Recertification Rules Changed

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