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Effective: October 1, 2007 | |
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03.55.05 - Renewals for Transitional MinnesotaCare |
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Transitional MinnesotaCare is available for only one six-month certification period at a time. After six months, Transitional MinnesotaCare enrollees are expected to move to MinnesotaCare.
Exception: Transitional MinnesotaCare may continue into a new certification period only if the certification period is interrupted. See Transitional MinnesotaCare - Household Composition for more information.
MAXIS Minnesota's statewide automated eligibility system for county-administered programs, including Food Support (FS), General Assistance (GA), General Assistance Medical Care (GAMC), Medical Assistance (MA), Minnesota Family Investment Program (MFIP), and Minnesota Supplemental Aid (MSA). will mail the Minnesota Health Care Programs Renewal form (DHS-3418) to most Transitional MinnesotaCare enrollees 60 days prior to the end of the six-month period. In some cases, the worker will need to send the renewal form; see below for further information.
The renewal is due by the last day of the six-month certification period, and is used to determine eligibility for MinnesotaCare. If the enrollee is not eligible for MinnesotaCare, the renewal is used to determine eligibility for other health care programs. This may include a new six-month period of Transitional MinnesotaCare eligibility.
Worker’s Role in Sending the Renewal.
Worker’s Role in Sending the Renewal
MAXIS will send the renewal form (DHS-3418) to Transitional MinnesotaCare enrollees only if they have been enrolled for four consecutive months. Enrollees who switch between programs during the certification period may not have four consecutive months of Transitional MinnesotaCare eligibility, or their renewal may be sent later than required.
The worker must track enrollees whose eligibility switches between GAMC and Transitional MinnesotaCare during the certification period to ensure a renewal is sent and returned timely. This ensures Transitional MinnesotaCare enrollees move to MinnesotaCare at renewal.
When an enrollee switches between GAMC and Transitional MinnesotaCare after the first month of the certification period, set a DAIL/TIKL in MAXIS 60 days prior to the end of the certification period. When the TIKL message appears on DAIL, check to see if the client is currently enrolled in GAMC or Transitional MinnesotaCare.
l If the client is enrolled in GAMC, check the STAT/REVW panel for accuracy. The appropriate renewal form will be sent by MAXIS 45 days prior to the renewal date.
l If the client is enrolled in Transitional MinnesotaCare, send the DHS-3418 and an Employer Insurance Information Form (DHS-3348), and set another DAIL/TIKL in MAXIS for 10 days prior to the end of the certification period.
l When that TIKL message appears at 10-day cutoff, check for a returned renewal form.
n If the renewal has been received, follow the guidelines for processing the renewal below.
n If the renewal has not been received, close Transitional MinnesotaCare coverage in both MAXIS and MMIS.
Do not require the DHS-3418 if another renewal form was sent to the client in error. Process the renewal form submitted by the client; request additional information and verification as needed.
When processing the Transitional MinnesotaCare renewal, first review the renewal form to see if the enrollee has gained an MA basis of eligibility. If so, determine eligibility for Medical Assistance. If not, determine eligibility for MinnesotaCare.
Exception: For enrollees who move back and forth between GAMC and Transitional MinnesotaCare, determine renewal month The month for which eligibility is being renewed. eligibility based on the program a person is enrolled in the month before the renewal month. For enrollees who are enrolled in GAMC at renewal (and have not gained an MA basis of eligibility), determine eligibility for GAMC.
Example:
Franco began his April through September certification period enrolled in Transitional MinnesotaCare. In August, he acquires a GAMC qualifier and is moved to GAMC.
Action:
Determine GAMC eligibility for the renewal month (October) if Franco continues to be enrolled in GAMC for September. If Franco is determined ineligible for GAMC at renewal solely because he no longer has a qualifier, he may be eligible for Transitional MinnesotaCare again.
