A complete renewal is a full review of all eligibility factors that can change. The CAO must use the review to decide on applicant/recipient group member’s continued eligibility and whether he or she is in the correct category. 55 Pa. Code § 133.73(a)(1) 55 Pa. Code § 133.84(c)
Since an interview is not required, the complete renewal can be completed by mail, fax or COMPASS. If it is necessary, the caseworker can contact the household for information.
The CAO must always review the following factors for the applicant/recipient group:
NOTE: If identity and citizenship were proven in the past, proof does not have to be given again at renewal, unless there is a change or something seems wrong.
Who is in the family
Gross income (earned and unearned) of the applicant/recipient group members, parents, and spouses
Important: If no income or limited income is reported, the CAO must ask for more information to show how the household lives on little or no income.
Income expense deductions
Resources (when necessary)
Applications for Social Security numbers that were not already reported to the CAO
Plans for the continuing care of a dependent child who is not living with a specified relative
Third-party resources (to update the third-party liability TPL file)
GA eligibility for PD and TD recipients
Answering a summons or bench warrant to appear as a defendant in a criminal court case (See Chapter 304, Appendix C for procedures for the criminal history inquiry.) 62 P.S. § 481.1
Medical expenses
The CAO must review all eligibility factors for the categories in which the household is enrolled. The renewal must be signed by an adult or an emancipated minor who is a member of the recipient group or by a individual acting for the recipient group.
As long as a individual cooperates during the renewal process, benefits can continue while the CAO is waiting for any needed proof. (See Chapter 378, Verification.)
Exception: Proof of an incapacity, if not already established, must be given so that a decision on continued MA eligibility can be made within 30 calendar days. Information about third-party resources must also be given within 30 calendar days.
Complete renewals can be done whenever one is needed, but they must be done at least as often as the following times:
For Nonmoney Payment (NMP) applicant/recipient groups, a complete renewal must be done every twelve months. A semiannual review (SAR) is required at six months between annual renewal periods. For NMP spend-down, an annual renewal is required, but a SAR review is not.
NOTE: For MAWD, a complete renewal must be done every twelve months. The MAWD premium amount is reviewed as part of SAR every six months.
NOTE: For monthly NMP spend-down, a new application is required if the applicant/recipient group does not get NMP for three months in a row.
For Healthy Beginnings (HB), a complete renewal must be done every twelve months. HB budgets will be enrolled in SAR, except for those that have only a pregnant woman or a child under the age of one. 55 Pa. Code § 140.111
For Healthy Horizons, a complete renewal must be done every twelve months. 55 Pa. Code § 140.321
For the Breast and Cervical Cancer Prevention and Treatment (BCCPT) program, a complete renewal must be done every twelve months for a woman who continues to need treatment for breast and cervical cancer or for a precancerous condition of the breast or cervix. A partial renewal is required for each woman enrolled in BCCPT whose first treatment was expected to last less than twelve months. The partial renewal must be done at the end of the first eligibility period.
For Medically Needy Only (MNO), a complete renewal must be done every twelve months. All MNO budgets must be enrolled in SAR, except for TD 55, TA 65, TA 67, TJ 65, TJ 67, Long-Term Care (LTC) and Home and Community Based Services (HCBS) categories (TAN, TJN, TAW and TJW).
55 Pa. Code § 133.84(c)(1) 55 Pa. Code § 133.84(c)(2)
For NMP and MNO, a complete renewal must be done when adding a new individual other than a newborn. (See Section 376.27, Adding a Person to an Applicant/Recipient Group. A newborn born to a MA or Children's Insurance Program (CHIP) eligible mother is automatically eligible on the date of birth and remains eligible until age one. 55 Pa. Code § 133.84(c)(4)
When MA is approved, CIS or e-CIS sets the renewal due date. The CAO must check the renewal due date and change it if it needs to be a different date. The system sets an alert for the due date.
NOTE There is no provision that extends the renewal due date longer than one year to allow the determination of other potential benefits, such as Title IV-E eligibility for children in Children and Youth Agency (CYA) or juvenile probation office (JPO) placement. The renewal due date cannot be longer than one year.
CIS or e-CIS will set the SAR review date for six months or six months from the last renewal, whichever is sooner. The SAR form will serve as:
55 Pa. Code § 133.83(a)(1)(ii)
The complete renewal for TD budgets;
The partial renewal for TA, TJ, and TC budgets.
The premium review for MAWD budgets.
CIS will set the next SAR review for six months or the next complete renewal, whichever occurs first.
When an MNO budget with a patient pay liability or a retroactive period is opened with another SAR budget, a SAR period for each SAR budget may be needed at first to fit the program rules.
An MNO budget with a patient pay liability cannot be set with any other SAR budgets in the record until the patient pay liability period has ended.
All SAR reviews must be processed through CAPRTL in CIS or Case Maintenance in e-CIS. To set a new SAR period for any category, the CAO must first process only that particular category through CAPRTL or Case Maintenance.
A renewal is timely if it is completed within the calendar month in which it is due. The renewal will appear as overdue on a supervisory alert if the due date is not updated in CIS on or before the last day of the month. 55 Pa. Code § 133.1(b)
When a renewal is needed, the CAO must contact a responsible member or representative of the recipient group if there are questions or if proof or an explanation of something is needed.
The CAO may make a home visit if there is a good reason to do so. The caseworker must get approval from his or her supervisor before conducting a home visit.
The Authorization for Release of Information (PA 4) form is a consent form signed by the client that lets a third party give information to the CAO. The form is needed only when information or proof is needed from someone else for the client’s eligibility. 55 Pa. Code 201.4(a)(2)(ii)
The following individuals must sign the PA 4 form when one is needed:
The recipient, when benefits are being reviewed for continued eligibility
An applicant for benefits who is at least 18 years old or an emancipated minor 17 years old or younger, during the application interview or within thirty calendar days of the approval date
The individual (of any age) who is the payment name, during the renewal interview
A recipient of ongoing benefits who is at least 18 years old or an emancipated minor 17 years old or younger, during the renewal interview or within fifteen working days of the interview date of the renewal
A required budget group member added to an existing budget who is at least 18 years old and an emancipated minor 17 years old or younger, within fifteen working days of the approval date
NOTE: The rules for signing a PA 4 are different from those for signing the application form. Only one signature is required on the application form. A PA 4 requires the signatures of all adults age 18 and older and those under 18 and emancipated.
The CAO must review the household’s situation for continued eligibility. The renewal process can be completed by:
55 Pa. Code § 133.73 55 Pa. Code § 133.84(c)
Receipt of the renewal form by mail, fax, or another way.
The COMPASS renewal process.
An interview. The CAO will conduct a face-to-fact interview only if required.
All MA budgets are renewed at the same time.
Before processing a renewal, the CAO must take the following actions:
1. Review the caseload alerts to find out which budgets are due for renewal.
NOTE: The renewals are listed by budget group rather than by applicant/recipient group. An applicant/recipient group may have more than one budget group.
2. Send the right renewal packet to the client and let him or her know what papers are needed for continued eligibility.
3. Complete an Income Eligibility Verification Systems (IEVS) status inquiry, and review the information on the “Individual Detail” and “Individual History” screens. The CAO must review this information for every client or legally responsible relative living in the household. If new information is available, complete an “information request.” inquiry (See the OIM Manual “Using IEVS” for complete IEVS procedures.)
Reminder: IEVS provides information on eligibility factors for extended NMP special circumstances. NMP coverage is continued for a individual whose SSI is stopped because of any of the following:
Receipt of or an increase in a COLA (Lynch v. Rank, or “Pickles”, cases)
Disabled Adult Child (DAC) benefits
Disabled employment benefits
Disabled widows and widowers benefits
NOTE: See Chapter 387, Supplemental Security Income, for complete eligibility information.
When renewal information is received from a client, the CAO must:
1. Review the renewal form to make sure it is complete, and contact the client if information is missing.
2. Review eligibility factors that may have changed. (See the beginning of this section for a list of things that must be reviewed with the applicant/recipient group.)
3. Review IEVS information for all individuals associated with applicant or recipient. If proof is needed, give or send the client a Verification Request (PA 162-VR) form, and communicate to the client that he or she has ten calendar days to provide the information.
4. For GA-related MA categories, review the client’s criminal history inquiry information. (See Chapter 304, Appendix C for procedures.)
5. Review and confirm all eligibility factors. Communicate to the client about any proof that is needed within fifteen working days after getting the renewal packet or by the date when the renewal information is reviewed.
If necessary, the CAO must help the client get proof, or set up a plan for the client to get proof. Except when the caseworker suspects fraud, he or she must try to let the client know before contacting individuals who know the client. The CAO does not need to get proof of eligibility factors that have already been proven and are not likely to change (such as SSN, birth date, identity, or citizenship) unless the caseworker has an indication that the current information may have changed.
6. When a delay in providing information is due to a third party and the client is cooperating, the CAO must continue benefits and review the progress of getting proof and the client’s cooperation every thirty days.
7. If there are other possible resources and income, including third-party resources (health insurance coverage), contact the client and discuss them. Get the client to agree to try to get those resources.
8. Look at the client’s social service needs and plans. Review DHS’s services and those of other agencies that eligible clients can get.
9. Make sure the client gets a copy of the Rights and Responsibilities page from the application.
NOTE: For COMPASS renewals, the client must show that he or she read the Rights and Responsibilities information.
10. Tell the client that he or she must report changes when they take place between renewal or SAR periods. Create an alert for any possible changes.
11. Give the client the chance to register to vote. Give the client a voter registration form if he or she wants to register. Offer to help the applicant fill out the form if he or she needs help. Help may be given by telephone, or a client may make an appointment to visit the CAO. (See the Supplemental Handbook, Chapter 980, Voter Registration.)
