A. Chapter Contents

The following topics are covered in this chapter:

Topic

1401.00 General Information About Renewals

1402.00 SSI MAO Renewals

1402.01 Customers Who Are Seriously Mentally Ill (SMI)

1402.02 Federal Emergency Services Renewals

1403.00 ExParte

1403.01 Eligibility Determinations

1403.02 DES Referrals

1403.03 SSI MAO Eligibility Determinations when ALTCS is Pending

1403.04 Sample PMMIS ExParte Notice

1404.00 Medicare Cost Sharing Renewals

1405.00 BCCTP Renewals

1405.01 Re-Qualifying for the BCCTP

1406.00 ALTCS Renewals

1406.01 Case Specific Verification Requirements

1406.02 How to do the Renewal

1406.03 ALTCS Renewal Processes

1407.00 AHCCCS Freedom to Work Renewals

1407.01How to do the FTW Renewal

B. Frequency

A renewal of ALTCS eligibility is required at least once every 12 months.

C. System Checks

For all renewal methods, obtain a WTPY for the customer and the customer's spouse during the ALTCS renewal process.

If the customer or the customer's spouse is employed, use the following link to "The Work Number" to verify earned income, http://www.theworknumber.com.

The Eligibility Specialist may request additional system checks (ASSISTS or AZTECS or GUIDE).

Appendix VII of the ALTCS ACE Procedures Manual provides specific information about system checks.

D. General Verification and Documentation Requirements

Review all the conditions of eligibility for one of the following months:

• The month of interview;
• The month prior to the month of interview;
• The month following the interview.

All income and resources must be verified for the same month. Review all of the conditions of eligibility but do no verify unless questionable.

A. Definition

A renewal is a periodic review of financial and non-financial eligibility factors.

B. Frequency

Federal law requires a renewal of all eligibility factors at least once every 12 months for each AHCCCS customer. 

The renewal process may be completed earlier if:

• The customer's circumstances have changed drastically;

• An ALTCS customer loses eligibility for SSI Cash;

• An ALTCS customer or community spouse requests early conversion to post-initial community spouse rules;

• The eligibility office prefers to complete the renewal prior to the required date.

C. Process Steps

The renewal process for any AHCCCS program involves the following steps:

Step

Action

1

Request information from the customer. Usually this means sending the customer a renewal application form and requesting documentation of specific conditions of eligibility.

2

Complete system checks. Required system checks are specified by program.

3

Review and evaluate the renewal application form and documentation received from the customer.

4

Review the information in the existing case record and compare it with the information on the renewal application.

5

Request missing information/documentation, if needed and resolve discrepancies.

6

Create a renewal control date in ACE and enter updated verification.

7

Disposition the renewal control date.

8

Send the customer a notice explaining any changes in eligibility or customer costs, including discontinuance if the customer no longer meets all of the conditions of eligibility for the program.

D. Medicare Cost Sharing Dual Eligibility

When the customer is eligible for a Medicare Cost Sharing program in addition to ALTCS, SSI MAO, or AHCCCS Freedom to Work, the renewal is completed for both programs at the same time.

E. Failure to Complete and Return the Renewal Application

If the customer fails to complete and return the renewal application, discontinue eligibility for the services the customer is receiving using the discontinuance reason "Renewal Not Completed".

F. Offering Customers Opportunity to Register to Vote

The National Voter Registration Act (NVRA) of 1993 and Arizona Revised Statute require that pubic assistance offices to provide applicants and recipients with an opportunity to register to vote at the time of application.

The NVRA requirements are specified both in Federal and State law. The legal basis are:

• The United States Code - 42 USC 1973gg.
• The Arizona Revised Statutes - ARS 16-140.

The ALTCS and SSI-MAO local offices are considered public assistance offices and must comply with NVRA.

Follow the instructions in Offering Customers the Opportunity to Register to Vote.

A. Frequency

A renewal of SSI MAO eligibility is required at least once every 12 months. Complete the renewal by the last day of the month in which the renewal is due.

B. Method

The renewal is completed by mail. Call the customer, if necessary, to clarify information relevant to the renewal.

