Recertification Information for Early 2026

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Jan 242026
 

GIS 26 MA/03, which is dated 01/23/2026, discusses Medicaid renewal (recertification).

It advises that when a Medicaid case is up for renewal with a budget “From” date of 01/01/2026 or later: it should be re-budgeted using the person’s 2026 Social Security benefit amount and the person’s 2026 Medicare Part B premium.

However, if this calculation results in the person going from no spenddown to having a spenddown, or if it results in the person’s spenddown increasing: the case should be budgeted using the person’s 2025 Social Security benefit amount and the person’s 2025 Medicare Part B premium.  These cases should be tracked.  After the 2026 Federal Poverty Level is published in the Federal Register, a new Medically Needy Income level will be announced based on the 2026 Federal Poverty level.  After that time, these cases should be updated using the person’s 2026 Social Security benefit amount and the person’s 2026 Medicare Part B premium.

All redeterminations effective 01/01/2026 or later will need to be re-budgeted, retroactive to 01/01/2026, after the new Medically Needy Income level based on the 2026 Federal Poverty Level is published in the Federal Register.

Posted 01/24/2026

Recertification Rules Changed

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Jul 162025
 

GIS 25_06, dated 07/14/25, has updated rules regarding Medicaid Recertification. Rules had been changed during the COVID-19 Public Health Emergency; now they are revised.

If a Medicaid Recertification was filed on or prior to 06/30/2025, the Social Services District was not allowed to decrease or terminate Medicaid coverage based on the Medicaid recipient’s resources. That rule applied to Recertifications, not applications.

This GIS tells us that Social Service Districts must apply the resource test for Recertifications received after 06/30/2025. Assets must be reviewed at renewal.

The GIS also tells us that the Asset Verification System (AVS) process will resume beginning with July renewals (cases with 09/30/2025 end dates). For renewals received after 06/30/2025, Social Service Districts must verify resources by submitting an AVS request. Social Service Districts also might need to submit AVS requests for non-applying spouses for cases which were authorized during the COVID-19 Public Health Emergency.

The GIS includes a timing reminder. A Medicaid recipient must be given 30 days to respond to renewal notices. If a Medicaid recipient’s eligibility is discontinued at the renewal process for failure to renew, but the applicant returns the completed renewal before the case expires, or within 90 days after the case is closed for failure to renew, the Social Service District must use the renewal to reopen the closed case. If it is within 30 days, the Social Service District must reactivate the case. If it is beyond 30 days, the Social Service District must reregister the case. If the Medicaid recipient is determined eligible, coverage may be authorized back to the effective date of discontinuance for the failure to renew.

The Attachment to the GIS reminds us that the changes discussed are for Recertifications only. For new applications, Medicaid applicants had already been required to provide information about resources, and use of the AVS system was already in place.

Posted 07/16/2025

Recertification Information for Early 2025

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Jan 092025
 

GIS 25 MA/01, which is dated 01/08/2025, discusses Medicaid renewal (recertification).

It advises that when a Medicaid case is up for renewal with a budget “From” date of 01/01/2025 or later: it should be re-budgeted using the person’s 2025 Social Security benefit amount and the person’s 2025 Medicare Part B premium.

However, if this calculation results in the person going from no spenddown to having a spenddown, or if it results in the person’s spenddown increasing: the case should be budgeted using the person’s 2024 Social Security benefit amount and the person’s 2024 Medicare Part B premium.  These cases should be tracked.  After the 2025 Federal Poverty Level is issued, a new Medically Needy Income level will be announced based on the 2025 Federal Poverty level.  After that time, these cases should be updated using the person’s 2025 Social Security benefit amount and the person’s 2025 Medicare Part B premium.

All redeterminations effective 01/01/2025 or later will need to be re-budgeted, retroactive to 01/01/2025, after the new Medically Needy Income level based on the 2025 Federal Poverty Level is announced.

Posted 01/09/2025