Medical Assistance for Families with Children and Adults

2.2.4.2 Renewals

Most Medical Assistance for Families with Children and Adults (MA-FCA) enrollees must have their eligibility renewed annually.

There are renewal exceptions for people enrolled in MA under the pregnancy basis and children enrolled in MA as auto newborns. See EPM 2.2.2.1.2 MA-FCA Pregnant Person Basis of Eligibility and EPM 2.2.2.1.1 MA-FCA Auto Newborn Basis of Eligibility for more information.

Enrollees in MA for Families and Children with a Medical Spenddown must complete an annual renewal and a six-month income review. See EPM 2.2.3.6, MA-FCA Medical Spenddown for more information.

Renewal Month

An enrollee’s renewal month is the month for which eligibility is redetermined when a renewal is conducted. The renewal month is the first month in the enrollee’s new certification period. The first annual renewal month after application is 12 months from the month of application, and renewals occur annually thereafter as long as the enrollee remains eligible for MA. Eligibility for retroactive MA does not affect when an enrollee’s annual renewal month occurs.

A renewal is conducted individually for each enrollee in a household. If there are multiple enrollees due for renewal within a household, a renewal must not be delayed if all required information is available to determine the enrollee’s eligibility, even if additional information or proof is needed for other enrollees in the household.

Ex Parte Renewals

When it is time for an enrollee’s annual renewal, the agency must attempt to confirm eligibility using information in the case file and from trusted electronic data sources before sending a renewal form and requesting information from the enrollee. This is called an auto or ex parte renewal. When the enrollee’s eligibility cannot be auto renewed, the renewal must be completed using a prepopulated renewal form.

If eligibility for an MA-FCA enrollee is automatically renewed, the enrollee must receive a notice that includes their renewal outcome, and a summary of the information used to renew their eligibility. If all the information is correct, the enrollee does not need to do anything. If any of the information for the enrollee is inaccurate, the enrollee must report corrections or changes to their county, tribal or state servicing agency.

Prepopulated Renewal Form

An MA-FCA enrollee whose eligibility cannot automatically be renewed must receive a prepopulated renewal form listing information the agency has about them. The enrollee must be given until the end of the certification period, but no less than 30 days from the issuance date on the renewal notice, to respond. The enrollee must review the form, make any changes or updates, sign and return the renewal form to their county, tribal or state servicing agency.

The county, tribal or state servicing agency must accept any renewal form returned by the enrollee in lieu of the prepopulated renewal and must accept renewal information by:

mail,
fax,
telephone,
document upload, and
in person

When all required information has been gathered to redetermine eligibility for an enrollee, a renewal decision must not be delayed for that enrollee while additional information or proof is requested for other enrollees in the household.

Combined Renewal Results

In households with more than one enrollee due for a renewal, some enrollees may be automatically renewed while other enrollees will need to complete a renewal form. When this occurs, the household must receive a notice that indicates who was automatically renewed and who is required to return a renewal form. A prepopulated renewal form will be included with the notice.

Changes in Circumstances at Renewal

Changes in circumstances reported on the renewal form or collected in the renewal process may change an enrollee’s eligibility and the eligibility of previously renewed household members. When a renewal is processed, eligibility for all household members is redetermined.

An enrollee who is no longer eligible under one MA basis of eligibility must be redetermined for all other potential MA bases without interruption in their coverage.

If the enrollee is ineligible for MA under any basis, eligibility must be redetermined for other programs such as MinnesotaCare, Advanced Premium Tax Credits, or a Qualified Health Plan. Enrollees who lose Medical Assistance eligibility due to changes must receive at least 10-day advance notice. See EPM 1.3.2.1, MHCP Change in Circumstance for more information.

Closure for Failure to Renew

MA-FCA eligibility ends for an enrollee who does not complete their renewal or submit required proofs by the last day of the certification period, regardless of whether other enrollees in their household were renewed. The enrollee must receive at least 10-day advance notice of closure for failure to complete a renewal.

Legal Citations

Code of Federal Regulations, title 42, section 435.916

Code of Federal Regulations, title 42, section 435.930(b)

Minnesota Statutes, section 256.01

Minnesota Statutes, section 256B.056