*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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. ***
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Effective: July 1, 2012 |
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08.25.05 - Processing MA Annual Renewals |
Archived: June 1, 2016 (Previous Versions) |
This section provides information on processing an MA annual renewal.
For information on processing six-month renewals and monthly renewals, see Six-Month Renewals and Monthly Renewals.
What Is a Complete Annual Renewal?
What Is a Complete Annual Renewal?
Clients must provide the following to consider the annual renewal complete and ready to be processed for eligibility:
l A completed renewal form. For more information on acceptable renewal forms, see Renewal Forms.
l A signature for everyone required to sign. See Renewal Signature for specific policy on who must sign the renewal form.
l Required verifications and any information needed to redetermine eligibility.
Exception: Participants in the Safe at Home (SAH) Address Confidentiality Program are not required to provide their actual address.
For more information on the Safe at Home Program:
r See Data Privacy.
r See the Minnesota Secretary of State’s Web site.
r Call (651) 201-1399 or (866) 723-3035 or TTY (800) 627-3529 or 711.
MA Annual Renewal Processing Steps
Follow these steps to process an MA renewal:
1. Process renewals in the order they are received.
l If possible, process the renewal before the 10-day notice cutoff.
l Processing the renewal before the date for payment of managed care capitations will ensure continued managed care coverage.
l Do not require an in-person interview as part of the renewal process for MA.
2. Review the renewal form.
l Review the renewal for missing data, verifications and the following:
n Required signatures.
n Address changes.
n Household member changes. See Adding a Household Member and Removing a Household Member.
n Pregnancy reported. Request verification. Consider the woman to be a pregnant woman when the pregnancy has been verified.
n Insurance changes. Request new insurance information.
n Assets.
n Income. Request verifications.
Exception: Do not request verification of Social Security Income. Use the State Verification and Exchange System (SVES) to verify the Social Security income
n Changes in parental status and medical support. Follow required steps.
n Managed care status changes.
l Contact the enrollee to obtain any missing information or verifications.
Note: County agencies may request the reimbursement officer to obtain information necessary to renew the eligibility of Regional Treatment Center residents.
l Set the client’s renewal status to ’I’ (incomplete) on the REVW screen if information is missing.
3. Update MAXIS with the new information.
4. Redetermine MA eligibility.
l If the client has completed the renewal and sent in all required information and verifications timely and:
n The client remains eligible, approve the renewal for the first of the renewal month .
Note: Add a worker comment to the approval notice if MA-EPD is closing but the client remains eligible under another basis of eligibility or under another health care program. Include notice that MA-EPD is closing, the effective date of closure and the reason it is closing.
n The client is no longer eligible, close eligibility for the end of the month before the renewal month using the appropriate closing reason.
m Determine MinnesotaCare eligibility. Transfer the renewal to MCRE Operations if the county agency is not a MCRE enrollment site.
m Add a worker comment to the closing notice if MA-EPD is closing. Include in the notice that MA-EPD is closing, the effective date of closure and the reason it is closing.
l MAXIS will generate a closing notice on 10-day cutoff in the month before the renewal month if information and verifications are incomplete (renewal status of ’I’) or the renewal has not been received (renewal status of ’N’).
Note: If the household turns in the renewal form before the last day of the certification period but after 10-day cutoff, and it is incomplete or the agency does not have time to act on the form before the end of the month, the case will remain closed. Reinstate MA coverage if the household submits the missing information during the renewal month and the agency determines that eligibility continues.
A renewal is late if it is returned after the end of the certification period.
Process the renewal as a new application if the complete renewal is received in the renewal month. For MA, approve coverage back to the first day of the renewal month or the date all eligibility factors are met.
Unless the household meets an exception under Application Not Required, require a new application if the enrollee submits:
l a renewal after the renewal month.
l an incomplete renewal before the end of the certification period, but submits missing information/verifications after the end of the renewal month.
Note: If the client is cooperating with obtaining verifications, do not require a new application.
l an incomplete renewal during the renewal month and the missing information is returned after the renewal month.
Exception: Safe at Home participants may request and be granted good cause for late submission or completion of renewals. See Data Privacy and the Minnesota Secretary of State’s Web site for further information.
Example:
Margaret’s renewal month is February. She submits a completed renewal form on January 2, but does not include verification of income.
Action:
Request the income verification and enter an "I" in the review status field on the MAXIS REVW screen.
Margaret has not returned the income verification by 10-day cutoff in January.
Action:
MAXIS generates a closing notice.
Margaret returns the income verifications on February 2, indicating she has been on vacation visiting her mother in Florida for the past month.
Action:
Process the renewal as a new application because it was returned during the renewal month.
Example:
Herbert’s renewal month is April. The renewal form has not been received as of 10-day notice cutoff in March. The review status field remains coded "N".
Action:
MAXIS generates a termination notice effective April 1.
Herbert returns the renewal form on May 5.
Action:
Require a new application because the renewal was received after the renewal month.