Author: Danielle Protzman

FROM: KIM EVANS, DIRECTOR

SUBJECT: QUALIFIED MEDICARE BENEFICIARY (QMB) AND SPECIFIED LOW-INCOME MEDICARE BENEFICIARY GROUP 1 (SLMB1) ENROLLMENT IS AUTOMATIC FOR MO HEALTHNET (MHN) PARTICIPANTS

MANUAL REVISION #

DISCUSSION:

Enrollment in QMB and SLMB1 is automatic for all eligible MHN participants. Eligibility for QMB and SLMB1 must be explored when processing an application for MHN coverage.

Explore eligibility for QMB and SLMB1 when completing annual renewals, changes in circumstance, or applications for other types of assistance. If the claimant does not already receive QMB or SLMB1 coverage and appears to be eligible, take actions to add QMB or SLMB1 coverage.

When a participant becomes eligible for QMB or SLMB1, the SMI premium is no longer an allowable deduction. This may cause an increase in spend down or cause a non-spend down participant to have a spend down. A participant may choose to close QMB or SLMB1 coverage. If the participant makes the request in person or by phone, explain the financial impact so the participant makes an informed decision.

Note: Medical expenses must be updated on the Medical Expense screen (MEDEXP/FMXA) in the eligibility system.

The following sections were added to the Family MO HealthNet (MAGI) Manual:

• 1805.065.00 Enrollment in Medicare Savings Programs (MSP)
• 1885.045.00 Participant Becomes Eligible for Medicare

The following section was added to the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual:

• 0840.010.40 Participant Becomes Eligible for Medicare

The remaining MHABD Manual sections listed above are updated to reflect automatic enrollment policy, update general terminology and remove outdated processes.

Note: Continue to follow current processing procedures for Non-MAGI applications.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/sh

FROM: KIM EVANS, DIRECTOR

SUBJECT: MO HEALTHNET (MHN) COVERAGE FOR FORMER FOSTER CARE YOUTH (FFCY) INDIVIDUALS WHO AGED OUT OF CARE IN A STATE OTHER THAN MISSOURI

MANUAL REVISION #
0875.000.00
1805.050.00
1900.020.60

DISCUSSION:

Section 1002(a)(2) of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act became effective 1/1/2023 changing the way eligibility is determined for individuals who age out of foster care in a state other than Missouri. Eligibility for these individuals will be determined under different criteria based on when they reached the age of 18.

Individuals who turned 18 before January 1, 2023

• Are under age 26;
• Declare they were in foster care in a state other than Missouri for at least 6 months prior to aging out of care; and
• Must be found ineligible for MHN coverage in all other applicable mandatory eligibility groups prior to being approved for coverage under the FFCY program.

Individuals who turned 18 on or after January 1, 2023

• Are under age 26;
• Declare they were in foster care in a state other than Missouri at the time they turned 18;
• Are not required to be found ineligible for MHN coverage prior to being enrolled in FFCY coverage; and
• Are ineligible for FFCY coverage if they are already covered under a mandatory level of Medicaid through the state of Missouri.

System updates are in progress to determine eligibility for these individuals. Until system updates are completed, send an email to COLE.MHNPOLICY@dss.mo.gov with “Former foster care state other than Missouri” in the subject line if an application is received for one of these individuals.

FFCY eligibility for individuals who age out of foster care in Missouri will continue to be handled through Children’s Division’s (CD) eligibility system.

The Family MO HealthNet (MAGI) and Presumptive Eligibility (PE) Programs Manuals have been updated to reflect these changes.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/rc

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATED MODIFIED ADJUSTED GROSS INCOME (MAGI) VERIFICATION PLAN

MANUAL REVISION #
1800.005.00

DISCUSSION:

The Missouri MAGI Verification Plan has been updated and posted online with an implementation date of April 3, 2023. The MAGI verification plan is required to outline policies, processes and data sources used to determine MAGI eligibility.

Federal Regulations, 42 CFR 435.945(j) and 457.380(j), require state Medicaid and CHIP agencies to develop and maintain a MAGI State Eligibility Verification Plan. States are required to submit their verification plan to Centers for Medicare and Medicaid Services (CMS) who posts the plan on Medicaid.gov.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/rc