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State of Wisconsin |
Release 26-02 |
A renewal is the process during which all eligibility factors subject to change are reexamined and eligibility is redetermined. For members who submit their renewal timely (see SECTION 3.1.1 TIMELY RENEWALS), existing heath care coverage must be maintained until the renewal is completed.
The first required renewal for Medicaid is 12 months from the most recent certification month, except for cases with a deductible. For cases that met the deductible, the renewal date is six months from the start of the deductible period. A renewal is not scheduled for an unmet deductible unless another health care program is due for renewal.
An early renewal can only be completed at the member’s request.
A child within their continuous coverage period (see SECTION 1.2 CONTINUOUS COVERAGE FOR QUALIFYING CHILDREN) may be adversely impacted by an early renewal (for example, they could be ineligible, or have a new or higher premium). However, the child will not lose coverage or be charged a new or higher premium during their current continuous coverage period. Other household members may be renewed early and may qualify for new 12-month certification periods.
Health care renewals received by the last business day of the renewal month are considered timely. When a renewal is received timely, the member’s existing health care coverage must be maintained until the renewal is fully processed by the agency. This includes situations where the member no longer meets the requirements of their current health care category and the agency needs to request additional information to determine if the member is eligible for a different form of health care.
| Example 1 | Marta is enrolled in MAPP. July is the last month of her certification period. On July 18, a notice is sent to inform Marta that her coverage will end July 31 because she did not yet complete her renewal. Marta's renewal is submitted on July 31 during business hours. Marta’s MAPP coverage is reinstated for the month of August, and she is sent a notice that she is enrolled in MAPP effective August 1 and will remain enrolled while the agency processes her renewal. On August 19, the renewal process is completed, and Marta is no longer eligible for any category of health care. Marta receives a notice that her MAPP coverage will end September 30, in accordance with notice requirements. |
For QMB renewals, benefits reopen from the first of the month following when coverage ends if the eligibility redetermination is fully completed during the renewal month or the month following the renewal month. See section 32.10.1 QMB RENEWALS.
| Example 2 | Diana is open for SSI-Related Medicaid and QMB which is due for renewal in February. She submits her renewal on February 20. Because her renewal is timely, her benefits are maintained for March. On February 22, the worker processes the renewal and requests needed verification with a due date of March 14. On March 14, verifications are received for the renewal and eligibility is determined. Diana is enrolled in a new certification period starting April 1. There is no gap in her MS or QMB enrollment. |
For Katie Beckett Medicaid renewals, see Section 29.2 Katie Beckett Medicaid Renewals.
Health care renewals received within three months of the renewal month can be processed as a late renewal instead of requiring a new application. There is no requirement for prior health care benefits to be maintained for a late renewal. The three-month period that allows for late renewals and renewal-related verifications starts the month after enrollment ended. It does not restart when a late renewal or when late verification has been submitted.
Exceptions: Late renewal policies do not apply to SeniorCare.
This policy applies to members receiving health care benefits based on a met deductible but not to members with an unmet deductible.
Late renewals are only permitted for people whose eligibility has ended due to lack of renewal and not for other reasons.
Late renewals and renewal-related verifications must be accepted for up to three calendar months after the renewal month. Members whose health care benefits are closed more than three months due to lack of renewal must reapply.
A late submission of an online or paper renewal form or a late renewal request by phone or in person is a valid request for health care. If verification is required to complete the renewal, the member has 20 days to provide it, even if this extends renewal processing into the fourth month after benefits closed.
| Example 1 | Jenny's renewal is due in January. No renewal is received by January adverse action, so a notice is sent to Jenny explaining her coverage will end effective January 31. Her renewal is later received on March 10, and Jenny requested backdated coverage for February. Jenny’s income verification is due on March 30. She provides verification of February and March income by the due date and meets all other eligibility criteria for Medicaid. Her new certification period starts on March 1 with a backdate to February 1. Her next renewal will be due in February of the following year. |
| Example 2 | Joni's renewal is due in January. Joni did not submit a renewal by January adverse action, so a notice is sent to Joni explaining her coverage will end effective January 31. She submits a renewal on April 25, with a backdate request to February. The renewal is processed the same day, and she is asked to provide verification of her income by May 15. If Joni provides verification of her February, March and April income on or before May 15 and meets all other eligibility criteria for Medicaid, she will be enrolled in a new certification period starting on April 1 with a backdate to February 1. Her next renewal will be due in March of the following year. If Joni submits verification after the May 15 due date, a new application is required. She can request up to three months of backdated coverage when she reapplies. |
For QMB renewals benefits reopen from the first of the month following when current coverage ends, whether the renewal is completed timely in the renewal month or completed late in the month following the renewal month. See Section 32.10.1 QMB Renewals.
| Example 3 | Shelly has Medicaid and QMB renewals due in February. She submits her Medicaid and QMB renewal late with the necessary verifications on March 20. On March 30, the worker processes the renewal and verifications which completes the Medicaid and QMB renewal. The member is enrolled in Medicaid and QMB with a new certification period starting March 1. There is no gap in her QMB eligibility because benefits are confirmed in the month following the renewal month. |
| Example 4 | Cindy has Medicaid and QMB renewals due in February. She submits her Medicaid and QMB renewal late with the necessary verifications on April 20, requesting a backdate for March. On April 22, the renewal and verifications for March and April are processed, which completes the Medicaid and QMB renewal. The member is enrolled in Medicaid with a new certification period starting April 1 with a backdate to March 1, and QMB with a new certification period starting May 1. There is a gap in her QMB eligibility because the redetermination was not confirmed during the renewal month or the month following the renewal month. |
If a health care renewal is received timely but verifications are not provided with the renewal submission, the health care program open during the renewal month is maintained while awaiting verifications. If verification is not received by the verification due date, the requirement to maintain benefits ends and health care coverage ends.
