***This version of the Health Care Programs Manual has been replaced and is no longer in effect. Please see the current Health Care Programs Manual for policy in effect as of December 1, 2006.***
MDHS Health Care Programs Manual (Eligibility Policy through 11/30/06)
Chapter 0905 - Reviews and Renewals
All chapters are numbered beginning with 09. The first chapter is 0901 (Table of Contents).
All of the health care programs require annual eligibility renewals. Most MA and GAMC cases require income reviews more often than annually, depending on client circumstances.
Approve renewed coverage for people who remain eligible as a result of the renewal process. Terminate coverage for those who are no longer eligible.
Require a signed Minnesota Health Care Programs Renewal Form (DHS 3418) from all active households every 12 months. Accept and process faxed renewal forms. See §0905.03 (Renewal Timelines) for follow up procedures for faxed renewals. The renewal month is 12 months after the month in which the case was initially pended awaiting payment, regardless of the month coverage begins. Renewals must be processed by the end of the month prior to the renewal month. The "renewal month" is defined as the first effective month of renewed eligibility.
All enrollees age 18 and older who are requesting health care for themselves must sign the renewal form annually. Authorized representatives must also sign. Send a photocopy of the renewal form to enrollees age 18 and over who did not sign the form. Eligibility will end for enrollees who have not provided required signatures by the first day of the renewal month, and for other enrollees whose eligibility depends on that of the person who failed to sign under the All or Nothing Rule. See §0908.11 (All or Nothing Rule).
The renewal month is the first month after the "Redetermination Date" on the RSLT screen in MMIS. The renewal month remains unchanged from year to year as long as the case remains active without a break.
The Andrew family is pended awaiting payment on February 12. MinnesotaCare receives their initial premium payment on February 20, and the case becomes active beginning in March. The Andrew family’s renewal month is March. MMIS shows a redetermination date of February 28.
The Burns family is pended awaiting payment on February 12. MinnesotaCare receives their initial premium payment on March 3, and the case becomes active beginning in April. The Burns family’s renewal month is March. MMIS shows a redetermination date of February 28.
If an incarcerated individual is removed from an active household at another household member’s request and chooses to be opened on a new case, the renewal date on the new case must be the same as the original household’s renewal date. Contact the MMIS User Services Help Desk to set the renewal date. If the person is still incarcerated at the time of renewal, cancel coverage. See §0908.13 (Temporary Absence--MinnesotaCare - Part I) and §0915.05 (Removing a Person From the Household).
M.S. 256L.05 subd. 3a
Minnesota Rule 9506.0020 subp.6, 7
Require a complete signed and dated renewal from all active households every 12 months. See §0905.05 (Annual Renewal–Eligibility) for signature requirements. Accept and process faxed renewals. See §0905.03.01(Annual Renewal Timelines--MA/GAMC) for follow up procedures for faxed renewals.
Apply the following EXCEPTIONS to the 12-month renewal timeline:
Women meeting either of these conditions are eligible without a spenddown until the next regularly scheduled renewal.
For women who must be renewed at the end of the post-partum period, determine continued eligibility from information in the case record. Request additional information from the enrollee if needed. Approve continued eligibility if the woman is eligible under another basis.
See §0907.19.05 (MA Basis: Pregnant Women).
For all others, the renewal month is:
The Barnes family applied for MA in May and requested consideration of retroactive coverage back to February. They met a spenddown and were opened effective March 10. Their renewal date is February 1.
When members of one household apply at the same time but are opened on different dates, assign the entire household the earliest renewal date. See §0904.07.09 (Eligibility Begin Date).
Bill, age 65, applies for MA on June 1 and requests retroactive coverage to March. His wife Julie, age 63, applies for GAMC at the same time. Bill is approved effective March 1. Julie is approved effective June 1. The household’s renewal date is March 1.
Do not require a separate renewal form for people who receive MA or GAMC with cash. Use the CAF Recertification Form (DHS 3217). Use the Medical Assistance Long Term Care Eligibility Recertification Form (DHS 2128) for clients in long term care. For all others, use the Minnesota Health Care Programs Renewal Form (DHS 3418). Also see §0905.03.01 (Annual Renewal Timelines--MA/GAMC).
MMIS sends renewal forms to enrollees approximately 10 weeks before the MMIS redetermination date. The renewal packet includes the following forms:
Enter the receipt date on MMIS as soon as you receive renewal forms from the enrollee. MMIS will automatically generate a termination notice if the renewal has not been processed by the cutoff date prior to the renewal month.
Process renewals in the order they are received. Give priority to processing renewals to avoid a gap in coverage. Enrollees must complete the renewal process by the last day of the month prior to the renewal month (shown on MMIS as the redetermination date) to remain covered. They must also pay the new premium for the renewal month by the last day of the month prior to the renewal month.
