1880.005.00 Pre-populated Annual Renewal Form – DSS Manuals

IM-25 March 23, 2023 ; IM-50 March 25, 2019 ; IM-08 January 25, 2019 ; IM-137 November 20, 2017

As provided in 42 CFR 435.916(a)(3), a pre-populated annual renewal form must be sent when an ex parte renewal cannot be completed. The pre-populated annual renewal form includes:

The most current or reliable information known or available to the agency through: the household’s case record, or other information available to the agency, such as electronic data sources as listed in f the MAGI Family MO HealthNet (MHN) policy manual.

Request for required information from the participant to complete, sign, and return the annual renewal.

Filer consent information request.

Reporting requirements for changes that the participant is required to report throughout the duration of the certification period.

The household is given at least 30 days to complete, sign, and return the annual renewal form and to provide the requested information. Do not consider a pre-populated annual renewal form as received unless it is signed. If the annual renewal form and/or requested information is not received, the adverse action period begins 10 days prior to the last day of the certification period. If the household returns the annual renewal form, confirm/verify the information provided on the form.

Check FAMIS for missing, inconsistent, insufficient, or questionable information.

If pieces of information require further verification or clarification, send a request for information to the household. Allow 10 days for the household to respond to the request for information. If the household does not respond to the request for information, the case is closed. An ex parte is not required prior to closing to determine eligibility for other MHN categories. If the household provides the requested information, complete an eligibility determination on the case. If all participants are found eligible, send a notice informing the household that the case is renewed for 12 months. Complete an ex parte review to determine if eligibility exists in another MHN programs, if any participant is found ineligible.

NOTE : Refer to 1880.025.00 Annual Renewal Case Action Notifications , of the MAGI Family MO HealthNet (MHN) policy manual, for notice procedures.

Refer to 1880.020.00 Reconsideration Period when the pre-populated annual renewal form is received after the case has closed.