Author: Danielle Protzman

IM-28 RECONSIDERATION PERIOD DURING THE TRANSITION PERIOD FOR ALL MO HEALTHNET (MHN) PROGRAMS

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FROM: KIM EVANS, DIRECTOR

SUBJECT: RECONSIDERATION PERIOD DURING THE TRANSITION PERIOD FOR ALL MO HEALTHNET (MHN) PROGRAMS

MANUAL REVISION #
0840.005.05
0890.010.00
1880.020.00
1895.010.00

 

DISCUSSION:

Effective April 1, 2023 through May 31, 2024, temporary reconsideration period policy is in effect for all MHN programs.

When a case has closed for failure to return the annual renewal form, cancel close/reopen the case when the signed annual renewal is received within 90 days of closing.

If the participant returns an annual renewal form, it must be signed. Telephonic signatures are allowed for MHN annual renewals, however, only the Family Support Division (FSD) vendor and specialized staff trained to accept and record telephonic signatures can complete annual renewals by phone. If the participant contacts the Customer Service Center and needs to complete the annual renewal, transfer the call to the FSD vendor.

Consider the annual renewal as received if the participant fails to return the annual renewal form but provides all information required to complete the annual renewal by phone, online, in-person, or through the mail within the 90-day reconsideration period. For example, the participant turns in a new application with all required information.

When the annual renewal is received 90 days or less after the case closed:

  • Cancel close/reopen the case.
  • Follow established procedures to complete the annual renewal.

When the annual renewal is received 91 days or more after the case closed:

Note: MEDES system changes to allow cases to be reopened up to 90 days will be in a future MEDES Release.

MO HealthNet for the Aged, Blind and Disabled (MHABD) Manual section 0840.005.05 Reconsideration Period and Family MO HealthNet (MAGI) Manual section 1880.020.00 Reconsideration Period were updated instructing staff to follow guidance in this memo during the transition period.

This memo has been added to the following MHABD and MAGI manual sections:

0890.010.00 Transition Period
1895.010.00 Transition Period

 

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/sh

IM-27 WAIVERS APPROVED BY CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) FOR ALL MO HEALTHNET (MHN) ANNUAL RENEWALS

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FROM: KIM EVANS, DIRECTOR

SUBJECT: WAIVERS APPROVED BY CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) FOR ALL MO HEALTHNET (MHN) ANNUAL RENEWALS

MANUAL REVISION #
0890.010.00
1895.010.00

 

DISCUSSION:

An increased number of eligibility and enrollment actions must be completed when MHN annual renewals resume on April 1, 2023. CMS has approved Missouri to use the following waivers to help expedite renewal processing, protect participants from inappropriate terminations, and reduce administrative burden. Headings shown below are the official CMS waiver titles.

These waivers are effective April 1, 2023 and will continue until further notice.

1. Renewal for Individuals Based on SNAP Eligibility

Renew MHN eligibility for participants under 65 years of age who are receiving Supplemental Nutrition Assistance Program (SNAP) benefits, despite the differences in household composition and income-counting rules.

Note: This waiver allows the “Targeted Enrollment SNAP Strategy” flexibility currently used for Modified Adjusted Gross Income (MAGI) applications to also be used for all MHN annual renewals.

2. Ex Parte Renewal for Individuals with No Income and No Data Returned

When using the ex parte (not requiring information from the individual) renewal process for non-CHIP cases, complete the income determination without requesting additional income information or documentation if:

  • An attestation of zero-dollar income was verified at an initial application or renewal completed no earlier than March 2019; and
  • No income information is reported on an electronic source, such as IMES, IIVE, or The Work Number.

Continue to take appropriate steps to complete a determination of non-financial eligibility requirements.

Note: This waiver does not apply to CHIP cases.

3. Facilitating Renewal for Individuals with no Asset Verification System (AVS) Data Returned within a Reasonable Timeframe

Assume there has been no change in resources and complete the ex parte (not requiring information from the individual) renewal process without any further verification of assets when:

  • No information is returned through Accuity; or
  • Accuity response is not returned within 15 days.

If information from Accuity indicating potential ineligibility is received after a renewal has been completed, treat the information as a change in circumstance.

