How to Complete Your Minnesota Medical Assistance Renewal Form (DHS-3418)

The DHS-3418 is Minnesota’s Medical Assistance renewal form for people age 65 or older, people who are blind or have a disability, Medicare Savings Program enrollees, people with an MA spenddown, and adults 21 or older without children who have Medicare.1Minnesota Department of Human Services. Renewal Forms for Health Care Programs To complete it, you report your current household, income, and assets, attach documents that back up what you reported, sign and date the form, and return the packet to your county, tribal, or state agency before the deadline printed on your renewal notice.2Minnesota Department of Human Services. Renew My Coverage

Make Sure the DHS-3418 Is the Right Form for You

DHS mails renewal packets in an envelope marked with a blue circle when your renewal date is coming up, and the form inside depends on your coverage category.2Minnesota Department of Human Services. Renew My Coverage The DHS-3418 is specifically for the asset-tested populations listed above. Families, children, and most non-elderly adults receive the DHS-8262 instead. People getting long-term care services use the DHS-2128. If the form you received does not match your situation, call your county or tribal worker before you fill anything out.1Minnesota Department of Human Services. Renewal Forms for Health Care Programs

You received a paper form because DHS could not confirm your eligibility automatically. Federal rules require the agency to try an ex parte renewal first, checking your file and electronic data sources. For MA-ABD and Medicare Savings Program enrollees, the automated check only works when assets are nonexistent, verifiable through electronic sources, or unlikely to increase in value. If any of your countable resources fall outside those categories, expect the paper form every year.3Minnesota Department of Human Services. Bulletin 24-21-06 DHS Modifies Ex Parte Renewal Process for MA-ABD and MSP Enrollees

Gather Your Documents First

The DHS-3418 asks for the same categories of information you provided when you first applied, with a stronger focus on resources than the forms used for families.4Minnesota Department of Human Services. Health Care Programs Manual – Renewal Forms Pull these together before you sit down with the form:

  • Social Security numbers for every household member listed on the form.
  • A current list of everyone living with you, with any changes since your last renewal: births, deaths, people who moved in or out, marriages, divorces.
  • Income documentation for each household member: pay stubs covering the last 30 days, Social Security award letters, pension statements, self-employment records, unemployment benefit statements, and anything else bringing money into the household.
  • Current balances for bank accounts, certificates of deposit, stocks, and bonds, plus the value of any vehicles or property beyond your primary home.
  • Information about any other health coverage anyone in the household carries, including employer plans and Medicare. MA often pays after other insurance, so the agency needs the full picture.
  • Anything else that has changed: address, citizenship or immigration status, disability status.

Getting everything together before you start cuts down on back-and-forth with your caseworker and reduces the risk of a delay for missing information.

Fill Out Each Section

Work through every section that applies to your household, even if nothing has changed. Leaving a section blank can trigger a request for more information and eat into your deadline.

Household

List everyone living in your home. Note any additions or departures since your last renewal, with dates where you can.

Income

Report each income source for each household member separately, and match the numbers to your pay stubs or benefit letters exactly. If you are paid every two weeks, write the biweekly amount and mark the pay frequency rather than converting to a monthly figure yourself. The agency uses its own conversion method. If you are self-employed, report your gross self-employment income and list deductible business expenses as a separate line.

Assets

This is where the DHS-3418 differs most from the family version. List each bank account with its current balance, every investment account, and the value of vehicles beyond your primary car. Minnesota’s Asset Verification Service can check savings accounts, checking accounts, money market accounts, and CDs electronically, so the numbers you write on the form should match what your institutions would report.3Minnesota Department of Human Services. Bulletin 24-21-06 DHS Modifies Ex Parte Renewal Process for MA-ABD and MSP Enrollees Your home is generally exempt as long as you live in it, though a home equity limit applies for people receiving long-term care services.

Other Coverage and Changes

Fill in details about any other health insurance in the household and note any change to your address, citizenship or immigration status, or disability status.

Signature

Sign and date the form. An unsigned renewal gets sent back to you, which cuts into your deadline.

Submit the Completed Packet

Return the form and your supporting documents to your county, tribal, or state agency before the deadline printed on your notice.2Minnesota Department of Human Services. Renew My Coverage Three options are typical:

  • Mail the packet to the address on your renewal notice, using the return envelope if one was included. Keep a photocopy of everything you send, and consider certified mail or tracking so you have proof of the mailing date.
  • Drop the packet off in person. Most county and tribal human services offices have secure drop boxes or a service counter. This is the fastest way to confirm receipt if your deadline is close.
  • Submit online or by phone where your county offers it. Availability varies, so check with your agency first.

If you originally enrolled through MNsure, your renewal still goes to your county, tribal, or state agency rather than through MNsure’s portal.5MNsure. Renew Medical Assistance or MinnesotaCare

What Happens After You Send It In

The agency reviews what you submitted against its electronic data sources. Processing times vary by category: federal rules give the state up to 45 days for most people and up to 60 days for people applying on a disability basis, with a 15-working-day window for pregnant individuals.6Minnesota Department of Human Services. Health Care Programs Eligibility Policy Manual – 1.2.4 Processing Period Renewals often resolve faster when the submitted information is complete.

You will get a written decision by mail: approved, denied, or a request for more documents. If the agency asks for more information, respond inside the window stated in the letter. Your coverage usually continues while the agency waits for your reply, but only if you answer in time. To check the status of your renewal, contact your caseworker directly.

If You Miss the Deadline

Act fast and call your caseworker. For people enrolled under MAGI-based rules, federal regulations allow a 90-day window after termination to send in the renewal information without starting a new application.7Medicaid.gov. Conducting Medicaid and CHIP Renewals During the Unwinding Period and Beyond: Essential Reminders Most DHS-3418 recipients are on asset-tested, non-MAGI categories, so ask your worker what reconsideration window applies to your case.

Minnesota also allows retroactive MA coverage for up to three months before the month of application. If a gap in coverage left you with medical bills, those costs may still be covered if you were eligible during those months.

If Your Renewal Is Denied

The denial notice explains the reason and tells you how to request a state fair hearing. You have 30 days from the date the notice is sent to file a hearing request, and up to 90 days if you have good cause for the delay.8Minnesota Department of Human Services. Grievance, Appeal, and State Fair Hearing Process

Timing matters. If you request the hearing before the “date of action” listed on your notice, the state must keep your MA active while the appeal is pending.9Medicaid.gov. Understanding Medicaid Fair Hearings A final decision can take up to 90 days. Wait until after the date of action and you may lose coverage during the appeal.

Common denial reasons on asset-tested cases include income above the limit for your household size, countable resources above the allowable threshold, or missing documents. If the denial was for missing information rather than actual ineligibility, sending the documents to your caseworker can resolve the problem faster than a formal appeal.

Where to Get Help

Your county or tribal human services office can walk you through the form by phone or in person. Minnesota’s Health Care Consumer Support line handles general questions about renewals.1Minnesota Department of Human Services. Renewal Forms for Health Care Programs Community organizations, legal aid offices, and certified application counselors around the state help with MA renewals at no cost and can flag documents you might not have realized you needed. If you have limited English proficiency, ask your caseworker for an interpreter or translated materials.