Annual Renewals for MAGI Family MO HealthNet (MHN) and MO HealthNet Children’s Health Insurance Program (CHIP) must be completed once every twelve months as provided by 42 CFR 435.916.
Automatic Annual Renewals occur when there is enough information available to the agency to complete the renewal without requiring information from the individual or intervention from the Eligibility Specialist. A redetermination of eligibility during an Automatic Annual Renewal is based on information available to the agency through the electronic data sources.
See the MAGI MO HealthNet policy section, 1805.002.02 Federal Hub Calls to see the items that will be pulled when the annual renewal is completed automatically.
When available information indicates no change in eligibility, renew the case without requesting anything from the individual.
EXAMPLE: Roberta’s three children are covered under CHIP 73. Roberta’s children are all citizens. A current review of the Work Number confirms Roberta’s income information. There is no change in coverage and the children remain eligible for CHIP 73. An Action Notice (IM-33) is sent notifying Roberta there was no change to her children’s coverage during the Annual Renewal process.
If the Annual Renewal cannot be completed because of insufficient information available to the agency, a pre-populated Annual Renewal Form (IM-1U) must be sent to request additional information from the individual. The IM-1U is automatically generated in this instance.
As provided in 42 CFR 435.916(a)(3), a pre-populated renewal form must be sent when an Automatic Annual Renewal cannot be completed. This occurs when a redetermination cannot be completed when information isn’t received from the HUB due to inconsistent, insufficient or questionable information.
The pre-populated form includes:
The individual is given 30 days to sign and return the IM-1U and to provide the requested information. The IM-80 Adverse Action period begins on the 30th day if the IM-1U and/or the information is not received.
If the individual returns the IM-1U, confirm/verify the information provided on the form.
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 form is received after the case has closed.
As provided in 42 CFR 435.916(d), when information is received regarding changes in the individual’s circumstances (CiC) that may affect eligibility, redetermine eligibility for MAGI Family MO HealthNet (MHN).
CiC’s that may impact the Level of Care (LOC) will prompt a floating renewal. If the CiC does not change the LOC but could have because of the type of change, the floating renewal should be completed. CiC’s that prompt a floating renewal include:
NOTE: A change that does not impact the LOC, such as an address change, will not prompt a floating renewal.
A floating renewal will be completed at a CiC mentioned above, when:
The system will reset the certification period when a CIC completes a floating renewal. The certification period is extended from the date of the CIC for another 12 months.
Floating renewals can only occur at CiC when there is enough information present to complete the renewal without requiring information from the individual. If there is not enough information available to FSD through the CiC, case record, electronic data source, or any other reliable source, a floating renewal will not be completed.
EXAMPLE: Katherine’s certification period ends March 15th. On June 25th Katherine reported she changed employers and will have an increase in income but did not provide any documentation. A review of electronic data sources cannot confirm Katherine’s change in employment and income, her income is not Reasonably Compatible. A Request for Information (IM-31A) is sent to Katherine requesting clarification of her employment status and income. Katherine provided the clarification required to process the CiC. Katherine’s income is the only income for the MAGI household. With the information provided for the CiC, there is enough information to complete a floating renewal. The renewal is completed and the certification period is extended another 12 months from the date of the CiC. Katherine will receive the 10 day Adverse Action Notice (IM-80) if the LOC decreases, and a Change Notice (IM-33C).
EXAMPLE: Eva’s certification period ends December 31st. On September 2nd Eva reported a new address. A review of the case shows that there were no changes in income, household compensation, or tax filing statues. Eva’s CIC to change her address does not include a change in the LOC for Eva’s household. The CiC to update the household’s address is processed. Information regarding her income is not requested since it was not a part of her CiC. The certification period is not renewed at this time. Eva’s case will be renewed at the end of her original certification period, December 31st.
If eligibility exists, under the same or a new LOC, a new 12 month certification period will begin. The new certification is effective as of the first of the month that the change(s) take effect.
EXAMPLE: On June 27th Charlene applied for MPW. She reported that her employment at Wal-Mart ended May 7th. The Work Number reflects Charlene is not currently employed at Wal-Mart and her last pay check was received on May 31st. Her two children, Ruby and Max, currently receive CHIP 0 with a certification period of November 1, 2016 to October 31, 2017. Since the change of income can be confirmed using an electronic data source (The Work Number), additional information was not requested from Charlene. The changes were applied to the case, and Ruby and Max’s level of care changed to MO HealthNet for Families (MHF). The certification period is reset as June 1, 2017 to May 31, 2018. Charlene is sent the Change Notice (IM-33C).
If a CiC is received during the annual renewal process but the IM-1U has not been signed and returned, the CiC may still complete the annual renewal. Follow the floating renewal guidelines of this section to complete the renewal. The policy for completing floating renewals does not change regardless of when a CiC falls in the certification period.
EXAMPLE: Josh's certification period ended August 31st. The case could not be renewed automatically. The manual IM-1U was triggered on July 17th. On August 8th Josh called to report a new residential address for the household. Josh's case record indicates income from XYZ Employer. A review of electronic sources provides the income in MEDES is no longer Reasonably Compatible with electronic data sources. More information is needed about Josh's income to complete the renewal. Since the CiC did not include income information, do not request additional information regarding his income. Josh did not return the IM-1U, and the case closed. Josh was provided a 10 day Adverse Action Notice (IM-80) period. After the adverse action period expired, Josh was sent a Change Notice (IM-33C) notifying him the case has been closed for failure to complete the annual renewal.