For enrollees who are enrolled in Transitional MinnesotaCare at renewal (and have not gained an MA basis of eligibility), determine MinnesotaCare eligibility.
l Apply all MinnesotaCare eligibility criteria and program rules. Any new household members must be added to comply with the MinnesotaCare All or Nothing Rule.
l If the enrollee is eligible for MinnesotaCare, approve coverage pending awaiting payment To approve an application conditioned on the receipt of the initial premium payment. For MinnesotaCare, if an application is pending awaiting payment, then the household has been found eligible for MinnesotaCare but will not have coverage until the month after DHS receives the initial payment..
n The enrollee is subject to all MinnesotaCare rules and policies, including the requirement to pay monthly premiums.
n Enrollees who fail to pay their initial MinnesotaCare premium, or who successfully enroll in MinnesotaCare but are later disenrolled for failure to pay premiums (or for any other reason), must file a new application to be determined eligible for GAMC or Transitional MinnesotaCare again.
Note: There is no penalty period or barrier to future GAMC or Transitional MinnesotaCare eligibility for these applicants.
l If the enrollee is not eligible for MinnesotaCare, do not require a new application. Use the renewal to determine eligibility for GAMC. If the enrollee is not eligible for GAMC, determine eligibility for Transitional MinnesotaCare.
Example:
Mike (age 27) is enrolled in Transitional MinnesotaCare. He returns his completed renewal at the end of the six-month certification period. Mike has access to employer-subsidized insurance (ESI) through his job. He does not have an MA basis of eligibility, or a GAMC qualifier, but meets all other GAMC eligibility criteria.
Action:
Mike is not eligible for MinnesotaCare because he has access to ESI. Since he meets all GAMC eligibility criteria except for having a qualifier, he has a new six-month period of Transitional MinnesotaCare eligibility.
Note: If Mike signed up for the insurance that is available through his employer and it is determined cost effective, he would have a GAMC qualifier. Mike would then be eligible for GAMC instead of Transitional MinnesotaCare.
Transitional MinnesotaCare enrollees who do not complete the renewal process by the end of the six-month certification period must reapply for Minnesota Health Care Program coverage.
l Consider renewal forms submitted in the renewal month The month for which eligibility is being renewed. (the month following closure for failure to renew) as applications for MinnesotaCare if the enrollee has no MA basis of eligibility.
l For renewal forms received after the renewal month, see Application Required.
See Transitional MinnesotaCare - Application Process for more information about when a new application is required for Transitional MinnesotaCare.
Retroactive MinnesotaCare is available to Transitional MinnesotaCare enrollees who meet any of the following in the renewal month The month for which eligibility is being renewed.:
l Are closed at the end of the six-month certification period and then return their renewal forms.
l Complete renewal forms that were originally submitted as incomplete.
l Provide required verifications.
Process these renewal forms as applications for MinnesotaCare (if no basis of eligibility for MA). If the enrollee is eligible:
l Approve MinnesotaCare pending awaiting payment To approve an application conditioned on the receipt of the initial premium payment. For MinnesotaCare, if an application is pending awaiting payment, then the household has been found eligible for MinnesotaCare but will not have coverage until the month after DHS receives the initial payment..
l Follow current policy and procedures for retroactive MinnesotaCare. The Retroactive MinnesotaCare Notice (DHS-3446) includes Transitional MinnesotaCare as a program that can precede retroactive MinnesotaCare.
Example:
Paula is enrolled in Transitional MinnesotaCare with a six-month certification period of August through January. She receives a renewal form (DHS-3418) in early December. Paula returns the completed renewal form in January but does not include all of the required verifications.
Action:
Close Paula's eligibility effective February 1 due to incomplete renewal.
Paula returns her verifications on February 10. She does not have a basis of eligibility for MA.
Action:
Process Paula's renewal form as a new application for MinnesotaCare. If she is eligible, approve MinnesotaCare pending awaiting payment effective March 1 and send the Retroactive MinnesotaCare notice (DHS-3446).
Retroactive MinnesotaCare is also available for Transitional MinnesotaCare enrollees who submit their renewal timely, are closed at the end of the six-month certification period and approved for MinnesotaCare, but may not have time to make their initial premium payment so that MinnesotaCare begins without a lapse in coverage.
If the enrollee is not eligible for MinnesotaCare, determine eligibility for GAMC or Transitional MinnesotaCare.