. This would result in a loss of benefits for the Medicaid recipient and the possibility of a gap in coverage.

Nancy Burner, Esq. is the founder and managing partner at Burner Law Group, P.C. with offices located in East Setauket, Westhampton Beach, New York City and East Hampton.