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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |507 Effective Month: August 2017 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 renewals have 30-days from the date the renewal form is issued;

• ABD renewals have 20-days plus time allowed for the issuance of a DOM-309, Second Request for Information, if needed.

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 to recipients in February and are due for completion/return to the Regional Office by March 31st. Reviews must be completed for adverse action by April 15th or the end of April, as appropriate.