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Effective: October 1, 2007 |
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08.25.05ar2 - Processing MA and GAMC Renewals (Archive) |
Archived: March 1, 2009 |
There are some similarities between processing renewals for MA/GAMC and processing them for MinnesotaCare (MCRE). However, there are also differences. This section provides information on processing an MA/GAMC renewal.
MA/GAMC Renewal Processing Steps.
The following must be provided to consider the renewal complete and ready to be processed for eligibility:
l A completed MHCP Renewal Form (DHS-3418). See Renewal Forms for more information on the renewal form and what must be sent with it.
l A signature for all people 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 must be received.
Accept and process faxed renewals.
l Do not delay processing eligibility. If the faxed renewal includes all information and verifications needed to determine renewed eligibility, continue coverage.
l The household must submit the original renewal form within 30 days from the date of the fax.
l If the household fails to submit the original renewal form, send a 10-day notice to terminate coverage for the first available month.
MA/GAMC Renewal Processing Steps
Follow these steps to process an MA/GAMC renewal:
1. Process renewals in the order they are received. Give priority to processing renewals to avoid a gap in coverage.
Note: If possible, process the renewal before the 10-day cutoff date to ensure continuous coverage.
l Do not require an in-person interview as part of the renewal process for MA/GAMC.
2. Review the renewal form.
l Review the renewal for missing data, verifications and the following:
n Required signatures.
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 Assets allocations for LTC spouses. See Asset Assessments for more information on asset allocations.
n Income. Request verifications.
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 ’r;I’ (incomplete) on the REVW screen if information is missing.
3. Update MAXIS with the new information.
4. Redetermine MA/GAMC eligibility.
l If the client has completed the renewal and sent in all required information and verifications timely and:
n The client is eligible, approve the renewal.
Note: If MA-EPD is closing but the client is eligible for another program or basis of eligibility add a worker comment to the approval notice. Include notice that MA-EPD is closing, the effective date of the close and the reason it is closing.
n The client is not eligible, close eligibility for the end of the month before the renewal month using the appropriate closing reason.
m Share/transfer the renewal with MCRE Operations if the county agency is not a MCRE enrollment site.
Exception: If eligibility is closed solely due to failure to provide asset verification, do not transfer the renewal to MCRE Operations or process MCRE eligibility at the county. See MA Asset Verification Denial/Closure for more information.
m If MA-EPD is closing add a worker comment to the notice. Include in the notice that MA-EPD is closing, the effective date of closure and the reason it is closing.
l If information and verifications are incomplete (renewal status of ’r;I’) or the renewal has not been received (renewal status of ’r;N’), MAXIS will generate a notice of closure by 10-day cutoff in the month before the renewal month.
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.
The worker should reinstate coverage if the household completes the renewal process during the renewal month and the agency determines that eligibility continues.
Renewals are late if the renewal form is returned after the end of the certification period.
Process the renewal as a new application.
l Do not require the household to complete a new application form if they submit the DHS-3418 as the renewal form.
l Require a new application form if the household submits a Long-Term Care and Elderly Waiver Renewal Form (DHS-2128).
Example:
Margaret’s renewal month is February. She submits a completed renewal form on January 2 but does not include verification of income.
Action:
The worker requests the income verification and enters an ’r;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:
Redetermine Margaret’s eligibility. If she remains eligible, reinstate eligibility for February. If she is not eligible, a closure notice with the reason for ineligibility must be sent.
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 ’r;N’.
Action:
MAXIS generates a termination notice effective April 1.
Herbert returns the renewal form on April 5.
Action:
The renewal must be processed as a new application because it was returned after the renewal determination month.