4. Extended Timeframe to Take Final Administrative Action on Fair Hearing Requests

All participants must remain active on MHN pending the outcome of a fair hearing decision regardless of whether the participant has requested that their MHN benefits continue. This flexibility does not extend the timeframe to take final administrative action when benefits cannot be provided pending the outcome of a fair hearing, such as a denial of eligibility for a new applicant.

  • Staff who submit the hearing request must place both the Adverse Action Benefit Reduction (AABR) and No Change (NOCH) actions on hold before submitting the hearing request handoff. Information on how to change an adverse action status can be found in FAMIS Resources.
  • The Income Maintenance (IM) Hearing Unit is responsible for reinstating coverage back to the date of the action for any person who requests a fair hearing after the date of action.

Note: Missouri will not recoup the cost of MHN benefits provided to the participant while the fair hearing is pending, regardless of whether the fair hearing ultimately upholds the agency’s determination.

This memo has been added to the following MO HealthNet for the Aged, Blind, and Disabled (MHABD) and Family MO HealthNet (MAGI) manual sections:
0890.010.00 Transition Period
1895.010.00 Transition Period

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/sh

IM-26 END OF CONTINUOUS ENROLLMENT CONDITION; TRANSITION PERIOD MANUAL SECTIONS ADDED TO MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED [MHABD (NON-MAGI)] AND FAMILY MO HEALTHNET (MAGI) MANUALS

Posted on

FROM: KIM EVANS, DIRECTOR

SUBJECT: END OF CONTINUOUS ENROLLMENT CONDITION; TRANSITION PERIOD MANUAL SECTIONS ADDED TO MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED [MHABD (NON-MAGI)] AND FAMILY MO HEALTHNET (MAGI) MANUALS

MANUAL REVISION #
0890.010.00
1895.010.00

 

DISCUSSION:

On December 29, 2022, the Consolidated Appropriations Act, 2023 (CAA, 2023) was enacted. Under the CAA, 2023, expiration of the continuous enrollment condition is no longer linked to the end of the Public Health Emergency (PHE). The continuous enrollment condition ends on March 31, 2023.

Effective April 1, 2023, annual renewals will resume for all MO HealthNet (MHN) programs. Family Support Division (FSD) will attempt to complete an ex-parte (not requiring information from the individual) renewal for each participant prior to sending a paper renewal form. An annual renewal must be completed before a determination of ineligibility or lesser coverage can be made.

Participants that are found to no longer qualify for MHN will be referred to the Federally Facilitated Marketplace (FFM).

Participants who receive a paper renewal form can return it or other documents in the following ways:

  • Uploading a document: Visit mydssupload.mo.gov to upload the document
  • Fax: 573-526-9400
  • Mail: Family Support Division
               PO Box 2700
              Jefferson City, MO 65102
  • Visit your local Resource Center (check the map for office hours before visiting)

Review Renewing Your Medicaid Eligibility for additional information.

Future memorandums will be released regarding returned mail, electronic verification, MAGI and Non-MAGI annual renewal processes and annual renewal waivers.

Manual Updates

The MHABD (Non-MAGI) and MAGI Manuals have been updated to add sections regarding the Transition Period. The Transition Period manual sections house links to related memos.

Note: Transition period refers to the conclusion of the Continuous Enrollment Condition and restart of annual renewals. Missouri’s transition period is from April 1, 2023 through May 31, 2024.

The following manual sections have been added:

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Share with community partners.

 

 

 

KE/sh

IM-25 UPDATE TO ANNUAL RENEWAL POLICY IN THE MAGI MANUAL

Posted on

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATE TO ANNUAL RENEWAL POLICY IN THE MAGI MANUAL

MANUAL REVISION #
1870.025.00
1880.000.00
1880.005.00
1880.010.00 obsolete
1880.015.00
1880.020.00
1880.025.00
1885.000.00

DISCUSSION:

Annual renewal policy in the Modified Adjusted Gross Income (MAGI) Manual is revised to update terminology, obsolete floating renewal policy, add ex parte renewal language, and for easier readability and understanding.

