26.1 Renewals

26.1.1 Renewals Introduction 26.1.2 Three-Month Late Renewals

26.1.2.1 Verification Requirements for Late Renewals

26.1.1 Renewals Introduction

A renewal is the process during which you reexamine all eligibility factors subject to change and decide if eligibility continues. The group’s continued eligibility depends on its timely completion of a renewal. Each renewal results in a determination to continue or discontinue eligibility. The first required eligibility renewal for a BadgerCare Plus case is 12 months from the certification month, except for:

CENS - The renewal date is 12 months from the date of birth.
Pregnant women -The renewal date is two calendar months after the date the pregnancy ends.

Note: Women in the BadgerCare Plus Prenatal Program lose eligibility on the date the pregnancy ends. However, they are automatically eligible for emergency services for two months after eligibility for BadgerCare Plus Prenatal Program ends (Chapter 41.6).

Deductibles - A renewal is not scheduled for a case that did not meet its deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. , unless someone in the case was open for BadgerCare Plus. For cases that did meet the deductible, the renewal date is six months from the start of the deductible period.

Note: For manually certified BadgerCare Plus cases, make sure the member receives a timely notice of when the renewal is due.

Agency Option

For individuals whose eligibility is determined under non-MAGIApply to households whose eligibility is determined using BadgerCare Plus relationship rules (prior to March 31, 2014) to budget income for a household prior to transitioning to MAGI BadgerCare Plus budgeting rules. rules, the agency may review any case at any other time when the agency can justify the need. Examples include:

Loss of contact
Member request

Note: Shortening certification periods in an attempt to balance agency workload is not permissible.

BadgerCare Plus members whose eligibility is determined using MAGIModified Adjusted Gross Income. MAGI rules are used to determine BadgerCare Plus eligibility for new applicants beginning in 2014 and for existing members as of March 31, 2014, or their next regularly scheduled renewal, whichever is later. MAGI rules are based on tax relationships and family relationships, and they consider taxable income and whether children and tax dependents are required to file. rules are required to complete a renewal no earlier or no later than 12 months from their certification period. Individuals whose benefits are time-limited, such as CENs or pregnant women, will not be required to do a renewal at the end of their time limited benefit if the individual is on a case with other open BadgerCare Plus assistance groups.

Once individuals’ BadgerCare Plus eligibility is determined under MAGIModified Adjusted Gross Income. MAGI rules are used to determine BadgerCare Plus eligibility for new applicants beginning in 2014 and for existing members as of March 31, 2014, or their next regularly scheduled renewal, whichever is later. MAGI rules are based on tax relationships and family relationships, and they consider taxable income and whether children and tax dependents are required to file. rules, workers can complete an early renewal only if the member requests an early renewal. Once the member requests an early renewal, the renewal must be completed.

26.1.2 Three-Month Late Renewals

26.1.2.1 Verification Requirements for Late Renewals

26.1.2.2 Gaps in Coverage

Most health care renewals received within three months of the renewal month can be processed as a late renewal instead of requiring a new application. This policy applies to the following subprograms:

BadgerCare Plus.
Family Planning Only Services (FPOS).
Elderly, Blind or Disabled Medicaid (EBD MA).
Home and Community Based Waivers (HCBW).
Institutional Medicaid.
Medicaid Purchase Plan (MAPP).
Medicare Savings Programs (QMB/SMLB/SLMB+/QDWI).

The policy applies to members receiving health care benefits based on a met deductible, but not to members with an unmet deductible.

Late renewals are only permitted for individuals whose eligibility has ended because of lack of renewal, and not for other reasons. Members whose health care benefits are closed for more than three months because of lack of renewal must reapply.

Agencies should consider late submission of an online or paper renewal form, or a late renewal request by phone or in person, to be a valid request for health care. The new certification period should be set based on the receipt date of the signed renewal. If verification is required during the completion of a late renewal, the member will have 10 days to provide it.

Example 1: Jenny’s renewal is due on January 31, 2015. She submits an online renewal via ACCESS on March 15, 2015. If the renewal is processed on the same day, and verification is requested, the verification will be due on March 25, 2015. If she provides verification on or before this due date and meets all other eligibility criteria for BadgerCare Plus, her eligibility and certification period will start on March 1, 2015. Her next renewal will be due February 28, 2016.

Note: The three-month period starts from the month the renewal was due. It does not restart when a late renewal has been submitted. If Jenny submits her renewal on March 15 but does not provide verification until May, she will need to reapply after the three-month period that started with her January renewal date.

26.1.2.1 Verification Requirements for Late Renewals

If the BadgerCare Plus renewal was completed timely, but requested verifications were not provided as part of the renewal, BadgerCare Plus can reopen without a new application if these verifications are submitted within three months of the renewal month. The submission of the renewal-related verifications is considered a request for health care. Only the missing verifications must be provided. However, the verifications must include information for the current month of eligibility. If verification is submitted for a past month, a new Verification Checklist (VCL) must be generated to request the current verification, allowing 10 days to submit the verification.

For EBD Medicaid, the member must provide the missing verification and verify assets for the current month if there was a gap in coverage.

