PM 19-02-02-e

new textAdministrative renewal is a simplified process for families on Family Assist, All Kids Assist, Share and Premium Level 1. Form 643E or Form 643E1 is centrally sent to families who are selected for administrative renewal. Information from the Client Database appears on the forms as appropriate.

Form 643E Your Children's Medical Eligibility

For cases containing children only, families receive renewal Form 643E. The client is asked to review the form. If there are no changes to report, the client is not required to return the form. If there are changes, the client is required to complete the form, submit proof of income and return the form by the due date.

Families that report changes may do so on the renewal form or complete the renewal over the phone. Changes in income, spousal or child support paid must be verified. Families are only required to send in proof of one payment for each source of income or support deduction. Accept the family's statement for monthly child care expenses.

If a family reports a change in income and fails to include proof, send Form 1721 Instructions to Client to request the proof. If conflicting information is known by the caseworker, send Form 1721 to the family to resolve the discrepancy. If the family fails to provide proof of income or otherwise fails to cooperate, cancel the case.

Form 643E1 Your Family's Medical Eligibility

For cases including both children and adults, families will receive renewal Form 643E1. Adults who wish to continue receiving medical benefits must complete and return the renewal form. Although the renewal can be completed over the phone, income and the amount of spousal or child support paid must be verified.

Adults who do not respond to the renewal form will lose their medical benefits. If additional information is needed, send Form 1721 Instructions to Client. If the family fails to cooperate, cancel the case. An example of conflicting information includes, but is not limited to, a case that appears on the Priority Action List (PAL) with a potential error code.

Item 80 Code 188 PPR

Item 80 code 188 PPR (for Pending Passive REDE) is entered on each case selected for the administrative renewal. If Item 30 is not updated by the worker on a case that has a code 188, the system will complete the following actions on the close of business of terminal entry for the renewal.

  • (System) Deletes any person age 19 or older;
  • (System) Sends Form 157C or 157KC when an adult is deleted;
  • (System) Updates Item 30 with the month and year of the administrative renewal;
  • (System) Updates Item 32 with the last month and year of the new enrollment period; and
  • (System) Sends Forms 3754 and 3722 on Share and Premium cases

Staff may delete code 188 PPR to stop the system from processing the central actions described above. The following situations are examples of when a worker would delete the 188 PPR code.

  • Customer applies for SNAP benefits;
  • Customer reports a change in income;
  • Customer reports someone moved in or out of the household;
  • The adult is QMB or SLIB eligible (to prevent the adult from audtomatically being cancelled from the Medicare Savings Program, which may take months to reinstate); or
  • A delay in processing the renewal is anticipated due to third party verification or other reason.

The central renewal action will not occur when the following actions are taken by the worker:

  • Code 188 PPR has been deleted, or
  • Item 30 has been updated.

Once the renewal is completed, the Item 80 Code 188 is deleted.

Examples

Example 1: Ms. A is RPY for her children on a 94 case and is due for renewal in 05/10. A Form 643E is mailed to Ms. A. She has no changes to report and does not contact her caseworker by 04/15/10. Because Code 188 PPR is on her case, the system will process the renewal by updating Item 30 and 32 on close of business 04/15/10.

Example 2: Ms.W is RPY for her children on a 94 case and is due for renewal in 05/10. A Form 643E is mailed to Ms. W. She reports that income has changed, signs and returns the form, but does not submit proof of income. The worker sends Form 1721 to Ms. W requesting proof of income. The worker deletes Code 188 PPR to prevent central action on the medical case.  The worker is responsible for completing the renewal process for the case.

Example 3: Mr. B and his children are active on a 94 case and are due for renewal in 05/10. A Form 643E1 is mailed to Mr. B. He completes the renewal form and sends it in along with proof of his income. The caseworker reviews the form and the proof and determines that Mr. B and his children remain eligible with no changes. The worker processes the renewal in ACM, updating Item 30. At close of business on terminal entry, the system takes no action on this case because the worker updated Item 30.

Example 4: Ms. C and her children are active on a 94 case and are due for renewal in 05/10. After Ms. C receives Form 643E1, she applies for SNAP benefits. The worker deletes Code 188 PPR to prevent the central action on the medical case. The worker is responsible for processing the SNAP and medical renewal for the case.

Example 5: Ms. D and her children are active on a 94 case and are due for renewal in 05/10. Ms. D does not send in Form 643E1, nor does she contact her caseworker. Code 188 PPR is on the case. On terminal entry for the renewal, the system changes Ms. D from Assistance to RPY only and updates Items 30 and 32 for the children.