Generating a Pre-filled MA Renewal Form

On the 1st Saturday after MA cutoff, VaCMS will utilize external income verification sources, SNAP income data, and other methods to verify earned and unearned income to automate ex parte renewals due two months from the end of the month the process is run. Assess the Automated Ex Parte Renewal Report and then manually generate a pre-filled Administrative Renewal Form if a renewal form was not automatically generated for a case with a renewal due two months from the end of the month the process is run.

The pre-filled renewal form includes current case details contained in the VaCMS to allow those case details to be reviewed and verified or updated as part of the MA administrative renewal process.

You can generate a pre-filled renewal form at any time prior to the renewal due date when the case is active in the VaCMS. Forms can also be generated for overdue renewals.

Note: Pre-filled renewal forms can be generated for shell cases converted from MMIS. Unless updates are made to the case prior to generating the renewal form, only information that was automatically transferred over during conversion will display as pre-filled. Pre-filled renewal forms only populate for cases within the VaCMS.

Before you generate and print the form, check Pending Forms and Forms History to see if a Renewal Form has already been generated for the case. If one exists, be sure to check that the generated form matches the correct date and information needed to complete the redetermination. If you need to generate a new form, the steps are as follows:

1. From the Left Navigation menu, select Redetermination, then MA Renewal Manager.
2. From the Action to be Performed dropdown menu, select Form Generation.
3. You can search by Employee User ID and Redetermination Due Month Between OR you can search by Case #.
   1. Click the radio button next to the option by which you want to search, then complete the field(s).
4. Click Search.
5. Select the checkbox in the Termination / Form Generation column.
6. Click Submit.

7. Navigate to the View Pending Forms page and locate the form you generated by its case number.

8. The form is marked for Central Print. No action is necessary.
   1. If you prefer, you can print the pre-filled renewal form and mail it to the customer.
   2. Be sure to mark the form as printed locally so it is not also printed by Central Print.

Note: Generating a new renewal form when one has been completed establishes a new due date 30 days from the current generation date.

The following entries describe the sections of the pre-filled renewal form in the order they appear.

Front Page

Provides Department of Social Services contact information, case information, and instructions for completing the renewal form. Header and footer data is generated automatically.

Section 1: Contact information

The customer reviews or modifies their contact information. The Review Your Contact Information Here section is pre-filled with the applicant information (if information is known in the system).

Section 2: Tax Information

The customer reviews or modifies their tax information. The Review your tax information here field is pre-filled with the tax information of all the individuals in the household (if information is known in the system). Tax information will not be pre-populated with data supplied by the IRS or Federal hub.

Section 3: People in Household Receiving Medical Assistance

This section details the household members currently receiving MA who need to renew.

Section 4: Other People in Household Not Receiving Medical Assistance

This is pre-populated with information for case individuals who do not receive MA in the current case AND who are also any of the following:

• In the household.

• A tax dependent, tax filer, or joint filer.

• Not in the household but intending to return to the household.

Section 5: Applying for Medical Assistance

Allows individuals not listed in section 3 who are currently living in the household to apply for Medical Assistance. No fields are pre-populated. A copy of this page must be created for every new individual who is seeking assistance; the VaCMS does not automatically generate multiple copies.

Section 6: Other Health Insurance

This section asks if anyone in the household renewing or applying for MA is enrolled in some other type of health insurance. This section is pre-filled with any health insurance and MCO information (if information is known in the system).

Section 7: Personal Information

This section collects additional information for everyone listed in Sections 3, 4 and 5. Question 1 will not be pre-filled. Questions 2, 3, and 4 are pre-filled (if information is known in the system).

Sections 8 & 9: Employment

There are three parts:

Employment: The customer provides information about anyone in the household who is working. It includes current non-end-dated employment information about individuals in the household.

Job Change: The customer provides information about anyone in the household who has a new job or has changed jobs. Month-to-month household income changes are not pre-filled.

Self-Employment: The customer provides information about anyone in the household who is self-employed. This subsection is pre-filled (if information is known in the system).

Section 10: Other Income

The customer reports any unearned income or deductions. Both the Unearned Income and Deductions sections are pre-filled (if information is known in the system).

Section 11: Aged, Blind, or Disabled General Questions

This section collects information about anyone in the household who is aged (65 or over), blind, or disabled. This section may include information about expenses, resources, and income.

Note: While the renewal form is pre-filled with resources listed prior, it does not detail the specifics of the resources other than the type. The customer will need to update and / or declare resources.

Section 12: Sign Application

The customer completes the following subsections:

• Renewal of coverage in future years.

• Your Rights and Responsibilities.

• Consent to Exchange Information.

• Other Request for Information:

• • Plan First coverage request for evaluation.

  • Confirmation of Incarceration.

Appendix

Contains three parts:

Appendix A. The customer provides information about anyone in the household who is an American Indian or Alaska Native (if applicable).

Appendix B. The customer chooses an Authorized Representative or Certified Counselor / Navigator / Broker. This section is pre-filled with Authorized Representative and Certified Counselor / Navigator / Broker information (if information is known in the system).

Appendix C. This section details eligible immigration status lists and immigration document types, as well as self-employment business deductions.

Updated 04/17/2017