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PROCESSING MEDICAID RECERTIFICATIONS Note: this worksheet is to be completed and stored in the case record for every case for which an SSR sends: (1) a request for additional info. and/or (2) a denial of continued Medicaid coverage.

Has this customer signed the recert form? D Yes D No If “YES,” register the recert in ACEDS and proceed to Step 2. If “NO,” do not register the recert. Instead, file the unsigned recert in the case record; then, document this and sign the case dictation. Stop here.

Check if the following applies: D Customer has moved outside of the District.

If you checked the box above, STOP here and send a denial notice.

Also, check if the following applies: D Customer’s only minor child turned 21.

If you checked the box above, deny AR/AX, add the SR or MC program for the Parent/Caretaker, if any. Register and process a separate MC application for the 21 year old. Go to Step 3 to determine Parent/Caretaker’s eligibility.

Also, check if any of these apply: D Customer’s only remaining minor child turned 19 and their income is over the MNIL. D Customer’s only child moved out.

If you checked either box above, deny AR/AX, add the SR or MC program and go to step 3. If you did not check any box above, go to Step 3.

STEP 3: Sufficient Info. to Process

Check if any of these apply: D Customer recertified for Food Stamps within the last 3 mos. (and reports no change). D Customer submitted 2 or more pay stubs for the last 60 days. D Customer submitted a benefits statement that is dated within the last 12 mos. (if statement reflects most recent COLA). D Customer stated that s/he receives only SS DI, SS RE, or SS SU income (see BENDEX).

AR/AX: If you checked any box above, you may have enough information to process the case. If you did not check a box, go to Step 4. MC and SR: continue to Step 5.

STEP 4: AR/AX Customers Only

AR/AX only: check if any of these apply: D AR/AX customer reported income in excess of the AR/AX standard; and D Customer has been enrolled in the AR/AX program (but not Transitional Medical Assistance) for at least 3 of the last 6 mos.

If you checked both of the above, you have enough info. to process the Transitional MA (TMA); STOP here and process the case. Send an approval for the appropriate TMA period (six mos. for earnings, four mos. for child support). Otherwise, please proceed to Step 7.

STEP 5: MC and SR Customers Only

MC and SR only: check if any of these apply: D Customer is 65 or older. D Customer claims to be blind or disabled. D Customer reports SSI or SSDI income. If you checked any box above, then go to Step 6. Otherwise, you may have enough information to process the case. If not, go to Step 7.

STEP 6: MC and SR Customers Only

MC and SR only: check if any of these apply: D Customer is 65 or older. D Customer’s has current DIS period on MERT. D Customer reports SSDI income. D Customer has Medicare (check BENDEX). D SR customer is now getting SSI (check SDX) and should have “9999” in cert thru field. If you checked any of the above, then you may have enough info to process the case. Otherwise, you should give the customer a Medical Exam Report (DHS Form 856). Go to Step 7. Customers will remain eligible for 120 days in order to have the 856 form completed.

Income Maintenance Administration Original: Case Record Page 1 D.C. Department of Human Services DHS Form 1210 (10/06) STEP 1: Registering All Signed Recerts STEP 2: Denials