EXAMPLE: Sue Ann's certification period ended August 31st. The case could not be renewed automatically. The manual IM-1U was triggered on July 17th. On August 8th Sue Ann reported she was laid off July 10th and now receives $260 in unemployment each week. She has not signed or returned the IM-1U. A review of IMES and The Work Number confirmed Sue Ann's statement. There were no other outstanding eligibility criteria needed to complete an eligibility renewal. The annual renewal was completed and the certification period is extended for another 12 months. Sue Ann’s LOC remained the same. She was sent a Change Notice (IM-33C) notifying her the case has been renewed.
When an individual or household is determined ineligible based on eligibility criteria, complete an ex-parte review to determine eligibility for other MHN categories. Refer to MAGI Policy manual 1890.000.00 Ex-parte Review Process.
NOTE: If the case closes for failure to return the renewal form or fail to cooperate by providing requested information, an ex-parte is not completed.
Federal guidance provided in 42 CFR 457.343 states that Annual Renewal procedures for MO HealthNet Children’s Health Insurance Programs (CHIP), should be reviewed in the same manner as Annual Renewals for other MAGI Family MO HealthNet (MHN) categories.
However, when completing an Annual Renewal on a CHIP case, review information needed to renew CHIP eligibility, including access to private or employer sponsored insurance.
EXAMPLE: Jacobi’s children are on CHIP 74 and are due for an Annual Renewal. Jacobi’s Annual Renewal is completed automatically. The electronic data sources confirm Jacobi’s circumstances have not changed. The CHIP affordability calculator is run and it is determined no affordable insurance exists. A Request for Information (IM-31A) is sent to Jacobi to clarify if there have been any updates to health insurance for the children; if any new private or employer sponsored insurance coverage began since last contact, or if there is now access to employer sponsored insurance.
Refer to MAGI Manual section, 1840.000.00 MO HealthNet Children’s Health Insurance Program, when determining eligibility for a CHIP level MHN category.
As provided in 42 CFR 435.916(C)(ii), allow submission of the pre-populated Annual Renewal Form (IM-1U) up to 90 days after termination of eligibility.
The reconsideration period allows cases that closed for failure to return the IM-1U to be reopened when the IM-1U is received within 90 days after the case has already closed.
Allow the reconsideration period if the individual fails to return the Annual Renewal form but provides all information required to complete the Annual Renewal by phone, online, in-person, or through the mail within the 90 day reconsideration period.
Follow normal procedures when information or clarification is required. When additional information is required, send a Request for Information Notice (IM-31A), to request the further information or clarification.
The reconsideration period is treated in two different manners:
NOTE: If there is a lapse in coverage and the individual attests to unpaid medical bills, explore eligibility in the Prior Quarter (PQ) months; refer to 1830.020.00 Prior Quarter.
EXAMPLE: Audrey’s MHN Annual Renewal could not be completed automatically and she was sent a pre-populated IM-1U. Audrey failed to reply to the IM-1U and her case closed. Audrey returned the IM-1U 60 days after the case closed. Further income clarification was required to complete the application. The IM-31A was sent allowing 10 days to return the clarifying information. Audrey responded to the request for information. Eligibility was explored for current month and ongoing. Audrey attested to having medical bills from July, therefore eligibility was also explored for the PQ. Audrey was found eligible. She was sent an Approval Notice (IM-33A) for current and ongoing months and an Approval Notice for Prior Quarter (IM-33APQ) for prior quarter months.
NOTE: If additional information is required, only request information needed to renew eligibility. Review and use current information in the case record and electronic data sources before requiring the individual to provide information for the Annual Renewal.
EXAMPLE: In November Katrina’s case closed for failure to provide requested information to complete the Annual Renewal. Katrina responded to the IM-1U 85 days after the case closed. Additional clarification is required to confirm Katrina’s attested income. A Request for Information (IM-31A) was sent to request clarification of income. Katrina failed to provide income clarification by the end of the 10 day timeframe. Katrina’s application was rejected and a Rejection Notice (IM-33R) was sent. An ex-parte is not completed to explore eligibility for other MHN programs since Katrina failed to respond to the request for information. The case was closed and the IM-1U was treated as a new application.
If the pre-populated Annual Renewal form is received more than 90 days after the case closed, do not use the Annual Renewal form in place of an application. The individual must reapply through normal application procedures. Notify the individual how to reapply by sending the, Letter for IM-1U’s Returned After 90-Days.
A redetermination is made and case action notices are sent within 10 days of receiving the necessary information to determine continued eligibility.
NOTE: An Pre-Closing Notice (IM-80PRE) is not required when the individual’s case is closing for failure to respond to the Request for Information (IM-31A).
When the annual renewal determination produces a result of ineligible for reasons other than failure to cooperate, it is necessary to evaluate eligibility for a different MHN category prior to taking action to close the case. If it is determined the individual is not eligible for any other MHN program, the individual’s information is sent to the Federally Facilitated Marketplace (FFM) for an eligibility determination.
NOTE: An ex-parte review is not required when the case is closed for failure to respond to the IM-1U or failure to provide requested information.
When the disability flag is marked, the system will make a referral task to MO HealthNet for the Aged, Blind and Disabled (MHABD). The case will remain open until a decision is made on the MHABD case. When approved or denied for MHABD, the MAGI the Eligibility Specialist must manually close the MAGI case.