Medicaid Recertification & Redetermination
Home / Legal Services / Medicaid Planning / Recertification & Redetermination
MEDICAID PLANNING
Kentucky Medicaid Recertification and Redetermination
Getting approved is not the end of the process. Kentucky Medicaid eligibility is reviewed periodically, and coverage that took months to obtain can be terminated by a single unreturned form.
Recertification is where families relax and where problems reappear. An inheritance arrives, a certificate of deposit matures, a life insurance policy is discovered, an income trust stops being operated correctly, or the renewal packet goes to an address nobody checks any more.
We handle recertifications for clients whose applications we filed and for families who obtained coverage themselves and would rather not risk losing it. It is small, unglamorous work that protects something the family spent a great deal of effort to secure.
If a renewal packet has arrived and you are not sure what to do with it, call (502) 348-2108.
What Recertification Involves
Recertification, sometimes called redetermination or renewal, is the periodic review confirming that a Medicaid recipient continues to meet the eligibility requirements. It examines income, resources and continued need for the level of care being provided.
For a long-term care recipient the review is generally narrower than the original application. It is concerned with what has changed rather than with reconstructing the previous five years. That said, anything that has changed will be examined, and changes are more common than families expect.
There is also an ongoing duty to report certain changes as they occur rather than waiting for the review. Waiting until renewal to disclose something that should have been reported earlier creates a larger problem than the change itself usually warranted.
What Puts Coverage at Risk
Terminations at recertification fall into two groups, and the first is entirely avoidable.
Paperwork failures
The most common reason coverage is lost is that the renewal packet was not returned, or was returned incomplete, or a request for additional verification went unanswered before its deadline. Where a recipient is in a facility and their mail goes to a family member who is themselves managing a job and a household, packets are missed. The termination that follows is not a finding of ineligibility, but the coverage stops all the same and it has to be reinstated or reapplied for.
Changes in the financial picture
The second group is substantive. An inheritance, even a modest one, can take resources above the limit. A certificate of deposit maturing, an annuity beginning to pay, a tax refund, a personal injury settlement, or the sale of a jointly owned property can all change the position. Life insurance policies that nobody remembered surface at review. And where income has increased, a qualified income trust that was never operated properly, or that was signed and then ignored, becomes visible.
None of these is necessarily fatal. Most can be addressed if they are identified early and handled correctly. What causes the damage is discovering them in a termination notice, at which point the family is dealing with an appeal deadline rather than a planning question.
What We Do at Recertification
Track the renewal date
Knowing when the review is due, and making sure the packet is expected rather than a surprise, prevents most of the failures in this area.
Review what has changed
Income, resources, living arrangements and level of care since the last determination, with particular attention to anything that arrived unexpectedly.
Address problems before they are reported
Where a change has taken the recipient out of the limits, there is usually planning that can restore the position. Doing it before the review is far better than explaining it afterwards.
Check the income trust is being operated
Where a qualified income trust is in place, income has to flow through it every month. Failures of operation are a recurring cause of trouble at review.
Complete and submit the renewal
Preparing the paperwork and supporting documentation and getting it in before the deadline.
Deal with a termination if one issues
Filing promptly, since prompt filing may allow coverage to continue during the appeal. See denial appeals and fair hearings.
The Inheritance Problem
This is the scenario we see most often, and it is worth understanding in advance because it usually arrives without warning.
A Medicaid recipient in a nursing home is left money by a sibling, a parent or a friend. The family is pleased, and then discovers that the inheritance takes the recipient resources over the limit, jeopardising coverage that is worth far more each month than the inheritance is worth in total.
Simply refusing or disclaiming the inheritance is generally treated as a transfer and can create a penalty, so the instinct to hand it straight back tends to compound the problem rather than solve it. Nor can it usually be quietly ignored, since it will surface at review.
There are recognised ways of dealing with it, and which is appropriate depends on the amount, the recipient circumstances and whether a spouse or a disabled family member is involved. What matters practically is getting advice before anything is done with the money, and before the next review.
The better answer, of course, is prevention: relatives leaving money to someone receiving benefits should be leaving it to a properly drafted trust instead. See special needs planning.
Changes That Should Be Reported
Report these as they happen rather than waiting for the renewal. Early disclosure is almost always easier to manage.
01
Money received unexpectedly
An inheritance, a settlement, a tax refund, a matured certificate of deposit, or a lottery or gambling win. Each affects resources, and each will be visible at review.
02
Changes in income
A pension beginning, an annuity starting to pay, a Social Security adjustment, or the death of a spouse changing what income the recipient receives.
03
Property transactions
The sale of a home or land, a transfer of any interest in real property, or a change in how property is held.
