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: MA budget closed for failure to complete the renewal on March 15, 20xx and the appropriate ineligibility notice was sent. Request for reconsideration is received with all necessary renewal information within 90 days but no later than June 12, 20xx.
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 date sources. See Section 312.6 Verification and Section 378.6 Automated Sources. If eligible, reopen benefits effective the day after benefits closure.
NOTE: If an individual requesting a reconsideration is ineligible for MA 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) or Children’s Health Insurance Program (CHIP) 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 day after MA was closed.
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 December 15, 2020, Replacing October 4, 2018