C. Renewal Application Form

ACE generates a renewal application form. 

When needed, mail an Application for AHCCCS Medical Services and Medicare Cost Sharing Programs (DE-103).

D. Required Forms

The following forms must be signed and dated by the customer:

• The ACE generated renewal application; or

• The Application for AHCCCS Medical Services and Medicare Cost Sharing Programs (DE-103)

NOTE: For customers who are under the age of 21, mail the EPSDT-Early, Periodic, Screening, Diagnosis and Treatment brochure to the customer (or the customer's parent or representative, if applicable).

E. System Checks

The following system checks are required for the customer and responsible relatives during each renewal:

• WTPY;

• PMMIS;

• AZTECS; and

• GUIDE.

F. Verification Required

Review verification documentation for conditions of eligibility that are not expected to change and re-verify only if you have information that makes the current status questionable. 

During the renewal process, re-verify the following conditions that are subject to change:

Condition

Verification Required

SSI-linked category:

• Age 65 or older;

• Blind; or

• Disabled

Use the policy in:

MS 511.00 (disabled); or

MS 505.00 (for blind).

If the customer has attained age 65, the categorical link is age.

Arizona Residency

Use the policy in MS 529.00

Citizenship or

Non-citizen Status

Check to make sure that the condition of eligibility was previously verified and the customer continues to meet the eligibility requirement. 

NOTE:  When qualified alien status was established at approval, it is not necessary to re-verify non-citizen status at renewal. 

If the customer reports a change in status obtain USCIS verification of the change (MS 522.00).

Income

Verify the income of the:

• Customer;

• Customer's responsible relative(s); and

• Customer's dependent children (for Child Allowance); and

• Sponsor deemed income (if applicable).

Use the policy in Chapter 600

Student Status

Verify student status for the following students under age 22 in the household who may qualify for Student Earned Income Exclusion:

• The customer for the income eligibility determination (MS 610.02); or

• The customer or customer's spouse's child to determine the child allocation (MS 610.08).

Medicare Entitlement and Premiums

Use the WTPY to verify Medicare information.

Medical Care Support

Complete a collateral contact with the TPL source (MS 504.02).

Potential Benefits

• Review documentation to ensure that prior referrals have been resolved. 

· Initiate a new referral if potential benefits are identified during the renewal process.

(MS 524.00)

G. SSI MAO Renewal Process

Complete the following steps to complete a SSI MAO renewal:

Step

Action

1

ACE generates a renewal application to the customer. 

NOTE: When needed, use an Application for AHCCCS Medical Services and Medicare Cost Sharing Programs (DE-103).

If the customer...

Then...

Returns the renewal application

Continue to Step 2

Does not return the renewal application

Create a renewal control in ACE and go to Step 5.

2

Request a WTPY.

3

Review:

• The completed renewal application;

• The customer's prior records;

• Documentation provided by the customer; and

• The WTPY response.

4

Create a renewal control date in ACE and update the control date with the information received.

If...

Then...

All documentation is complete;

Go to Step 5.

Information or documentation is missing;

Send a Request for Information to the customer and allow the customer 10 days to provide the information. 

Then go to Step 5.

5

Disposition the control date for SSI MAO. 

NOTE: If the customer has Medicare, also evaluate and disposition Medicare Cost Sharing eligibility.

If the customer...

Then...

No longer meets all of the conditions of eligibility

Discontinue SSI MAO using the appropriate reason.

Does not provide the information or documentation requested at Step 4

Discontinue SSI MAO using the appropriate failure to verify reason.

Did not return the renewal application

Discontinue SSI MAO using the reason "Renewal Not Completed".

Meets all the conditions of eligibility

Approve the renewal control date to continue SSI MAO eligibility.

6

Review the notice in ACE to make sure that it is correct.

• ACE automatically generates a notice when there is a change in eligibility.

• The notice is suppressed when there is no change in eligibility.

• If needed, send a manual notice.

A. General Process

Follow the policy and instructions for SSI MAO renewals in MS 1402.00, but work with the Tribal and Regional Behavioral Health Authorities (Tribal/RBHA) contact person (as described in this subsection) to obtain documentation required for the renewal.