12. Review the case record to determine if all budgets are aligned with a common renewal date. The renewal due date for all budgets in a case record must be aligned. If MA budgets are the only budgets open in a case, align all MA budgets to the same renewal date when processing the renewal.
NOTE: The requirement to align MA budget renewal dates does not apply to the following MA budget exceptions:
MA-EMC budgets (PC/PU71)
MA Extension for support budgets (PC/PU23)
MA-MAWD budgets (PW/PI)
MA-BCCPT budgets (PH/20)
Other MA budgets that have a specific time period that the budget must be open (examples: pregnant woman, newborns, and certain MA spend-down budgets).
Important: When a SNAP (576.1) or cash (176.2) budget is open with a MA budget, follow SNAP and Cash policy when aligning renewal dates for all budgets in a case record. Failure to comply with the requirements to align all budgets in the case record with a common renewal date will result in the CAOs processing additional renewals.
13. Process the renewal in the system and determine ongoing MA eligibility. Make sure eligibility, renewal due date, and case record information is updated.
14. Ensure that the correct notice is sent to the individual if the individual no longer qualifies for MA benefits or if the individual's MA benefits have been increased or decreased. If a individual continues to qualify for MA and the benefit does not change, a notice does not get sent out to the individual.
15. Enter a case comment in the system.
When renewal information is not received from the individual the CAO must:
Confirm that the renewal form and verification information have not been received in the CAO by the renewal date.
If there has been no contact from the individual to demonstrate that the individual is cooperating in providing the renewal information, close the MA budget for failure to provide information (reason 042) with a 15-day advance notice.
For all programs, a new application form is NOT required only when all these conditions are met:
Recipients completed the required renewal form, but failed to provide pending information or verification; and
Benefits were discontinued ; and
Recipients provided pending information or verification within 60 days of discontinuance.
A new application is not required for individuals who completed the required renewal form and ask for MA to be reopened, request reconsideration, ask for a new application, and/or submit required verification within 90 days of the date of benefits closure.
See Chapter 379.3 reopening benefits that were Closed at Renewal
The Automated Renewals (AR) system lets caseworkers identify and review monthly 001 alerts for renewal. The AR system creates and sends out renewal packets and lets caseworkers schedule interviews as needed.
The AR system creates each packet on the basis of the categories that are due for renewal and whether the renewal is to be done by mail-in, telephone, or a face-to-face interview. Each packet has certain forms that are required. The caseworker can select other forms that the client may need to fill out. (For more information, see (Appendix B, Automated Renewal Forms.)
The AR system provides two types of processes:
Quick Process
The Quick Process lets the CAO schedule renewals for several cases at the same time. The CAO enters the appointment date and time or the packet due date. The CAO can select any optional forms that may be needed.
Detail Process
The Detail Process lets the CAO view each case in detail. The Detail Process gives the CAO the chance to include future budgets in the current renewal process. The CAO may also change the packet mailing address or the mailing date.
After the CAO processes the 001 alerts using the Quick Process or the Detail Process, the AR system pulls, prints, packages, mails the renewal packets and automatically enters a case narrative including the due date.
To continue to be eligible, the client or representative must take the following actions: 55 Pa. Code § 133.74 55 Pa. Code § 133.84(c)
1. Complete all forms to the best of his or her ability, and sign the PA 600R or other renewal form.
2. Provide the information needed to complete the renewal.
3. Provide the information needed to complete the third-party liability form. The client must provide information about third-party resources within 30 days after each renewal review. 55 Pa. Code § 178.3(1)
4. If sent, sign a PA 4 to let the CAO get information from third parties if more information or proof is needed to decide on continued eligibility.
A new application form, a renewal form, or a COMPASS application can be used to add a individual (other than a newborn) who was not previously known or in the record to an existing applicant/recipient group. The payment name or that individual’s representative must complete the application and turn in all necessary papers of proof with the application. The CAO must update the case record. The completed form serves as an application for the individual who is being added and as a renewal for the rest of the applicant/recipient group.
NOTE: A change of status for a household member who is in the record but is not getting benefits requires a complete review of all eligibility factors for all household members. A new application form is not required.
Exception: A newborn is automatically eligible for one year as long as the mother was eligible for MA or CHIP on the day the child was born. The CAO must set a renewal due date for twelve months from the date of birth. A renewal is not needed until the newborn reaches his or her first birthday. When the child reaches age one, the CAO must process a renewal to determine whether the child remains eligible for MA. This redetermination occurs no later than the first work day of the week after the child’s birthday. (See Section 338.41, Medical Assistance for Newborns, for complete information on approving medical benefits for newborns.) 55 Pa. Code § 141.71(c)(3) 55 Pa. Code § 141.81(a)(8)(ii)
For MNO, the CAO must begin a new six-month eligibility period when a individual is added.
Updated February 14, 2012, Replacing October 25, 2008