Effective, March 25, 2023, floating renewals are discontinued. MAGI Manual section 1880.010.00 Floating Renewal is obsolete as of this date. Annual renewals are completed once every 12 months. Do not complete a renewal when a change in circumstance is reported.

Note: If the participant returns an annual renewal form, it must be signed. Telephonic signatures are allowed for MHN annual renewals if the participant contacts the Customer Service Center and is transferred to complete the renewal with the Family Support Division (FSD) vendor by phone.

The following MAGI Manual sections are revised:

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Refer to MEDES Resources for information on processing an annual renewal.

 

 

KE/sh

IM-24 UPDATE TO ANNUAL REVIEW/REINVESTIGATION POLICY IN THE NON-MAGI MANUALS

Posted on

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATE TO ANNUAL REVIEW/REINVESTIGATION POLICY IN THE NON-MAGI MANUALS

MANUAL REVISION #

0430.000.00  0840.000.00
0430.005.00  0840.005.00
0525.000.00     0840.005.00.05
0525.005.00 0850.015.00
0630.000.00 0855.015.00
0630.005.00 0865.025.00
0745.000.00  0870.025.00
0745.005.00  1030.000.00
0820.040.05 1320.000.00
0825.040.05 1320.020.00

 

DISCUSSION:

Annual renewal policy in the Non-Modified Adjusted Gross Income (Non-MAGI) Manual is revised to update terminology from review/reinvestigation to annual renewal, add ex parte renewal language, add the requirement for annual renewal forms to be signed, and for easier readability and understanding.

An ex parte renewal (not requiring information from the individual) must be attempted before a renewal form is sent. Ex parte renewals are completed using reliable information available to the agency without requiring information from the participant. If staff are able to verify all necessary eligibility factors by accessing available electronic data sources, do not send a renewal form.

The following Non-MAGI Manual sections are revised:

Supplemental Aid to the Blind (SAB) Manual

Blind Pension Manual

Supplemental Nursing Care (SNC) Manual

Supplemental Payments Manual

MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual

December 1973 Eligibility Requirements Manual

Breast or Cervical Cancer Treatment (BCCT) Manual

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Refer to FAMIS Resources for information on processing an annual renewal.

 

 

KE/sh

IM-23 MILEAGE REIMBURSEMENT RATE INCREASE FOR ALL INCOME MAINTENANCE (IM) PROGRAMS

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FROM: KIM EVANS, DIRECTOR

SUBJECT: MILEAGE REIMBURSEMENT RATE INCREASE FOR ALL INCOME MAINTENANCE (IM) PROGRAMS

FORM REVISION #
APPENDIX J

 

DISCUSSION:

The state mileage rate used to calculate expenses for all IM programs increased from $.55 per mile to $.62 per mile effective 03/01/2023. Use the rate of $.62 per mile when calculating mileage expenses.

Effective 03/19/2023, the eligibility system is updated to reflect the rate increase. Appendix J of the MO HealthNet for the Aged, Blind, and Disabled manual has been updated to reflect the change.

Note: Final approval for the increased rate was received after March benefits were created. Affected cases have been adjusted to reflect this change for March 2023 and notices will be generated.

 

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/mc

IM-22 MAGI MANUAL APPENDIX H UPDATE

Posted on

FROM: KIM EVANS, DIRECTOR

SUBJECT: MAGI MANUAL APPENDIX H UPDATE

MANUAL REVISION #
APPENDIX H

 

 

DISCUSSION:

MAGI Appendix H is updated. MO HealthNet Eligibility Codes (ME) Codes 07 (Foster Care), 36 (MHD IV-E Adopt-FFP Adoption Subsidy), and 56 (Adoption Subsidy) have been moved to the Newborn qualifying ME Codes side of Appendix H as they are Title XIX funded.

In addition, the appendix wording was corrected to show ME Code 83 as BCCT-PE and ME Code 84 as BCCT.

 

NECESSARY ACTION:

  • Grant automatic newborn coverage to children born to women receiving (or retroactively eligible for) ME Codes 07, 36 and 56.
  • Review this memorandum with appropriate staff.

