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Effective: December 1, 2006 |
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08.25ar1 - MA and GAMC Renewals (Archive) |
Archived: October 1, 2007 |
MA and GAMC renewals are similar to MCRE renewals in that they review the client’s eligibility factors to redetermine eligibility and uses some of the same renewal forms. This section describes specific requirements for MA and GAMC renewals.
MA Pregnant Woman Requirements.
Determining the MA/GAMC Annual Renewal Month.
The renewal month is the month for which eligibility is being renewed.
There are three types of renewals MA/GAMC enrollees may be required to submit depending on their circumstances. They are:
l An annual renewal.
n Enrollees who do not meet a renewal exemption must complete an annual renewal every 12 months.
n Renewals must be processed by the renewal month for eligibility to continue.
n Enrollees who do not meet a renewal exemption must complete a renewal every six months.
n Income renewals must be processed by the end of the month before the income renewal month.
l Monthly renewal. A monthly review, also known as a monthly renewal, must be completed in specific situations. For more information on who these reports are for and other policy see Monthly Renewals.
n Monthly renewals are due and processed in the month following the month eligibility is being determined for.
n People with monthly renewals must also complete an annual renewal unless an exemption is met. The annual renewal will be mailed by the system around the 27th of the second month before the annual renewal month.
MA Pregnant Woman Renewal Requirements
All women who wish to continue MA coverage following the 60-day postpartum period must update their income and asset information and submit required verifications.
l Collect the required information and verification upon notification of the birth.
n Attempt to contact the woman by phone to gather the information.
n If a telephone update is not possible send the woman a MHCP Request for Information (DHS-3271) and, if needed, the Asset Information form (DHS-3499).
n Require verifications be returned at least 20 days before the end of the postpartum period.
m Request asset verifications if there are none on file or are older than six months.
m Request income verification if the enrollee has new or increased earned income.
l If a completed renewal form (DHS-3418, DHS-3441, or DHS-3440) has been received, including all required verifications, within the past six months, do not require additional information or verification.
l Determine continued eligibility in the last month of the postpartum period for the following month from information in the case record.
l Approve continued eligibility if the woman is eligible under another basis of eligibility and meets all other eligibility criteria.
l Close MA eligibility for the end of the postpartum period giving 10-day notice for women who:
n Do not meet another basis of eligibility.
n Are not eligible for another reason.
n Do not return requested information and/or verification.
Determining the MA/GAMC Annual Renewal Month
The renewal month is determined for a household as follows:
l The first renewal after application is 12 months after the first month of the certification period.
Note: When members of a household apply at the same time but the eligibility begin date differs, assign the entire household the earliest renewal date.
Example:
The Barnes family applied for MA in May. They requested retroactive coverage beginning in February. MA was approved March 10 effective February 1.
Action:
Their renewal month is February of the next year.
Example:
Bill and Julie apply for health care on June 1 requesting retroactive coverage back to March. Bill is approved eligible for MA effective March 1. Julie is approved for GAMC effective June 1.
Action:
The renewal month for the household is March.
l Subsequent renewals are due 12 months following the effective date of the last annual renewal.
Example:
The Shallam family has been eligible for MA for four years. Their last renewal was due in August for September’s eligibility. Their renewal month was September.
Active:
The next renewal month is September of the following year. The renewal must be received and processed by August 31 to continue eligibility into September.
The renewal is systematically sent for households who are not required to report monthly around the 15th of the second month before the month the renewal is due. The system determines which renewal form to send according to what programs the household receives.
Exception: The renewal form for MA Breast and Cervical Cancer enrollees is not sent automatically by the system.
Manually mail the MA-BC Application/Renewal Form (DHS-3525) and Certification of Further Treatment Required (DHS-3525A) to MA-BC enrollees on the 15th day of the second month before the renewal is due.
Example:
Hillary’s renewal month is May.
Action:
Send Hillary her renewal on March 15.
For more information on renewals, see: