Author: Patrick Ellison

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  2022 UPDATE OF POVERTY INCOME GUIDELINES FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS

MANUAL REVISION #
Appendix J
Appendix K

DISCUSSION:

Effective April 1, 2022, the Federal Poverty Level (FPL) income guidelines increase for the following programs:

• MO HealthNet for the Aged, Blind and Disabled (MHABD)
• Ticket to Work Health Assurance (TWHA)
• Qualified Medicare Beneficiary (QMB)
• Specified Low Income Medicare Beneficiary (SLMB and SLMB2)
• Qualified Disabled Working Individuals (QDWI)
• MO HealthNet for Disabled Children (MHDC)
• Gateway to Better Health (GTBH)
• Blind Pension (BP)

The weekend of March 12, 2022, programs with income eligibility based on the FPL will be adjusted in the eligibility system.

MO HealthNet cases will be adjusted based on the new FPL income guidelines; however, due to the COVID-19 Public Health Emergency (PHE), no cases will have coverage closed or reduced to a lower level of care due to FPL adjustments until after the PHE has ended. 

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. The refund process will take approximately 8 weeks to complete.

Program Descriptions

Appendix K: MO HealthNet eligibility for people who are Aged (65 or older), Blind, Disabled, or need treatment for Breast or Cervical Cancer in the MHABD Policy Manual has been updated to include the change in FPL income limits.

Income Standards

Appendix J: Eligibility Standards for MHABD has been updated in the MHABD Policy Manual to show the updated FPL income limits.

All FPL income guidelines are effective from April 1, 2022 through March 31, 2023. These standards may be referenced as needed for historical purposes.

NECESSARY ACTION:

• Begin using the new federal poverty level income guidelines for eligibility determinations effective April 2022 and ongoing.
• Follow the FAMIS Changes Due to FPL Adjustments user guide to resolve conflicting actions.
• Review this memorandum with appropriate staff.

KE/cj

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  2022 UPDATED PRESUMPTIVE ELIGIBILITY (PE) INCOME GUIDELINES

MANUAL REVISION #
PE APPENDIX A

DISCUSSION:

PE income guidelines have been updated due to the increase in the Federal Poverty Level (FPL). These guidelines are effective from April 1, 2022 through March 31, 2023. PE Appendix A, found in the Presumptive Eligibility Programs Manual, reflects the new income guidelines.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/bl

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) MANUAL UPDATE TO BUY-IN FOR QUALIFIED MEDICARE BENEFICIARY (QMB)

MANUAL REVISION #
0865.015.05

DISCUSSION:

MHABD manual section 0865.015.05 Buy-In for QMB was updated to correct the email address for the Medicare Buy-In Unit. The correct email address is MHD.MEDICARE-BUYIN@dss.mo.gov.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Begin using the updated email address.

KE/sh

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  UPDATES TO PRESUMPTIVE ELIGIBILITY (PE) FORMS AND POLICY

MANUAL REVISION #
1900.010.00
1900.020.80
1900.030.00
1900.030.10
1900.030.20
1900.040.00
PE Appendix A

OBSOLETE
1900.050.00
1900.050.10
1900.050.10.10
1900.050.10.20
1900.050.10.20.10
1900.050.10.20.20
1900.050.10.20.30
1900.050.10.30
1900.050.10.40

FORM REVISION #
PE-1SSL 
PE-2 Worksheet
PE-3
PE-3 PW

DISCUSSION:

Several changes have been made to PE policy and forms which includes the addition of PE for the Adult Expansion Group (AEG-PE). Updates are outlined below:

• PE Manual section 1900.020.80 is a new section regarding eligibility for AEG-PE. Only qualified hospitals are allowed to make determinations for this group.
• The citizenship/qualified immigrant requirement for all PE programs has been removed. Qualified Entities (QE) are no longer required to screen for citizenship/immigrant status for PE applications.
• QEs do not need to ask applicants about tax-filing status. How to calculate household size has been simplified, which determines what income should be counted.
• Income calculations are now simplified to include earned income and unearned income. Deductions counted on federal taxes are no longer allowed.
  • Self-employment income is still determined by monthly gross business income minus business expenses.
• PE forms previously listed have been updated to reflect the changes noted above. In addition, the TEMP/SMHB-PE Authorization form, which was previously designated PE-3TEMP is now titled PE-3PW.
• Additional minor changes have been made in the manual sections listed above such as:
  • Updating how paper applications may be submitted;
  • Removing processes for entry of PE coverage. A specialized unit enters all PE coverage;
  • Adding the legal reference for AEG-PE.

QEs have been notified of these changes and PE training has been updated.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• QEs have been advised to destroy all previous versions of the forms and to use the versions dated 10/2021.

KE/df

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  UPDATES TO MANUAL SECTION INCOME INCLUDED UNDER MAGI

MANUAL REVISION #
1805.030.20.05

DISCUSSION:

Family MO HealthNet (MAGI) manual section 1805.030.20.05 Income Included Under MAGI has been updated. Revisions include:

• Updated taxable thresholds for Social Security Income to include a married child
• Formatting changes

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/ams

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  VISUAL DETERMINATION LENGTH FOR SUPPLEMENTAL AID TO THE BLIND (SAB) AND BLIND PENSION (BP)

DISCUSSION:

Approval notices for BP and SAB coverages have been updated to notify the participant of the length of their eligibility determination and if a re-examination is waived for coverage renewal.

The State Ophthalmologist notifies the Family Support Division (FSD) if the participant has met the blind assistance criteria and the length of eligibility. Based on the information provided by the State Ophthalmologist the participant may need a re-examination no less than every fifth year after initial approval unless they have been deemed to have no usable vision.

All BP and SAB approval notices will include one of the following paragraphs:

Time limited approvals (requiring a reexamination)

(Participant’s Name) has been approved for assistance based on blindness until _________. You will be contacted prior to that date to determine if you continue to be eligible. You are required to report if your vision improves. 209.040 RSMo

Waived approvals (not requiring a re-examination)

(Participant’s Name) has been approved for assistance based on blindness. No review of your vision will be required, unless your vision improves. You are required to report if your vision improves. 209.040 RSMo

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/nw