If the renewal is received in the renewal month, treat the renewal form as a new application. If a terminated household reapplies more than one month after they submit a renewal form, contact the household to update the information on the renewal form. Do not require a new application if the renewal was completed in the 11 months preceding reapplication. See §0904.05.05 (When Not to Require an Application).
If possible, process the renewal before the cutoff date to ensure continuous coverage.
If the renewal form is received the month before the renewal month, process as a renewal. Contact the enrollee to obtain any missing information. If a renewal is held for additional information, the household has until the last working day prior to the renewal month to provide the necessary information to ensure continuous coverage. If the household returns the renewal and all required information by the end of the month but the worker has not had time to process it, contact MMIS User Services to extend the renewal for an additional month at the old premium rate.
The Barrett family’s renewal month is August. MMIS shows a redetermination date of July 31. MMIS mails the renewal packet on May 15. The renewal form was returned on June 12. The worker is unable to reach the Barretts by phone and requests additional information on June 13. The information has not been received by June cutoff, so the worker closes the case for incomplete renewal (C 48) with an end date of July 31 on the MMIS RELG screen. At July cutoff, MMIS also closes the case for non-payment of the August premium. The information is not received by July 31 and the case closes. The information is received on August 8 and the worker pends the case awaiting payment for September. The family will be without coverage for August. Coverage will resume for September if the premium payment is received by noon on the last working day of August. MMIS will enter a new redetermination date of August 31 of the following year.
If the family returned the information on the last working day of July but the worker did not have time to process the renewal until August, contact the family with the new premium amount. Ask if they wish to have August coverage. If they do not want coverage for August, pend awaiting payment for September 1. If they do want coverage for August, request a systems change to continue coverage for August.
The Smith family’s renewal month is October. MMIS shows a redetermination date of September 30. MMIS mails the renewal form on July 15. The family returns a competed renewal form on July 29. The receipt date is entered on MMIS. The worker processes the renewal on August 18. The worker determines that the family remains eligible and enters necessary information on MMIS to continue eligibility and recalculate the premium. MMIS sends a premium notice reflecting the new amount for October. If the family is now eligible for a lesser benefit set, the new benefit set will be effective in October.
The Jones family’s renewal month is November. MMIS shows a redetermination date of October 31. MMIS mails the renewal on August 15. The family has not returned the renewal form as of October cutoff. MMIS generates a termination notice for failure to renew and non-payment. The family returns a complete renewal form and all verifications on October 17. The worker processes the renewal on October 20. The worker determines that the family remains eligible and enters the necessary information in MMIS to continue eligibility and recalculate the premium. MMIS sends a premium notice reflecting the new amount for November and December the same day. The family remains active as long as the November premium is received by the last working day of October.
The Baer family’s renewal month is February. MMIS shows a redetermination date of January 31. MMIS mails the renewal packet on November 15. The family has not returned the renewal form as of cutoff on January 17. MMIS generates a termination notice for non-payment of February premium and failure to renew effective January 31. The family returns the renewal form on the morning of January 31. If the family remains eligible, update MMIS information including income and approve the results. Unless the family pays the February premium on January 31 or has a credit, MMIS will cancel the household for nonpayment of the February premium They will be eligible for the reinstatement option. If you cannot determine continued eligibility from the available information on the renewal form, request the missing information and leave the end date of January 31 on the MMIS RELG screen. The family will be without coverage until they are determined eligible and pay the premium.
If the renewal was received via fax and includes all information and verifications needed to determine renewed eligibility, continue coverage. The household must submit the original renewal form within 30 days from the date of the fax. If the household fails to submit the original renewal form, send 10-day notice to terminate coverage for the first available month.
M.S. 256L.05 subd. 3a
Minnesota Rule 9506.0020 subp. 6, 7
Minnesota Rule 9506.0040 subp. 1
See §0905.03.01 (Annual Renewal Time Lines--MA/GAMC).
See §0905.03 (Renewal Timelines).
MAXIS mails renewal packets for households who are not required to report monthly around the 15th of the second month before the month the renewal is due. For monthly reporters, MAXIS mails the form around the 27th of the second month before the month the renewal is due. See §0905.07 (Monthly Reporting) for information on monthly reporters.
Ethel is on MA and is not a monthly reporter. Her renewal is due December 1. MAXIS will mail the renewal packet on or around October 15.
MAXIS determines which renewal form to send according to what program(s) the household receives.
Use the DHS 2128 for people who reside in LTC and receive MSA for personal needs. This group is not automatically MA-eligible.
See TEMP Manual TE02.07.366 (Eligibility Review Forms--Health Care Prog’s) if the recertifications are due at different times.
