Medical Assistance

2.1.4.3 Renewals

Renewing eligibility means redetermining eligibility. Most MA enrollees have an annual renewal. Some MA enrollees have a six-month renewal. Some MA enrollees are exempt from the renewal requirement.

The types of MA that have specific renewal policies are:

MA for Families with Children and Adults (MA-FCA) Renewals
MA for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD) Renewals, including MA for Employed Persons with Disabilities MA-EPD), MA under the TEFRA Option for children with disabilities, 1619 (a), 1619 (b), and Medicare Savings Programs (MSP)
Children receiving Title IV-E or non-Title IV-E Foster Care, Kinship Assistance, or Adoption Assistance
MA for women with Breast or Cervical Cancer (MA-BC) Renewals
MA for people receiving services at the Center for Victims of Torture (MA-CVT) Renewals

Exempt from Renewal

The types of MA that are exempt from health care renewals, unless specified, are:

Auto newborns have eligibility renewed the month following the month of their first birthday
People enrolled in Refugee Medical Assistance (RMA)
People enrolled in Transitional MA (TMA) or Transition Year MA (TYMA), unless a scheduled renewal is due when TMA or TYMA is ending
Pregnant people have eligibility renewed the month following the month the 12 month postpartum ends

Timely Renewals

A renewal is timely if one of the following occurs:

The renewal form is received during the enrollee’s eligibility period.
Any additional information or verifications required to renew are received during the enrollee’s eligibility period.

When an enrollee returns a renewal form timely, eligibility must continue until the agency processes the renewal, even if the enrollee’s eligibility period has ended. If additional information is needed for the renewal, the enrollee must be given at least 10 days to provide it.

Eligibility must continue until either:

The renewal is processed using the additional requested information and the enrollee’s eligibility is redetermined, or
The end of the month in which the deadline to submit the additional information has passed without a response, whichever happens later.

If an enrollee’s eligibility is extended past their eligibility period and the redetermination results in an adverse action, the enrollee must be given at least a 10-day advance notice that includes the action and the reason for the action before their eligibility changes. The enrollee is eligible through the end of the month in which the 10-day advance notice is provided. If 10-day advance notice of adverse action cannot be given in the month the determination occurs, eligibility must be extended an additional month to provide the required 10-day advance notice.

Reconsideration Period

The reconsideration period is the four-month period after an enrollee’s MA is terminated for failure to complete a renewal. Enrollees in the same household may have different MA end dates and different reconsideration periods. During an enrollee’s reconsideration period, they may return their renewal paperwork instead of reapplying for health care coverage.

A former enrollee’s eligibility must be redetermined when either of the following is true:

their renewal form is received on or before the last day of the fourth month after closure for failure to renew, or
any additional information or proof that was requested for renewal is received on or before the last day of the fourth month after closure for failure to renew.

A renewal form or requested information for renewal received during an enrollee’s reconsideration period is treated as a new application, and all application policies apply. The date of application is the date that the renewal form or requested information for renewal was received by the agency. See EPM 1.2, MHCP Applications and 1.2.5 MHCP Retroactive Eligibility for more information.

A former enrollee determined eligible for MA during the reconsideration period will continue to have the same renewal schedule as other enrollees in their household whose MA eligibility was successfully renewed.

After the reconsideration period ends, former enrollees or households whose eligibility was terminated for failure to renew must reapply to request a new eligibility determination.

Legal Citations

Code of Federal Regulations, title 42, section 435.916

Minnesota Statutes, section 256B.056, subdivision 7a