*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: December 1, 2006 |
|
08.20.10 - MinnesotaCare Renewal Examples |
Archived: June 1, 2016 |
Examples of MCRE renewal processing are provided in this section.
The Smith family’s renewal month is October and the redetermination date is September 30. MMIS mails the renewal form on August 15.
The Smith’s return the completed renewal form on August 20.
Action:
The worker processes the renewal on August 30 and determines the family remains MCRE eligible. The worker updates the information on MMIS including the receipt date. MMIS recalculates the premium amount and sends a premium notice reflecting the new amount for October.
If the family is redetermined to be eligible:
l For a lesser benefit set or a higher premium, the new benefit set will be effective in October.
l For a better benefit set or a lower premium, the change will be effective in September because it is to the client's benefit.
The Jones family’s renewal month is November and the redetermination date is October 31. MMIS mails the renewal on September 15.
The family has not returned the renewal form as of October MCRE billing (cutoff).
Action:
MMIS generates a closing notice for failure to renew and non-payment.
The family returns a completed renewal with all verifications on October 17.
Action:
The worker processes the renewal on October 20 and determines that the family remains eligible. The worker updates the information on MMIS including the receipt date. MMIS recalculates the premium amount. The system sends a premium notice reflecting the new amount for November and December the same day.
The family will remain active as long as the November premium is received by the last working day of October.
The Baer family’s renewal month is February with a redetermination date of January 31. MMIS mails the renewal packet on December 15.
The family has not returned the renewal form as of the MCRE billing (cutoff) on January 17.
Action:
MMIS generates a closing notice for non-payment of the February premium and failure to renew effective January 31.
The family returns the renewal form on the morning of January 31.
Action:
The worker reviews the renewal and redetermines eligibility.
l If the family remains eligible, MMIS is updated and eligibility is approved.
The family must pay the February premium on January 31 or have a credit that will cover the premium. If the premium is not received, MMIS will cancel the household for nonpayment of the February premium.
l If continued eligibility cannot be determined 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.
The Barrett family has a renewal month of August and the redetermination date is July 31. MMIS mails the renewal packet to the family on June 15. The Barrett family completes the renewal form and returns it on June 23.
The worker reviews the application and finds that income verification has not been provided. She tries to contact the Barretts by phone but cannot reach them. She then sends the Barretts a request for the income verification on July 3.
Action:
The worker closes the case for incomplete renewal (C 48) for the end of July when she sends the request for income verification.
l If the income verification is received on July 8, before MCRE billing (cutoff):
Action:
Complete the eligibility determination process.
l If the verification is not received by the July 31 redetermination date:
Action:
MMIS will close the case and send a notice of non-payment for the August premium.
l 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:
Action:
The worker must contact the family with the new premium amount and ask if they want August coverage.
n If they do not want coverage for August, set the status to pending, awaiting payment for September 1.
n If they do want coverage for August, request a systems change to continue coverage for August.
l If the income verification is received on August 8:
Action:
The renewal will be considered a new application because the verification was received in the renewal month. The worker redetermines eligibility using the information from the renewal. The family will be without coverage for August.
If the worker then finds the household eligible and sets their status to pending, awaiting payment for September:
Action:
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.