MAXIS does not send renewal forms for the MA-BC basis of eligibility. See §0907.19.13 (MA for Breast/Cervical Cancer (MA-BC). Mail an MA-BC Application/Renewal Form (DHS 3525) and Certification of Further Treatment Required (DHS 3525A) to MA-BC enrollees on the 15th day of the second month before the renewal is due.
Do not require an in-person interview as part of the renewal process for MA/GAMC.
County agencies may request the reimbursement officer to obtain information necessary to renew the eligibility of Regional Treatment Center residents.
Terminate benefits if a household fails to complete the appropriate renewal form or fails to provide mandatory verifications or signatures before the last day of the certification period. Enter an I (incomplete) in the Review Status field on the MAXIS REVW screen. If the agency has not received the renewal form, leave the code as N. MAXIS will generate a notice of termination 10 days before the end of the certification period.
All enrollees age 18 and older who are requesting health care for themselves must sign the renewal form annually unless there is an authorized representative. If there is an authorized representative, require only the authorized representative’s signature as long as signatures are on file for all household members age 18 and over. Send a photocopy of the renewal form to enrollees age 18 and over or authorized representatives who did not sign the form. Eligibility will end for enrollees who have not provided required signatures by the renewal due date. See §0905.05 (Annual Renewal–Eligibility).
If the renewal form was received by fax, the household must submit the original renewal form within 30 days of the date of the fax for eligibility to continue. Send 10-day notice to terminate for the first available month if the household fails to submit the original form.
Margaret’s renewal is due February 1. She submits a completed renewal form on January 15 but does not include verification of income. Request the missing verifications. Enter an I in the review status field on the MAXIS REVW screen. If Margaret does not submit verification by 10-day notice cutoff, MAXIS will generate a termination notice. If you receive the verifications before the end of February and Margaret remains eligible, reinstate eligibility for February.
Herbert’s renewal is due March 1. The renewal form has not been received as of 10-day notice cutoff. The review status field remains coded N. MAXIS generates a termination notice for March. Herbert returns the renewal form on March 5. Process as a new application.
If the unit applies for Food Support on the Recertification Form (DHS 3217), treat this as an application. If the unit requests cash, require a CAF and interview.
When processing a renewal application:
For households who were determined to have income over the limit at the last renewal but were found eligible for the MCHA exemption under §0912.03.03 (MinnesotaCare Excess Income), compare the household’s current income to the appropriate standard as well as to the applicable MCHA premium.
If income remains above 275% FPG for families with children AND 10% of the income is now greater than the MCHA premium for the family in §0912.03.05 (Annual MCHA Premiums), send the MinnesotaCare Over Income Letter - (DHS 3407). Also send the form Private Health Insurance in Minnesota (DHS 3416).
If the household’s income is now equal to or less than the applicable standard, OR 10% of the household’s income remains equal to or less than the appropriate MCHA premium, send the MinnesotaCare Income Change Evaluation Letter (DHS 3408) advising the household that coverage will continue.
For households with children who are in the 12-month extension period, compare the household’s current income to the appropriate standard as well as to the applicable MCHA premium.
If the household’s income is now equal to or less than the applicable standard, OR 10% of the household’s income is now equal to or less than the appropriate MCHA premium, send the MinnesotaCare Income Change Evaluation Letter (DHS 3408) advising the household that coverage will continue.
If the household’s income remains greater than 275% FPG, continue coverage for the remainder of the 12-month extension period.
If the income of a household with children has dropped below 150% FPG, determine the effect on the household’s group status and insurance requirements. See §0907 (Eligibility Groups and Bases of Eligibility) and §0910 (Other Health Coverage).
Karen, Paul and their 3 children are all enrolled in MinnesotaCare. Their renewal month is December. They return the renewal form on November 9 without Karen’s signature. The worker sends a photocopy of the renewal form requesting that Karen sign and return it by November 19. If Karen does not return the signed photocopy, eligibility will end for both her and Paul effective November 30 because Paul cannot be enrolled without Karen under the All or Nothing Rule. Eligibility continues for the children with Paul’s signature.
See §0905.03 (Renewal Timelines) if you do not have enough information to redetermine eligibility and premium amount.
Terminate eligibility for household members who no longer qualify for MinnesotaCare. MinnesotaCare Operations will send the renewal to the household’s county of residence if the household notifies MinnesotaCare that they wish to be considered for MA or GAMC. County agencies that are MinnesotaCare enrollment sites will determine MA/GAMC eligibility for people who no longer qualify for MinnesotaCare. See §0904.09.05 (Transfers from MA/GAMC to MinnesotaCare).