Example 2: Jenny’s renewal is due on January 31, 2015. She completes her renewal on January 20, 2015, and a VCL is generated requesting income verification for the 30 days prior to January 20. Jenny does not submit the requested verification, and her BadgerCare Plus eligibility is terminated as of January 31, 2015. On April 27, 2015, she submits her paystubs for April 10 and April 24. If she meets the eligibility criteria for BadgerCare Plus, her certification period will start on April 1, 2015, and her next renewal will be due March 31, 2016. If she had submitted the verification of her income for January, a new VCL should be generated asking for verification of her current income for April.

26.1.2.2 Gaps in Coverage

If a member has a gap in coverage because of his or her late renewal, he or she may request coverage of the past months in which the gap occurred. Backdated coverage under the late renewal policy is available to all BadgerCare Plus members who meet program rules, including children who would not otherwise qualify for backdated coverage because their income is too high (see Chapter 25.8.1). However, this does not change the rules for backdating at application.

If a member requests coverage for past months during a late renewal, he or she must provide all necessary information and verifications for those months (including verification of income for all months requested) and must pay any required premiums to be covered for those months.

26.1.3 Administrative Renewals

Administrative Renewals through December 31, 2013 An administrative renewal is an extension of program eligibility for certain low-risk cases based on the information in CARESThis system supports the Income Maintenance operations for DHS and DCF. CARES is used to determine eligibility, issue benefits, track premium payments, and manage support for BadgerCare Plus, EBD Medicaid, W-2, Child Care, and Work Programs. as of the month prior to the renewal month. Cases selected for administrative renewal are cases that are highly unlikely to lose eligibility at renewal due to increases in income or assets. The extension of program eligibility under an administrative renewal is based on the information in CWWCARES Worker Web. The web-based pages used in the CARES operations. as of the month prior to the month a full renewal would otherwise have been due. An administrative renewal case will not receive an eligibility renewal notice and is not required to provide the IM agency with any additional information in order to have program eligibility continued. Administrative renewal cases remain subject to change reporting requirements. The administrative renewal notice identifies program specific change reporting requirements, as well as the potential consequences for not reporting changes timely. Changes reported for a case that has undergone an administrative renewal should be processed under existing policy. BadgerCare Plus cases selected for administrative renewal must meet all the following criteria:

No child in household turning 18 in current or next month
Countable income at or below 75% FPL
No premium
No open FoodShare, Child Care or W-2

Through December 31, 2013, Family Planning Only Services (FPOSFamily Planning Only Services - This plan provides certain services and supplies to people who are of childbearing or reproductive age to prevent unplanned pregnancies.) cases selected for administrative renewal must meet all the following criteria:

No child in household turning 18 in current or next month
Countable income of individuals age 18 and older at or below 275% FPL

Open for Multiple Programs

If the case is open for MSP and BadgerCare Plus (BCP) or FPOS, the case may be selected for administrative renewal if the BCP/FPOS renewal is due and the case meets all the selection criteria listed above. If the MSP renewal is due but not the BCP/FPOS renewal, or the case does not meet all the selection criteria listed above, the case will not be selected for administrative renewal.

Continuous Eligibility

To be selected for an administrative renewal, the case must be open and currently eligible with continuous program eligibility for at least the twelve month period prior to the month in which the case is being considered for an administrative renewal. Additionally, the case must have had at least one full regular renewal.

Alternate Years

Cases will not be selected for administrative renewal if the last renewal requirement was met through an administrative renewal. Administrative renewals will be done every other year. The exceptions to this rule are:

HCBW or MLTC members who are Group A due to their eligibility for SSI or 1619b.
Family Planning Only Services cases where the only eligible case member is under 18 and will not turn age 18 in the current or next month.

Persons meeting these criteria may be selected for administrative renewal annually as long as the detailed selection criteria are met.

Schedule

Administrative renewal case selection will occur prior to sending the regular renewal notices. Any cases not selected for an administrative renewal will be sent the regular renewal notice.

Renewal Mode

Cases in renewal mode will not be selected for administrative renewal.

CARES

CWW will automatically:

Select cases subject to administrative renewal,
Determine the continued eligibility, and
Notify the member of the administrative renewal and eligibility determination.

Worker intervention is not necessary to complete the administrative renewal process. Cases selected for Administrative Renewal will run through a batch eligibility process. Cases that have a pending or fail status after running through the batch eligibility process will not continue through the Administrative Renewal process and will be set for regular renewal. Cases that are passing after eligibility batch run will go through the administrative renewal confirmation process. During the confirmation process:

Case level renewal dates are set.
A case comment is added indicating that the case has gone through an Administrative Renewal.
The ApplicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process./Review Interview Details page will display 'Admin Renewal’.
The Notice of Decision process is triggered and will generate an administrative renewal letter. The letter will be stored in the ECF.
The Enrollment and Benefit brochure is sent to the customer.

Administrative Renewals Effective January 1, 2014 Effective January 1, 2014, administrative renewals will be suspended for BadgerCare Plus and FPOS cases.

This page last updated in Release Number: 15-01

Release Date: 05/15/2015

Effective Date: 05/15/2015