 

 

 

KE/bl

IM-21 2023 MAGI COST OF LIVING ADJUSTMENT (COLA) FOR SSA/SSI INCOME

Posted on

FROM: KIM EVANS, DIRECTOR

SUBJECT: 2023 MAGI COST OF LIVING ADJUSTMENT (COLA) FOR SSA/SSI INCOME

 

DISCUSSION:

Effective April 1, 2023, MAGI cases will be updated to reflect an 8.7% COLA for Social Security Administration (SSA) and Supplemental Security Income (SSI) participants.

Note: Due to the Continuous Eligibility Condition, no cases will have coverage closed or reduced to a lower level of care until an annual renewal has been completed.

Cases Adjusted

Cases that include income types Social Security Adult (disability or received off disabled/deceased spouse), Social Security Adult (retirement), Social Security Child (disability or received off disabled/deceased parent), and SSI are subject to an automatic increase of 8.7%. The eligibility system will end date the previous income and add a new piece of income evidence that reflects the adjusted income amount.

Cases That Did Not Adjust

Some cases will not adjust during COLA. These cases will require manual intervention from staff to add the increased income amounts. As cases are reviewed, check the income on each case to determine if the current income is entered. Update and verify income as required using established procedures.

Notices

For case updates made as a result of COLA, the eligibility system will finalize the decision(s) and send out the appropriate notices. Adverse Action notices will not be acted upon until an annual renewal has been completed on the case.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

KE/kg

 

IM-20 UPDATE OF 1619 THRESHOLD AND INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY PENALTIES

Posted on

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATE OF 1619 THRESHOLD AND INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY PENALTIES

MANUAL REVISION #
Appendix J
Appendix N

 

 

DISCUSSION:

The threshold amount established by the Social Security Administration (SSA) to determine eligibility under Section 1619 of the Social Security Act has increased to $4,134 effective January 1, 2023. Additional information regarding 1619 eligibility is available in manual section 0850.005.20 Financial Need.

The average private pay nursing care rate increased to $6,983 per month effective. For applications taken on or after April 1, 2023, use $6,983 to determine the number of months of ineligibility for vendor level services.

Appendix J of the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual lists the current average private pay nursing care rate and current 1619 threshold.

Appendix N of the December 1973 Eligibility Requirements Manual lists the historical values for average private pay nursing care rates.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/rnr

IM-19 2023 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI PROGRAMS

Posted on

FROM: KIM EVANS, DIRECTOR

SUBJECT: 2023 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI PROGRAMS

MANUAL REVISION #
1805.030.20.10
APPENDIX A
APPENDIX A (PE)
APPENDIX B
APPENDIX D
APPENDIX E
APPENDIX I

FORM REVISION #
IM-4PRM

DISCUSSION:

Effective April 1, 2023, the Federal Poverty Level (FPL) income guidelines increase for all MAGI programs, including Presumptive Eligibility (PE).
MAGI cases will be adjusted on March 29, 2023 based on the new FPL income guidelines; however, due to the Continuous Eligibility Condition, no cases will have coverage closed or reduced to a lower level of care until an annual renewal has been completed.

Note: Change in circumstance or applications processed prior to April 1, 2023 will need to be authorized before the FPL change can be viewed.

PREMIUM REFUNDS

Premiums paid for April coverage will be refunded to the participant if the FPL causes the case to:

  • become eligible as a non-premium case;
  • go from CHIP75 to CHIP74; or
  • go from CHIP74 to CHIP73.

The refund process will take approximately 8 weeks to complete.

MAGI MANUAL REVISION, PROGRAM DESCRIPTIONS, AND OTHER RESOURCES

MAGI Manual section 1805.030.20.10 Income Excluded Under MAGI has been updated to reflect an increase in the tax filer threshold for earned income from a child to $12,950 based on the 2022 IRS Publication 501.

NOTE: The tax filer threshold for unearned income from a child has not increased.

PRESUMPTIVE ELIGIBILITY

PE Manual Appendix A income standards are updated. These standards are effective from April 1, 2023 through March 31, 2024.

 

NECESSARY ACTION:

  • Use the new FPL income guidelines beginning April 1, 2023.
  • Review this memorandum with appropriate staff.

 

 

 

KE/kg