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