IM-178 CLARIFICATION AND CHANGES TO 5% DISREGARD FOR FAMILY MO HEALTHNET (MAGI)

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  CLARIFICATION AND CHANGES TO 5% DISREGARD FOR FAMILY MO HEALTHNET (MAGI)

MANUAL REVISION # 178
1805.030.20.20.05
Appendix A
Appendix B

 

DISCUSSION:

The purpose of this memorandum is to advise staff of changes to the 5% disregard income calculation for Family MO HealthNet (MAGI) eligibility determinations. 

Due to receiving a Payment Error Rate Measurement (PERM) finding from the Centers for Medicare and Medicaid Services (CMS) as well as clarification from the Division of Legal Services (DLS), the Missouri Eligibility Determination and Enrollment System (MEDES) has been updated to no longer add a 5% disregard at every eligibility level.  Instead, the 5% disregard will only be applied when the disregard means the difference between being eligible for MO HealthNet or Children’s Health Insurance Program (CHIP) and being ineligible.

The 5% disregard will still apply to the highest MO HealthNet level for each level of Medicaid (non-CHIP coverage) and CHIP (including Show-Me Healthy Babies), as well as MO HealthNet for Pregnant Women (MPW) and Uninsured Women’s Health Services (UWHS).  Participants will first have an eligibility determination without the 5% disregard.  If found ineligible at either the highest Medicaid or highest CHIP level, the 5% disregard will be added and a new eligibility determination run before moving to the next level of care (if another level of care exists for the participant).

NOTE: The 5% disregard will still apply to MO HealthNet for Families (MHF) Adult as it is the highest level for adults but will no longer be applied to MHF Child as it is not the highest Medicaid (non-CHIP) level for children.  Due to this change, it is possible that a household could have a child/children eligible for MHK while the adult(s) is eligible for MHF Adult.

NOTE: The 5% disregard will still apply to MO HealthNet for Kids (MHK) as it is the highest Medicaid (non-CHIP) level for children but will no longer be applied to CHIP 71 & CHIP 72 as it is not the highest CHIP level for children.  Due to this change, the MHK income level is now higher than the CHIP 71 & CHIP 72 level, placing no one under CHIP 71 & CHIP 72.

EXAMPLE: Please see policy section 1805.030.20.20.05 for examples.

The MEDES system was updated November 22, 2020 to reflect these changes.

NOTE: As MEDES runs the updated eligibility determinations for past active periods, eligibility will appear to negatively change on the Product Delivery Case; however, benefits on the Integrated Case and downstream will not change and no adverse action will be triggered.  If the current coverage is determined to change due to the 5% updates, an adverse action will be triggered.

Appendices A and B have been updated to reflect the updated income guidelines.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/al