What Is a Medicaid Recertification Form?

A Medicaid recertification form is a questionnaire sent to a Medicaid recipient each year that he must complete and return by a specified date to continue receiving Medicaid benefits and avoid losing coverage. Most states require Medicaid recipients to complete an annual recertification process to confirm that they remain eligible for coverage for the upcoming year. The state’s Medicaid authority generally mails a recertification package containing the form 60 to 90 days before the day coverage is due to expire.

The form asks the recipient to verify whether there has been any change in household members, address, insurance, employment or household income. The recipient must generally furnish documentation of any affirmative responses such as tax returns or bank statements. The form also asks whether the recipient has acquired or disposed of any assets during the prior year, had any changes in medical expenses over the last 12 months and whether he anticipates any changes for the next 12 months.

The recipient must sign and date the form and include any supporting documentation. Once received, a specialist reviews the information and determines whether the recipient remains eligible for coverage. If the insured is found to be ineligible, he must receive notification and given a chance to appeal any adverse decision. If the insured does not receive the form or return it by the specified deadline, he must resubmit to the entire application process to reinstate coverage.

Proposed efficiencies to the recertification system include expanded use of telephone and Internet-based interviews, biennial recertifications and using recertification data from other programs such as the Supplemental Nutrition Allowance program to recertify Medicaid benefits.