Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: INTRODUCING A NEW FORM AND REVISED FORMS FOR MO HEALTHNET (MHN) PARTICIPANTS WHO ARE INCARCERATED AND SUSPENDED
FORM REVISION #
IM-150
IM-151
IM-152
IM-153
DISCUSSION:
When MHN participants are incarcerated, benefits must be suspended. If an incarcerated participant goes to the hospital or other medical facility where they are admitted for an inpatient period of more than 24 hours, the suspended benefits are restored. When an incarcerated participant is released, the suspended benefits are redetermined and restored.
Family Support Division (FSD) has several existing forms that are used in the course of work for suspended participants. These forms have been revised as explained below:
- Suspending Incarcerated Participants (IM-150)
- Revised form name
- Provided new email address for submitting the form
- Added fields:
- to indicate that a new application was submitted
- for DOC/Offender ID
- for reporter’s contact information details.
- Inpatient Coverage for Incarcerated Participants (IM-151)
- Updated the email address for submitting the form
- Added fields to indicate that a new application was submitted
- Restoring a Suspended Participant Change Report (IM-152)
- Revised form name
- Provided new email address for submitting the form
- Added fields for:
- DOC/Offender ID
- Additional contact information
- Additional pregnancy details
- The report’s contact information details.
A new form, Applying for Incarcerated Participants in Department of Corrections (IM-153) was created specifically for new applicants who are being assisted by Department of Corrections (DOC) staff and/or their medical provider, Centurion. Participants assisted by DOC or Centurion are managed by a specialized unit and the coversheet is used to identify these participants.
If any of these forms are received by staff, notify the specialized unit by sending an email to FSD.SuspendedDOC@dss.mo.gov. The email should include:
- Subject line: Incarceration information received
- The participant’s name
- The participant’s DCN
- What was received and when
- Any other relevant information
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
KE/cj