IM-108 APPLICATION FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (IM-1MA) REVISION

Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri

TO:  ALL FAMILY SUPPORT OFFICES

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT: APPLICATION FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (IM-1MA) REVISION

FORM REVISION #24

IM-1MA

 

DISCUSSION:

The purpose of this memorandum is to introduce changes to the IM-1MA Application for MO HealthNet (Medicaid).

Page (1) of the IM-1MA has been revised to include the Greene County Family Support Division (FSD) mailing address and fax number where MO HealthNet for the Aged, Blind, and Disabled (MHABD) applications should be submitted. The myDSS.mo.gov website has also been added.

MHABD applications may now be submitted to FSD at:

  • Greene County FSD
    101 Park Central Square
    Springfield, MO 65806
    Fax: (417) 895-6080

The revised IM-1MA is available in the IM Forms Manual.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Destroy all previous paper versions of the IM-1MA and immediately begin using the 06/19 version.

PL/vm