Family MO HealthNet (MAGI) Manual

1880.005.00 Pre-Populated Renewal Form

IM-50 March 25, 2019; IM-08 January 25, 2019; IM-137 November 20, 2017

As provided in 42 CFR 435.916(a)(3), a pre-populated renewal form must be sent when an Automatic Annual Renewal cannot be completed. This occurs when a redetermination cannot be completed due to inconsistent, insufficient or questionable information, or no information is returned from the HUB.

The pre-populated form includes:

  • The most current or reliable information known or available to the agency through:
    • the individual’s case record, or
    • other information available to the agency, such as electronic data sources as listed in 1805.030.05 Income Evidence of the MAGI Family MO HealthNet (MHN) policy manual.
  • Request for required information from the individual to complete the Annual Renewal.
  • Filer consent information request.
  • Reporting requirements for changes that must be reported by the individual throughout the duration of their certification period.

The individual is given 54 days to sign and return the IM-1U and to provide the requested information. If the IM-1U and/or requested information is not received, the IM-80 Adverse Action period begins 10 days prior to the last day of the certification period. If the individual returns the IM-1U, confirm/verify the information provided on the form.

  • Check FAMIS for missing, inconsistent, insufficient, or questionable information.
  • If information is not available in FAMIS, send a Request for Information (IM-31A) to the individual if there are pieces of evidence that require further clarification or verification. Allow 10 days for the individual to respond to the request for additional information.
    • If the individual does not respond to the request for information, the case is closed. It is not required to complete an ex-parte review to determine eligibility for other MHN categories
    • If the individual provides the requested information, a redetermination of the case must be completed.
      • If all participants are found eligible, send a notice informing the individual that the case is renewed for 12 months.
      • If any participant is found ineligible, complete an ex-parte review to determine if eligibility exists in another MHN program.

NOTE: Refer to 1880.025.00 Annual Renewal Case Action Notifications, of the MAGI Family MO HealthNet (MHN) policy manual, for notice procedures.

Refer to 1880.020.00 Reconsideration Period when the pre-populated form is received after the case has closed.