04
Changes in living arrangements or care
Moving between facilities, returning home, entering hospice, or a change in the level of care being provided.
05
Marital and household changes
The death of a spouse, a marriage, or a change in who is living in the home. The death of a community spouse in particular can alter the position significantly.
If something has changed and you are unsure whether it matters, ask before the review rather than after. (502) 348-2108.
Keeping Coverage Secure
Most of what protects coverage at recertification is administrative rather than legal, and it is straightforward once someone is paying attention to it.
Make sure the mailing address on file is one that is actually monitored. Where a recipient is in a facility and an adult child is managing their affairs, the renewal correspondence should go somewhere it will be opened promptly, and it is worth confirming that annually.
Keep records as you go. A file with statements, notices and correspondence, kept contemporaneously, makes each review straightforward and makes any dispute far easier to deal with. Reconstructing a year of records under a deadline is unpleasant and avoidable.
And where a qualified income trust is in place, treat operating it as a monthly obligation rather than an occasional one. Income must actually pass through the account. This is the single most common ongoing failure we correct.
- Confirm the address on file is monitored by someone who will act
- Diary the renewal date each year
- Keep statements, notices and correspondence in one place
- Operate any qualified income trust every month without exception
- Report changes when they happen rather than at review
- Do not accept or disclaim an inheritance before taking advice
- Open notices immediately and note any deadline
Ongoing Medicaid Support in Bardstown and Louisville
Thomas Hamilton has been admitted to the Kentucky bar since 2011 and has focused on elder law since 2014. He is a member of the Kentucky Bar Association Elder Law Section and the National Academy of Elder Law Attorneys.
We support families across Nelson, Bullitt, Washington, Marion, Larue, Hardin, Anderson, Spencer and Jefferson counties, from 117 E. Stephen Foster Avenue in Bardstown and the First Trust Centre, 200 S. 5th Street in Louisville.
We handle recertifications for existing clients and for families who obtained coverage on their own. The initial consultation is free. Schedule a consultation.
Mistakes That Lose Established Coverage
Missing the renewal packet
The leading cause of termination, and entirely administrative. Coverage stops even though nothing about eligibility actually changed.
Not operating the income trust
Signing a qualified income trust and failing to route income through it every month is a recurring and avoidable failure that surfaces at review.
Accepting an inheritance without advice
And equally, disclaiming one without advice, since a disclaimer is generally treated as a transfer. Both reactions can be worse than the problem.
Not reporting a change and hoping
Changes surface at review. Disclosing at the time is nearly always easier to manage than explaining under a deadline months later.
Letting mail go to an unmonitored address
Notices and requests carry deadlines. Correspondence should reach someone who will open it promptly.
Ignoring a termination notice
Prompt filing may allow coverage to continue during an appeal, but that option disappears quickly. Act the day the notice arrives.
FREQUENTLY ASKED QUESTIONS
Common Questions About Recertification
How often is Medicaid eligibility reviewed?
Eligibility is reviewed periodically, and the recipient also has an ongoing duty to report certain changes as they occur rather than waiting for the review. For a long-term care recipient the review is generally narrower than the original application, focusing on what has changed in income, resources and level of care.
My mother inherited money while on Medicaid. What should we do?
Get advice before doing anything with it. An inheritance can take resources above the limit and jeopardise coverage worth far more each month than the inheritance itself. Simply disclaiming or handing it back is generally treated as a transfer and can create a penalty, so the instinctive response often makes matters worse. There are recognised ways of dealing with it depending on the amount and the circumstances.
What happens if we miss the renewal deadline?
Coverage can be terminated for failure to complete the renewal, even though nothing about actual eligibility has changed. That is a procedural termination and is usually correctable, either by appealing promptly or by reapplying, but the interruption means the facility bills privately in the meantime. Prompt action on the notice is what limits the damage.
Do we need to report a change straight away?
Yes, for changes in income, resources, property, living arrangements and level of care. Reporting at the time is almost always easier to manage than having the change surface at review, when the family is working to a deadline rather than considering options.
Can you handle the recertification for us?
Yes, including for families who obtained coverage without our help originally. We track the renewal date, review what has changed, address any problem before it is reported where that is possible, confirm any income trust is being operated correctly, and submit the paperwork before the deadline.
REVIEWS
Hear From Our Clients
CONTACT
Do Not Lose What Took Months to Obtain
Most terminations are administrative, not substantive, and almost all of them are preventable. Call attorney Thomas Hamilton at (502) 348-2108 or use the form below.
Phone:
Address:
117 E. Stephen Foster Avenue, Bardstown, KY 40004