In order to continue to receive Medicaid coverage, Individuals and families must renew their Medicaid coverage once a year. The Affordable Care Act (ACA) introduced a new way to determine household composition and income which is called Modified Adjusted Gross Income (MAGI) methodology
. This new methodology is only applied to certain eligibility groups. These groups are known as the MAGI groups:
Converted MAGI Renewals (M1 Renewals) vs. DC Health Link Renewals (D1 Renewals)
If you fall within one of the MAGI groups and you applied for Medicaid prior to October 2013, your Medicaid eligibility was determined using pre-MAGI rules. This simply means that your eligibility for Medicaid was determined prior to the implementation of the ACA and eligibility for you and your household will have to be redetermined using the new MAGI rules. These renewals are called Converted MAGI renewals or M1 Renewals. You are considered a part of the Converted MAGI group if you receive a M1 pre-populated renewal form. The pre-populated form will be mailed 60 days prior to the end of your certification period.
Passive Renewals for M1 Renewals Only
If the District is able to renew your Medicaid eligibility based on reliable and current information available to the District, including but not limited to information accessed through any local and federal data bases, the District will issue a notice of the determination and its basis to you no later than sixty (60) days before the end of the certification period. The District will renew your eligibility for twelve (12) months. This process is known as a passive renewal. When the District cannot determine eligibility using available electronic information, you will receive a pre-populated renewal form with information available to the District, with M1 on the top right corner of the form with a statement of the additional information needed to renew eligibility, and the date by which you must provide the requested information.
DC Health Link D1 Renewals
If you applied for Medicaid through DC Health Link, then your eligibility for Medicaid was determined using MAGI rules when you submitted your application. There is no conversion process for those who applied for health coverage via DC Health Link. These renewals are known as D1 renewals. When it is time for your Medicaid coverage to be renewed, you will receive a D1 pre-populated renewal form in the mail. The form will be mailed out 60 days before your Medicaid coverage is scheduled to end.
For more information on the different methods in which to renew coverage for M1 and D1 beneficiaries and what the forms look like, please visit this link below.
It is very important that you submit your renewal form back to the Economic Security Administration (ESA) timely. If you have not received your renewal form and you know that the end of your certification period is approaching or you may have misplaced your renewal form, please contact the Call Center to speak with a caseworker on (855) 532-5465. They will be able to ensure that the system generates a new form and is sent to the right address.
If you have not submitted your renewal form by the end of your certification period, DO NOT PANIC! Although your eligibility for Medicaid may have ended, you still have up to 90 days after the end of your eligibility period to submit your renewal form. This is known as the renewal grace period. If you do not get your renewal form in by the 90th day, you will be required to submit a new application for medical coverage.
Non-MAGI Renewals, Alliance, and Immigrant Children’s Program
Non-MAGI renewals apply to any individual who does not meet the requirements for the respective MAGI-Medicaid eligibility categories. The Non-MAGI Medicaid groups include: SSI recipients, Aged, Blind, and Disabled individuals, Foster Care (IV-E or Non-IV-E), Spend Down, Breast and Cervical Cancer, Long Term Care beneficiaries, and Qualified Medicare Beneficiaries (QMB) and Qualified Medicare Beneficiaries Plus beneficiaries. SSI recipients, Optional State Supplement Payment recipients, and children and youth in foster care are categorically eligible for Medicaid and do not have to submit an application or renewal as long as they continue to meet the eligibility requirements for their respective programs.
Eligibility for beneficiaries enrolled under one of our Non-MAGI program and the Immigrant Children’s Program will last for twelve (12) consecutive months. DC Alliance program recipients must recertify for benefits every six (6) months and complete a face to face interview. Persons may request a waiver of this requirement due to being hospitalized, disabled or elderly (documentation is needed to support a waiver request).
ESA will send a renewal form to your address 90 days before your certification period ends. Once you receive the form, fill it in completely and send it back to ESA. You may be asked to provide proof of your income, residency, or resources with the form. You may submit the renewal form:
Mail your original, signed application for medical assistance (and appendices, if applicable) to ESA:
P.O. Box 91560