M.S. 256L.05 subd. 3a and 4
Minnesota Rules 9506.0020 subp. 6 and 7
For people receiving Title IV-E or state adoption assistance, verify annually that the adoption assistance agreement remains in effect. Review the health insurance information. If health insurance information has changed, enter the new information in the TPL subsystem on MMIS. Close out the outdated information. See §0910 (Other Health Coverage).
For other renewals:
Terminate people who no longer qualify for MA or GAMC. If the household completed a Minnesota Health Care Programs Renewal Form, county agencies that are MinnesotaCare enrollment sites will evaluate MinnesotaCare eligibility or transfer the application to MinnesotaCare Operations based on the household’s choice of enrollment site. County agencies that are not MinnesotaCare enrollment sites will forward the renewal to MinnesotaCare Operations as an application. See §0904.09.05 (Transfers from MA/GAMC to MinnesotaCare).
MAXIS will send notice of termination or changes in eligibility. See §0916 (Notices).
Require people to complete a monthly Household Report Form (HRF, DHS 2120) if they have:
MAXIS will send the HRF to households 6 working days before the end of the month the HRF covers. The household must submit the report by the 8th day of the month following the month it covers. MAXIS will send a Notice of Late Household Report Form (DHS 2414) if the household does not submit the report on time.
MAXIS will send a 10-day notice of termination if the household does not submit the report by 10-day notice cutoff. If the HRF has not been received by the end of the month, the case remains closed. Reinstate the case if the household returns the HRF before the end of the month and remains eligible.
Require a Minnesota Health Care Programs Income Renewal Form (DHS 3440) or Long Term Care Renewal Form (DHS 2128) and proof of current income at 6-month intervals beginning with the month of initial eligibility for all enrollees EXCEPT:
Seth’s only sources of income are SSI and RSDI in the same amount each month. Do not require him to submit 6-month income renewals.
Apply these exceptions to the Medicare Supplement Programs and the PDP as well as to regular MA. Do not require 6-month renewals for QMB, SLMB, QWD, QI enrollees who meet any of the above criteria.
When approving the new 6-month budget period for people exempt from submitting 6-month renewals, base eligibility on information in the case record or available from other sources, such as BNDX and SDX. People with spenddowns who are exempt from 6-month renewals may be required to submit documentation of medical expenses if needed to determine continued eligibility for the next 6-month budget period.
Require all other households to complete 6-month renewals. These enrollees must verify all countable assets.
Mario and Louise receive MA. Mario’s only income is SSI. Louise is employed, and her income is considered in determining Mario’s SSI eligibility and benefit level. Require income renewals at 6-month intervals to determine Louise’s continued eligibility.
Review eligibility for enrollees who report receipt of lump sums or additional assets.
Six-month reporting enrollees must return a complete report form by the 8th day of the 6th month of the budget period. If you do not receive the form, MAXIS will send the Notice of Late or Incomplete Household Report Form or Income Renewal (DHS 2414) on the 16th day of the month. If the enrollee does not submit a complete Minnesota Health Care Programs Income Renewal Form or Income and Asset Renewal Form by the cutoff date in the 6th month, MAXIS will autoclose the case. Reinstate coverage if you receive the report form by the end of the month and the household remains eligible.
NON-LONG TERM CARE CASES:
All non-exempt enrollees must complete a Minnesota Health Care Programs Income Renewal Form (DHS 3440) for the 6-month income renewal for a Minnesota Health Care Programs Income and Asset Renewal (DHS 3441) for income and assets renewals.
MAXIS will attach instructions for income or income and asset renewals to the renewal form.
Require verification of current income (previous 30 days) to determine eligibility for the next 6-month budget period. Do not require enrollees to verify all income for the previous 6-month period. MA does not reconcile actual income against income used in a projection. Base projections on the most accurate information available at the time of the renewal. Also see §0911.11.03 (Computing Countable Income--MA/GAMC).
For people on an automated monthly spenddown, require verification of income received in the 5th month of the certification period. See §0913.09 (Automated Monthly Spenddown Calculation).
If the household is no longer eligible for MA due to income or assets, refer the case for a MinnesotaCare determination within 5 days. If your county is not a MinnesotaCare enrollment site, send the most recent application and renewal form along with the current income or income/asset renewal and verifications to MinnesotaCare Operations. See §0904.09.05 (Transfers from MA/GAMC to MinnesotaCare) for additional information to include with the transfer.
LONG TERM CARE CASES:
All non-exempt enrollees must complete a Long Term Care Renewal Form (DHS 2128) for the 6-month renewal of assets and/or income and the annual renewal. MAXIS will attach instructions for 6-month income or income and asset renewals to the renewal form.
Follow MA for non-long term care cases, EXCEPT do not require 6-month asset renewals.
There are no reviews or renewals for GAMC Hospital Only (GHO) cases.Report/Rate this page