101.15.04 PRE-POPULATED RENEWALS

If a renewal of eligibility cannot be accomplished by an administrative review, a pre-populated review form is issued to the recipient displaying the information that is available to the agency. The renewal form is an initial request for information. Renewal due dates are included on the form which provides the recipient with time to respond and provide any necessary information specified on the form that is needed to renew eligibility. Renewal includes returning the signed renewal form. Renewal due dates are as follows: • MAGI-related and ABD renewals have 30-days from the date the renewal form is issued. The signed form and any paper verifications may be returned to the Division of Medicaid through any of the methods permitted for submission of applications. MAGI pre-populated renewals are issued with known household composition and demographic data, current income information, tax and dependent status of each known household member and information on any health insurance coverage for household members. There is space on the form for the head of the household to make any needed changes to information reported on the form. ABD pre-populated renewals are issued with known demographic and income information for each eligible individual or couple. There is space on the form for the individual or couple to make any needed changes to information reported on the form. • Pre-populated renewal forms (MAGI and ABD) are issued by the system two months in advance of the review. For example, May renewals are mailed out or available on Common Web Portal for beneficiaries with accounts (with electronic notice issued) to recipients in March and are due for completion/return to the Regional Office by April 15th. Reviews must be completed for adverse action by May 15th or the end of May, as appropriate. • The case must have no open contacts or pending time periods by the published deadline in order for the system to generate a pre-populated renewal form. Any cases that are not in the appropriate status as of the date of mailing will be by-passed by the system making it necessary for the specialist to issue a pre-populated renewal form manually. If a renewal form is issued manually, the specialist must pre-populate the form will all known information required by the renewal form. • If a returned form is incomplete, meaning there is missing information or verification needed, attempt a telephone contact with the head of household to explain what is needed. • If a returned form suggests the client may qualify for a different program (e.g., MAGI reports disability, cost sharing indicates nursing home stay), send a 307 to request any additional information needed to evaluate eligibility for that program • If a renewal form (MAGI or ABD) is not returned by the due date, attempt telephone contact with the recipient as a reminder that the form is due for completion and return to the regional office via mail, in-person or electronically. • When the ABD or MAGI recipient or head of household fails to provide all needed information, action cannot be taken to terminate eligibility due to failure to provide information without first attempting a telephone contact to inform the individual of the information needed and when it must be provided to prevent termination. All efforts to contact the individual must be documented in the case record. • When a renewal form or other requested information is not returned, the worker must attempt to use available electronic data sources to complete a renewal. Any beneficiaries who could be renewed ex parte must be renewed ex parte. Any clients who would change from Medicaid to CHIP, CHIP to Medicaid, or to a lower coverage group must be changed to the new coverage. • Monthly and Weekly Redetermination Due Listings for both ABD and MAGI cases are available in the system to track and monitor cases due for review. Cases that are overdue for review are also part of these reports. • If needed information is provided after the applicable due date for renewal, refer to 101.16.12 “Requested Information Provided After Closure.”