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Medical Services – Appendix O, Renewal Forms Chart Eligibility Group MAGI Renewal DCO-95 DCO-777 DCO-811 DCO-950 DCO-7779 DCO-7781 DCO-81 DCO-237 DCO-662 DCO-702 DCO-704 DCO-710 DCO-712 DCO-713 DCO-727 Pub 405 Pub 407 DCO-106 DCO-107 DCO-108/108C DMS-2602 DCO-2603 DHS-3330 DCO-4000 Miscellaneous PACE X X X X X X X X ● ● ● X ● Foster Care (CHRIS) X Aged Individual-EC X X X Foster Care-EC (CHRIS) X SSI Medicaid Pickle (COLA) X X X X Disabled Adult Child (DAC) X X X X Widows or Widowers (OBRA) X X X X The eligibility groups with (CHRIS) signifies completion by the Foster Care Eligibility Unit through the CHRIS system. DCO-662 is required at renewal if there is a change in insurance information. Appendix O (01/17) 2 of 2 Must be an SSI Recipient A red dot signifies this form will be needed for a renewal if a disability determination from MRT is needed. A green X signifies this form will be needed for a renewal.