3.1 Renewals

3.1.1 Renewals Introduction

A renewal is the process during which all eligibility factors subject to change are reexamined and a decision is made if eligibility should continue. 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 Medicaid case is 12 months from the certification month except for cases open with a deductible. A renewal is not scheduled for a case that did not meet its deductible unless someone in the case was open for Medicaid. For cases that did meet the deductible, the renewal date is six months from the start of the deductible period.

Note: For manually certified Medicaid cases, send a manual renewal notice 45 days prior to the end of the renewal month.

Agency Option

The agency may renew any case at any other time when the agency can justify the need. Examples include:

Loss of contact, or
Member request

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

3.1.2 Choice of Renewal

The member has the choice of the following methods for any Medicaid renewal:

Face-to-face Interview,
Telephone Interview.
Mail in: Mail in renewals can be submitted using the paper application (F-10101) or the pre-printed renewal packet generated through CWW . Cases requesting to complete a Mail-in renewal must be sent the pre-printed renewal packet if the case includes a blind or disabled child, or
ACCESS

3.1.3 Renewal Processing

A Medicaid eligibility renewal notice is generated on the first Friday of the 11th month of the certification period. The notice states that "some or all of your benefits will end" if a renewal is not completed by the end of the following month. Do not process a renewal until after adverse action in the month prior to the month of renewal.

Example 1: CARES sends out the renewal letter on July 7 for a renewal due in August, do not process the renewal prior to July 18.

Do not require a new Authorized Representative form at renewal if the person signing the renewal is the Authorized Representative on file.

If the renewal is not completed by the end of the certification period, the case will close. The closure notice is generated through CARES at adverse action in the renewal month.

3.1.4 Signature at Renewal

The member must include a valid signature at the time of renewal. This includes signing:

The paper application form,
The signature page of the Application Summary,
The ACCESS or FFM application form with an electronic signature, or
Telephonically.

The signature requirements for renewals are the same as those for applications. See Section 2.5 Valid Signature.

3.1.5 Administrative Renewals

An administrative renewal is an extension of program eligibility for certain low-risk cases based on the information in CARES 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 CWW 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.

MA cases that could be selected for administrative renewal include:

SSI -related Medicaid
Home and Community-Based Waivers (HCBW)
Managed Long Term Care (MLTC including Family Care, Partnership, PACE )
MSP

MA cases must also meet all the following criteria to be selected for an administrative renewal:

SSI-related Medicaid

No MAPP eligibility
No earned income
No Medicaid deductible
Countable income at or below 84 percent FPL
Countable assets at or below 50 percent of the asset limit

HCBW, MLTC (Family Care, PACE/Partnership)

No spouse
Living at home (i.e., living arrangement code must be "01")
No Group B or C eligibility
No Group A eligibility due to BadgerCare Plus, MAPP, or Medicaid deductible
No earned income
Countable income at or below 223 percent FPL
Countable assets at or below 50 percent of the asset limit

Medicare Savings Programs

Countable income at or below 120 percent FPL
Countable assets at or below 50 percent of the asset limit

Open for Multiple Programs

If the case is open for MSP and one of the Medicaid categories listed above, the case may be selected for administrative renewal if the Medicaid renewal is due and the case meets all the selection criteria listed above. If the MSP renewal is due but not the Medicaid 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.

3.1.6 Late Renewals

Late renewals are only permitted for individuals whose eligibility ended because of lack of renewal and not for any other reasons for the following EBD programs:

Elderly, Blind or Disabled Medicaid (EBD MA)
Home and Community Based Waivers (HCBW)
Institutional Medicaid
MAPP
MSP ( QMB / SLMB / SLMB+ / QDWI ).

Late renewals and related-renewal verifications should be accepted for up to three calendar months after the renewal date. Members whose health care benefits are closed more than three months due to lack of renewal must reapply.

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

If the health care renewal was completed timely but the requested verifications were not provided as part of the renewal, the health care program can be reopened without a new application if these verifications are submitted within three months of the renewal month. The verifications must include information for the current month of eligibility. If verification was submitted for a past month, a new Verification Checklist must be generated to request current verification. The member will have 10 days to provide it.

If a gap in coverage occurs because of a late renewal, the member may request coverage of the past month in which the gap occurred. The member must provide all necessary information and verification for those months and must pay any required premiums to be covered for those months. For EBD MA renewals, the member must provide the missing verification and verify assets or the current month if there was a gap in coverage.

Note: QMB coverage is not retroactive. Members cannot request backdated eligibility for this program.

This page last updated in Release Number: 15-01

Release Date: 06/10/2015

Effective Date: 06/10/2015