If a health care renewal is received late, health care is not maintained while eligibility is being redetermined. Regardless of whether a renewal was received timely or late, if verifications are submitted anytime in the three months following the renewal month health care can reopen without a new application.
During the three months following the renewal due month, any verification that was previously provided as part of the renewal process, including AVS results, remains acceptable unless a subsequent change was reported. Only the missing verifications must be provided.
If a member has a gap in coverage, and is requesting backdated coverage, verification is required for all requested months. The member will have 20 days to provide the verification.
| Example 5 | Sunny's Medicaid renewal is due in January. She completes her renewal timely on January 5, and income verification is requested with a due date of January 25. Medicaid coverage is maintained for February. Sunny does not submit the requested verification by January 25, and her Medicaid eligibility ends February 28. On April 27, she submits paystubs for March 10 and March 24, and requests a backdate to March. Verification of her current income for April is requested, with a due date of May 17. On May 17, April income verification is provided. Sunny meets the eligibility criteria for Medicaid and her new certification period begins on April 1 with a backdate to March 1. Her next renewal will be due in March of the following year. |
If a member has a gap in coverage because of a late renewal, late verifications, or both, the member may request coverage of the past months in which a gap in coverage occurred. Backdated coverage under the late renewal policy is available to all health care members who meet program rules (see Section 2.8.2 Backdated Eligibility).
If a member requests coverage for past months during a late renewal, they must provide all necessary information and verification for those months (including verification of income and assets for all months requested). A member must also pay any required premiums to become eligible for those months.
| Note | QMB coverage is not retroactive. For QMB see Section 32.10.1 for QMB begin dates following a renewal. |
| Example 6 | Marge's SLMB+ renewal is due in January. No renewal is received by January adverse action. A notice of SLMB+ coverage ending January 31 is sent to Marge. She calls the agency to complete a late renewal on April 15 and requests a backdate to February. Verification is requested for February, March and April. The due date is May 5. If she provides verifications for each month on or before May 5 (and she meets all other eligibility criteria) her certification period starts as of April 1 with a backdate to February 1. Her next renewal will be due in March of the following year. |
If health care coverage was maintained during a renewal and the member’s enrollment changes to a new health care program or has a reduction in their premium, liability, or cost-share, their eligibility may need to be redetermined for the month(s) that coverage was maintained.
After a renewal is processed, if a member’s enrollment changes from a limited-benefit to a full benefit health care program, the eligibility in the new program may need to be redetermined for the months that coverage was maintained and any month in which the member may be eligible for the new health care program.
After a renewal is processed, if the member becomes eligible for SLMB, SLMB+, or QDWI, their eligibility will be redetermined in the new MSP program retroactively back to the date their prior benefits were maintained. Normally, an individual cannot qualify for SLMB+ if they are enrolled in full-benefit Medicaid, but in this circumstance the overlap is allowed.
| Example 7 | Tom is enrolled in MAPP and receives Medicare. The only Medicare Savings Program he qualifies for financially is SLMB+, but he is not enrolled because he has full-benefit Medicaid. His health care renewal is due in February. He submits a renewal on February 3. Verification is requested with a due date of February 23. Because his renewal was received timely, his MAPP coverage is maintained for March. Verification is received on February 19 along with a report that Tom is no longer meeting the MAPP work requirement. MAPP enrollment ends as of March 31 and Tom’s eligibility for SLMB+ begins on March 1. |
| Example 8 | Matt’s Institutional Medicaid is due for renewal in February. He submits a renewal on February 3. Income verification is requested with a due date of February 23. Because his renewal was received timely his Institutional Medicaid coverage and his patient liability from February are maintained for March. Verification is received on February 19 verifying an income reduction. Although Institutional Medicaid coverage was maintained through March, the income reduction was reported in February and verified timely, so his patient liability is reduced retroactively for February and March. |
Eligibility must be retroactively determined in situations where health care coverage was maintained for one household member and, after the redetermination of eligibility, another household member that was previously not eligible for health care is newly eligible. Eligibility is determined back to the date the change was reported.
| Example 9 | John and his wife Julieta both applied for health care. Julieta was denied for being over assets for MAPP, but John opened for MAPP. John is due for renewal in February. On February 3 the renewal is submitted. Verification is requested with a due date of February 23. John’s MAPP coverage is maintained for March. Verification is received on February 19. A joint asset decrease makes both John and Julieta eligible for MAPP with a new certification period starting April.1. However, because the asset reduction was reported and verified in February, Julieta’s eligibility for MAPP is determined retroactively for February and March. |
This page last updated in Release Number: 26-01
Release Date: 02/13/2026
Effective Date: 02/13/2026
The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.
Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.
Publication Number: P-10030