Reinstatement and Reenrollment

Revised: August 1, 2025

This section of the manual describes policies for health plan reinstatement and reenrollment.

· For instructions on how to trigger automatic reinstatement or reenrollment in MMIS, review the MMIS User Manual - Reopen - Reinstate.

· For instructions on how to enter and edit health plan enrollment spans in MMIS, review the OneSource - Managed Care Enrollment Process

Reinstatement

Reinstatement occurs when an enrollee’s health plan coverage is scheduled to close on a future date and eligibility is reestablished in MMIS on or before the effective closing date. The enrollee will be reinstated into the same health plan for the following month with no lapse in coverage.

Note: If eligibility is not reestablished in MMIS before the effective closing date due to a processing delay, health plan enrollment must be manually reinstated for the next available month.

Example: On June 15 the enrollee’s health care eligibility and health plan enrollment are set to autoclose on June 30. On June 28, the processing entity updates the health care case and re-establishes eligibility for the enrollee on RELG with no break in coverage. If no exclusions and no new enrollment spans are added to RPPH, the enrollee will automatically be reinstated into the same health plan with no lapse in coverage on July 1.

Reenrollment

When an enrollee is disenrolled from a health plan for any reason and regains eligibility after the month of disenrollment, as long as a new exclusion is not added to RPPH, reenrollment will occur if:

· It has been less than 12 months since the disenrollment and prior to first capitation, the enrollee will be reenrolled into the same health plan for the next available month.

· It is after first capitation, the enrollee will be fee for service for next available month and reenrolled into the same health plan at first capitation the following month for the next available month. The worker sends a Fee for Service (DHS-3403) (PDF) to the enrollee confirming their reenrollment.

Example: The enrollee’s health care eligibility ends and they are disenrolled from their health plan on June 30. The enrollee regains health care eligibility on September 15 of the same year. No exclusions and no new enrollment spans were added on RPPH.

Because it is before first capitation in September, the enrollee will be automatically reenrolled in the same health plan they were on in June. Health plan enrollment will be effective for the enrollee October 1.

Reenrollment Change Options

When an enrollee is disenrolled from their health plan and later regains eligibility to enroll, they may also be eligible for a change option in the following situations:

1. The enrollee has a break in eligibility greater than 2 months.

2. The enrollee has a change in their major program.

3. The enrollee is disenrolled from health plan for longer than 12 months.

For more information on change options related to these situations, refer to Changing Health Plans in this manual.

Reenrollment for Minnesota Senior Health Options (MSHO), Minnesota Senior Care Plus (MSC+), and Special Needs Basic Care (SNBC)

If the following circumstances are met, the processing entity will restore the MSHO, MSC+ or SNBC enrollee’s health plan coverage back to the date their Medical Assistance (MA) terminated without an enrollment form:

· An enrollee’s MA eligibility is reopened within 90 days.

· An enrollee’s MA eligibility is continuous without a break in coverage.

Example: an enrollee’s health care eligibility ends March 31. On May 15, the enrollee’s health care eligibility is reopened retroactive to the closure date of March 31, making it continuous. The enrollee will be reenrolled into health plan retroactively to March 31.