IM-69 FORM USED FOR INCARCERATED PARTICIPANTS WHO HAVE AN INPATIENT EVENT (IM-151) REVISED AND RENAMED

FROM: KIM EVANS, DIRECTOR

SUBJECT: FORM USED FOR INCARCERATED PARTICIPANTS WHO HAVE AN INPATIENT EVENT (IM-151) REVISED AND RENAMED

FORM REVISION #
IM-151

DISCUSSION:

Revisions were made to the IM-151 to allow incarcerated applicants and suspended participants to use the form for an inpatient event. The form was renamed Inpatient Coverage for Incarcerated Participants (IM-151).

New applicants should submit the IM-151 at the same time as their application. Suspended participants who were receiving MO HealthNet prior to incarceration should submit the IM-151 within 10 days of the end of the inpatient event.

Medical facility staff, jail/prison staff, or the participant (or their representative) may submit the IM-151 to Family Support Division (FSD) by email to FSD.inmatehospapp@dss.mo.gov.

FSD reviews the information provided and makes a determination if the inpatient event qualifies for MO HealthNet coverage. FSD will notify MO HealthNet Division (MHD), the participant, and their authorized representative (if applicable) of the eligibility decision.

Department of Corrections (DOC) may also receive information regarding eligibility during an inpatient event as allowed by agreements between DOC, FSD, and MHD.

Policy revised to reflect the updated name of the form:

• MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual section 0840.020.00 Suspending Incarcerated Participants
• Family MO HealthNet (MAGI) Manual section 1802.010.80.15 MO HealthNet Applications for Incarcerated Individuals

The IM-151 was updated in the public and internal forms manuals.

NECESSARY ACTION:
• Review this memorandum with staff.
• Begin using the updated form immediately.
• Share with any relevant community partners and stakeholders.

KE/cj