Ex-Parte Review at Health Care Renewal and Allowable Timeframes for Information in the Case Record PMA-22115-376 (Published April 23, 2025)
A renewal is a periodic review of Medical Assistance (MA) eligibility. Renewal forms can be submitted via:
Fax
COMPASS
Telephone
In-Person
Verification documents can be submitted via:
Fax
COMPASS
In-Person
A renewal can be completed through an Ex Parte Review (See Chapter 376.22). An Ex Parte Review is competed by using information available through trusted data sources or from the existing case record.
An MA renewal can be completed whenever one is needed, but they must be completed at least every twelve months.
Certain households are open in MA categories that may require a Semiannual Review (SAR) which requires a review date of six months after the MA budget opening or six months from the last renewal (See Section 376.3 Semiannual Reporting).
For all MA eligibility groups, an application (PA 600 or PA 600HC), renewal form (PA 600R or PA 600HCR), or COMPASS renewal may be required, but a face-to-face or individual interview is not.
Note: If an individual turns in the wrong application or renewal form, they do not need to complete another one. If information is missing, the County Assistance Office (CAO) can get it by the modalities listed above or by using pages of the PA 600 or a different application.
For individuals who receive payment of the Medicare Part B premium (SLMBs or QI-1s), the PA 600M or COMPASS renewal may be used.
The CAO must decide when to review eligibility on the basis of expected changes in an individual's situation and on the required time frame for each type of program and category of MA.
If an individual no longer meets the eligibility conditions for MA, the CAO must take action to discontinue benefits and refer the individual to other medical or health programs, including the Children's Health Insurance Program (CHIP) and the State Based Exchange (SBE)/Pennie.
A renewal of MA eligibility may be completed at the same time as renewal of other programs as long as all information necessary for the MA determination is available with the renewal for the other program.
Note: Eligibility for MAWD (PW0/66), TMA (MG71), and BCCPT (PH20) budgets must not be reviewed prior to renewal date.
Updated April 24, 2025, Replacing December 11, 2024