A new application (paper or electronic) is not required when MA benefits were closed because the individual did not complete the renewal process and the individual requests reconsideration, asks for a new application, and/or submits required verification within 90 days of the date of benefits closure. See Section 304.16, Where to Find a Form, and Who Does or Does Not Need One. If the individual did not submit the renewal form before MA was closed, give the household a renewal form and have them complete and submit it within 30 days.
Example: An MA budget was closed for failure to complete the renewal process on March 15, 20xx and the appropriate ineligibility notice was sent. If a request for reconsideration is received with all necessary renewal information within 90 days but no later than June 12, 20xx, a new application is not required.
Reminder: A new application is required if there is anyone new who wants to apply for MA or if the benefits were closed because the applicant(s) was over the income and/or resource limit unless the applicant(s) subsequently provides verification that they were within the allowed income and/or resource limits at the time of closure.
When an individual requests a reconsideration and/or submits required documents and it is within 90 days of benefits closure, reconsider the case using the paperwork and information in the case record on the date benefits were closed plus any paperwork or information the individual submitted after benefits were closed. Also review information available through electronic data sources. See Section 312.6 Verification and Section 378.6 Automated Sources. Treat the renewal form as an application. If eligible, authorize a new 12-month eligibility period from the date the renewal form was provided to the CAO and cover a gap in coverage if an individual was eligible in the retroactive period.
Example: An MA budget was closed for failure to complete the renewal on October 15, 20xx and the appropriate ineligibility notice was sent. Request for reconsideration is received with all necessary renewal information on December 15, 20xx. The CAO will authorize MA effective December 15, 20XX with a new 12-month renewal due date. The CAO will process an NCE for 10/16/20xx-12/14/20xx if the individual is eligible in the retroactive period.
If a renewal form is returned by the due date but required verifications are returned during the reconsideration period, the CAO will maintain the original renewal due date.
Example: An MA budget with a renewal due date of August 31, 20xx had a completed renewal form returned to the CAO on August 15, 20xx. However, all necessary renewal verifications were not returned by the due date and the CAO was unable to complete an ex-parte review. MA budgets were closed at renewal effective August 31 with the appropriate ineligibility notice sent. On November 11, the household provides all necessary verifications and requests reconsideration. The CAO will authorize MA effective September 1. Because the renewal packet was returned timely, the CAO maintains the same renewal due date of August 31, 20xx.
NOTE: If an individual requesting a reconsideration is ineligible for MA or Children's Health Insurance Program (CHIP) based on information and paperwork provided, the CAO must process the benefit for reconsideration in the system, issue an eligibility notice, and generate a referral to Pennsylvania’s Health Insurance Marketplace (Pennie) as applicable.
If an individual submits a new application within 90 days of MA closure and the individual is eligible for MA based on the information in the case record, available to the CAO electronically or already submitted by the individual, the CAO will reopen MA effective the date of application and cover a gap in coverage if the individual was eligible in the retroactive period.
The CAO may have the individual complete a new application when it would expedite benefit delivery.
Example: A new application may benefit the individual if there are delays in locating or transferring previously completed documents from district to district or from county to county.
NOTE: A household may file an appeal as well as having a case reopened. Filing an appeal does not preclude reopening a case. Reopening a case does not preclude an appeal.
Although a new application (paper or electronic) is not required, the CAO must register a non-application in eCIS when the individual requests reconsideration, asks for MA to be opened, asks for a new application, and/or submits required verification.
NOTE: If the individual provides some but not all of the pending information, the CAO must work with the individual in an effort to get the required information.
Updated February 24, 2025, Replacing December 19, 2024