Certificate of Creditable Coverage 510-05-10-33

(Revised 1/03 ML #2833)

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1. The Health Insurance Portability and Accountability Act of 1996 included provisions designed to improve the availability and portability of health coverage. This act limits exclusions for preexisting medical conditions by allowing credit for prior health coverage. Exclusions for preexisting conditions can be up to 12 months (18 months for late enrollees) but are reduced by days an individual has creditable coverage for that condition under another health plan. Coverage under Medicaid is considered creditable coverage.

2. Effective June 1, 1997, Medicaid began providing certificates of creditable coverage for individuals who lose Medicaid eligibility. These certificates are sent as automatic notices on all Medicaid case or client closings except for Medicare recipients. The certificate provides information regarding each individual’s Medicaid coverage for the past 18 months.

3. In order to avoid sending certificates on recipients whose eligibility ends and then reopens the next month, the automatic certificates are not sent until 32 days after the case or client is closed. The certificate is then only sent if the case or recipients has not been reopened.