B. ADHS Participation

The Arizona Department of Health Services/Division of Behavioral Health Services (ADHS) contracts with Regional Behavioral Health Authorities and Tribal Regional Behavioral Health Authorities (Tribal/RBHA) to coordinate the delivery of mental health service to eligible customers. ADHS collaborates with AHCCCS to screen and refer customers who are potentially eligible for AHCCCS Health Insurance when the customer is receiving or requesting behavioral health services (MS 1303.07). 

The Tribal/RBHA helps AHCCCS and the customer complete the annual renewal and/or reestablish disability for the DDSA diary date by:

• Providing necessary medical information;

• Obtaining necessary financial information; and

• Helping the customer complete the annual Renewal Form.

C. SMI Processing Instructions

In general, follow the processing instructions in How to Process Initial and Renewal Applications for SMI A and SMI B Customers Referred by ADHS. 

However, follow the processing instructions in How to Refer a Customer with a Serious Mental Illness (SMI) to DES for a Decision if the customer has income less than 100% FPL, and:

• The SSI MAO office has not received the required medical documentation after sending written requests to both the Tribal/RBHA designee and the customer; or

• DDSA determined the person is not disabled.

A. Frequency

Renewal of eligibility for Federal Emergency Services (FES) under SSI MAO is required every six months. 

EXCEPTION: Customers with End Stage Renal Disease (ESRD) receive a 12-month eligibility period. 

FES eligibility is approved for six month or twelve month certification periods and eligibility is automatically terminated in ACE and PMMIS at the end of the certification period. When a renewal is completed timely, eligibility continues without a break.

B. Method

The renewal is completed by mail. Call the customer, if necessary, to clarify information relevant to the renewal.

C. Renewal Application Form

Use the Application for AHCCCS Health Insurance and Medicare Cost Sharing Programs (DE-103).

D. Required Forms

• Federal Emergency Services Renewal Notice (MA-200)

• Application for AHCCCS Health Insurance and Medicare Cost Sharing Programs (DE-103)

E. System Checks

The following system checks are required for the customer and responsible relatives during each renewal:

• PMMIS;

• WTPY, if the customer has a Social Security number;

• GUIDE, if the customer has a Social Security number; and

• AZTECS.

F. Verification Required

During the renewal process, re-verify the following conditions that are subject to change:

Condition

Verification Required

SSI-linked category:

• Age 65 or older;

• Blind; or

• Disabled

Use the policy in:

MS 511.00 (disabled); or

MS 505.00 (for blind).

If the customer has attained age 65, the categorical link is age.

Arizona Residency

Use the policy in MS 529.00

Income

Verify the income of the:

• Customer;

• Customer's responsible relative(s);

• Customer's dependent children (for Child Allowance); and

• Sponsor deemed income (if applicable).

Use the policy in Chapter 600

Medicare Entitlement and Premiums

Use the WTPY to verify Medicare information.

Medical Care Support

Complete a collateral contact with the TPL source (MS 504.02).

Non-citizen status

If the customer reports a change in non-citizen status obtain USCIS verification of the change (MS 522.00).

Potential Benefits

• Review documentation to ensure that prior referrals have been resolved. 

•Initiate a new referral if potential benefits are identified during the renewal process.

(MS 524.00)

Student Status

Verify student status for the following employed students under age 22 in the household who may qualify for the Student Earned Income Exclusion:

• The customer for the income eligibility determination (MS 610.02); or

• The customer or customer's spouse's child to determine the child allocation (MS 610.08).

G. FES Renewal Process

Follow these steps to process an application for a new FES certification period.

Step

Action

1

At the beginning of the 5^th or 11^th month in the customer's certification period, mail the Application for AHCCCS Health Insurance and Medicare Cost Sharing Programs (DE-103) to the customer so the customer can reapply. 

Write FES boldly on the first page of the application form to facilitate routing to the correct unit when the application is returned. 

NOTE:  If the customer does not return the application, no further action is necessary. Eligibility will stop when the certification period ends.

2

Request a WTPY for customers with a SSN.

3

When you receive the DE-103, register the new application as follows:

If you receive the DE-103...

