Renewals for MAGI MA budgets are completed once every 12 months. There is no semiannual reporting (SAR) for MAGI MA.
At application, the renewal date is the last day of the 11th month from the earliest authorized MAGI budget (this applies to retroactive eligibility also).
Example: Application date of 06/15/2014, the renewal date is set for 05/31/2015. At renewal, the renewal date is the last day of the 12th month from the renewal processing.
Example: Renewal date is 05/31/2015, the next renewal date is set for 05/31/2016. MAGI and Non-MAGI MA renewals for cases with MAGI and Non-MAGI MA budgets must be processed at the same time.
Ex parte is defined as “an action by one party without the involvement of the other party in obtaining verification or information.”
At renewal, MAGI budgets must have an ex parte review completed and must be processed without requiring additional information from the individual, if the CAO is able to obtain necessary verification through available data sources or from the existing case record.
For all ex parte reviews, the CAO must narrate that the ex parte was completed, what information was used to complete the renewal (if able to renew based on the ex parte review) and what action was taken based on the ex parte review.
Reminder: Before taking any action to close an MA budget at renewal with reason code 042 (Failure to Furnish Required Information), the worker must complete an “MA Closure Checklist”. The worker must submit the completed checklist to his/her supervisor for review prior to the case closing.
Note: Any information from a data source must be considered “reasonably compatible” in order to be used as verification (See Section 312.72, Reasonable Compatibility).
Note: If the recipient is cooperating in providing the renewal packet and verification, the CAO should give additional time for the recipient to return the renewal form and/or verification.
To complete an ex parte review at renewal for MAGI budgets:
Manually Scheduled Renewals
Before sending a paper renewal packet, the CAO must complete an ex parte review to determine if all necessary verification is available through information on file or through data sources. If the information is available and the individual will remain eligible at the same level of coverage, the CAO must process the renewal without requiring a paper renewal packet.
If all necessary verification is not available through information on file or data sources, or if the information available would either change the level of coverage or make the individual ineligible, the CAO must send a paper renewal packet and allow a minimum of 30 days for the individual to return the packet and all necessary verification.
If a paper renewal packet is returned without all necessary verification, the CAO must complete an ex parte review, which includes checking all available data sources in an attempt to verify the reported information on the renewal.
If the required verification is available through existing data sources or the case record, the CAO must process the renewal.
If the required information is not provided with the renewal and not available through existing data sources or the case record, the CAO will close the MAGI budget(s) for failure to provide verification.
If a paper renewal packet is not returned, the CAO will:
Close the MAGI budget(s) for failure to provide a completed renewal packet.
Note: The process for manually scheduled renewals applies to MA-only cases. If the case has non-MA budgets, an ex parte cannot be completed before the packet is generated. The CAO must send the packet and complete an ex parte before taking action to renew or close the MA benefits.
Automatically Scheduled Renewals
If the individual returns a renewal packet that was scheduled systematically, the CAO must review the information reported and check to see if all necessary verification is available either through electronic data sources, or in the case record.
If the required verification is available through existing data sources or the case record, the CAO must process the renewal.
If the required information is not provided with the renewal and not available through existing data sources or the case record, the CAO will close the MAGI budget(s) for failure to provide verification.
If the system-scheduled renewal packet is sent and not returned, the CAO will complete an ex parte review.
If the required verification is available through existing data sources or the case record, the CAO must process the renewal.
If required verification cannot be obtained through data sources, close the MAGI budget(s) for failure to provide a completed renewal packet.
The CAO will send a notice informing the recipient of the outcome of the renewal, regardless of whether there is a change in MA or not.
If MAGI renewal is not received timely, and MA is closed, the reconsideration time frame is 90 days (See Section 379.3, Reopening Benefits that were Closed at Renewal).
Updated May 25, 2016 issued September 19, 2014