Health Care Renewal Notice Page 5
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46Bulletin #14-21-05
December 23, 2014
Page 5
Example: Jose is enrolled in MA. He receives a pre-populated renewal form on
November 13. The form shows a new increased income amount based on
electronic data sources. Jose reviews the form, signs it and mails it to his servicing
agency on November 20. His worker processes the renewal on December 10, and
Jose’s income is verified electronically. Jose is determined MinnesotaCare eligible.
MA ends effective December 31. Jose’s MinnesotaCare coverage begins January 1
or the month after Jose submits the premium, if he is required to pay one.
C. Late Renewals
A late renewal is a renewal for which either of the following is true:
The renewal form is received during the reconsideration period.
The renewal form is received before the end of the certification period, but
additional information or verifications that were required are received during the
reconsideration period.
A late renewal is complete if the client returned both the pre-populated renewal form
and any information or verifications that a worker requested during the renewal
process. A late renewal must be treated as a new application.
The date of application set by a late renewal is the date the agency received the
pre-populated renewal form, if it was received during the reconsideration period. If
the agency received the pre-populated renewal form before the end of the
certification period, the date of application is the date the information or verifications
were received. Retroactive MA is available up to three months before the month of
application if the enrollee meets the MA eligibility requirements for those months. An
MA enrollee who submits a renewal form late and who moves from MA to
MinnesotaCare when the late renewal is processed as a new application may have
a gap in coverage, as MinnesotaCare is not available retroactively.
A pre-populated renewal form received after the end of the reconsideration period
cannot be used to reapply for coverage. A former enrollee who wishes to reapply
must either complete a new application online using the MNsure website at
or complete the MNsure Application for Health Coverage and Help
Paying Costs (DHS-6696).
Example: Eva’s MA certification period ends March 31. Eva receives a pre-
populated renewal form in February. Eva does not return the pre-populated renewal
form by the last day of March. Instead, Eva returns the completed and signed form
to her servicing agency on July 9. The worker treats the pre-populated renewal form
as a new application, because the agency received it within the reconsideration
period. Eva may be eligible for retroactive MA coverage for April through June if she
was MA eligible in those months.
Minnesota Department of Human Services · PO Box 64238 · St. Paul, MN 55164-0238
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