Then...

During the 5^th or 11^th month of the current certification period

Do not register the application in ACE until the following month. 

However to prevent any delay in approving the case in the following month, start the application process immediately by reviewing the DE-103 and requesting missing information that is needed to make the eligibility determination.

After the certification period ends

Register a new application for the month in which the DE-103 is received

4

Review the completed DE-103 and the documentation provided by the customer and update the application control date.

5

Disposition the control date:

If the customer...

Then...

• No longer meets all of the conditions of eligibility

• Does not provide documentation requested

Deny the application using the appropriate denial reason.

Continues to meet all the conditions of FES eligibility

Approve a new 6-month or 12-month certification period.

Meets all the conditions for full AHCCCS Medical Services

Approve SSI MAO. The next renewal will occur in 12 months.

6

Review the notice in ACE to make sure that it is correct.

• ACE automatically generates an approval notice.

• If needed, issue a manual notice.

A. What is ExParte?

A customer who receives SSI Cash in Arizona is also eligible for AHCCCS Medical Services. If the customer loses SSI Cash, the customer loses automatic eligibility for AHCCCS Medical Services as a SSI Cash recipient (MS 415.00), but may be eligible under another AHCCCS program. 

Prior to discontinuing AHCCCS Medical Services, a renewal of eligibility is completed to see if the customer meets the eligibility requirements for any other AHCCCS program. This renewal can sometimes be based on information available from the WTPY, ACE, PMMIS and AZTECS, but usually additional information needs to be requested from the customer. This eligibility renewal process is called ExParte.

B. SDX/ PMMIS Interface

When the Social Security Administration (SSA) terminates SSI Cash, the termination is communicated to AHCCCS by a State Data Exchange (SDX) file. SSA sends the SDX file to AHCCCS for processing against the PMMIS database. 

PMMIS processes the actions based on the:

• Payment Status Code;

• Medicaid Test indicator;

• Medicaid Eligibility Code;

• Transaction Code; and

• Appeal Status, including decision and date.

C. ExParte Status in PMMIS

Not all customers who lose SSI Cash eligibility enter the PMMIS ExParte process. 

PMMIS does not create an ExParte record when the customer was reinstated for SSI Cash or lost SSI Cash eligibility due to:

• Moving out of the country;

• Moving out of state;

• Incarceration;

• Institutionalization; or

• Death

PMMIS applies other edits to the SDX information before releasing the ExParte record to SSI MAO or DES for processing.

D. ExParte Eligibility Key Codes

Unless the customer already has eligibility in another coverage group, the customer's eligibility for AHCCCS Medical Services is continued in one of the ExParte Eligibility Key Codes listed below:

Key Code

Description

382

SSI-MAO ExParte Aged

392

SSI-MAO ExParte Blind

422

SSI-MAO ExParte Disabled

424

SSI-MAO Appeal (Blind or Disabled)

E. Customer Notification from PMMIS

When PMMIS continues eligibility under an ExParte Key Code, PMMIS automatically mails the Notice About AHCCCS ExParte Medical Services form (MS 1403.04) to the customer that tells the customer the following information:

• What happens to the customer's AHCCCS Medical Services when the customer's SSI Cash benefits stop;

• AHCCCS or DES may contact the customer to complete an eligibility renewal for AHCCCS Medical Services; and

• Where to call if the customer has any questions about the health plan or information in the letter.

F. ExParte Period

PMMIS posts ExParte eligibility with a begin date and an end date. Usually, this is a two to three month period to allow sufficient time to determine on-going eligibility. The ExParte renewal must be completed prior to that end date.

G. PMMIS/ Systems Interfaces

PMMIS sends information about the customer's ExParte status to ACE or to DES based on a system screening. 

PMMIS applies certain logic and edits to decide whether to send an ExParte case through the SSI MAO ACE ExParte process or to send the ExParte case to DES. PMMIS refers to DES when the customer is potentially eligible for on-going Medicaid through a DES category. This includes:

• Children under age 19; and

• Adults under age 65 who lost their SSI Cash benefits because the Social Security Administration no longer considers them to be blind or disabled.