Author: Jody Clark

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  AFFORDABLE INSURANCE QUOTES UPDATED ON
FAMILY MO HEALTHNET (MAGI) APPENDIX G

MANUAL REVISION #
APPENDIX G

DISCUSSION:

The purpose of this memorandum is to notify staff that Appendix G has been updated with 2021 insurance quotes from the Federally Facilitated Marketplace (FFM).  Affordable insurance determinations for Children’s Health Insurance Program (CHIP) premium children must still be completed with the CHIP Affordability Test Calculator (MAGI Appendix G).

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Begin using the updated CHIP Calculator January 1, 2021

KE/df

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  CLARIFICATION AND CHANGES TO 5% DISREGARD FOR FAMILY MO HEALTHNET (MAGI)

MANUAL REVISION # 178
1805.030.20.20.05
Appendix A
Appendix B

DISCUSSION:

The purpose of this memorandum is to advise staff of changes to the 5% disregard income calculation for Family MO HealthNet (MAGI) eligibility determinations. 

Due to receiving a Payment Error Rate Measurement (PERM) finding from the Centers for Medicare and Medicaid Services (CMS) as well as clarification from the Division of Legal Services (DLS), the Missouri Eligibility Determination and Enrollment System (MEDES) has been updated to no longer add a 5% disregard at every eligibility level.  Instead, the 5% disregard will only be applied when the disregard means the difference between being eligible for MO HealthNet or Children’s Health Insurance Program (CHIP) and being ineligible.

The 5% disregard will still apply to the highest MO HealthNet level for each level of Medicaid (non-CHIP coverage) and CHIP (including Show-Me Healthy Babies), as well as MO HealthNet for Pregnant Women (MPW) and Uninsured Women’s Health Services (UWHS).  Participants will first have an eligibility determination without the 5% disregard.  If found ineligible at either the highest Medicaid or highest CHIP level, the 5% disregard will be added and a new eligibility determination run before moving to the next level of care (if another level of care exists for the participant).

NOTE: The 5% disregard will still apply to MO HealthNet for Families (MHF) Adult as it is the highest level for adults but will no longer be applied to MHF Child as it is not the highest Medicaid (non-CHIP) level for children.  Due to this change, it is possible that a household could have a child/children eligible for MHK while the adult(s) is eligible for MHF Adult.

NOTE: The 5% disregard will still apply to MO HealthNet for Kids (MHK) as it is the highest Medicaid (non-CHIP) level for children but will no longer be applied to CHIP 71 & CHIP 72 as it is not the highest CHIP level for children.  Due to this change, the MHK income level is now higher than the CHIP 71 & CHIP 72 level, placing no one under CHIP 71 & CHIP 72.

EXAMPLE: Please see policy section 1805.030.20.20.05 for examples.

The MEDES system was updated November 22, 2020 to reflect these changes.

NOTE: As MEDES runs the updated eligibility determinations for past active periods, eligibility will appear to negatively change on the Product Delivery Case; however, benefits on the Integrated Case and downstream will not change and no adverse action will be triggered.  If the current coverage is determined to change due to the 5% updates, an adverse action will be triggered.

Appendices A and B have been updated to reflect the updated income guidelines.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/al

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 VERIFICATION FOR FAMILY HEALTHCARE PROGRAMS (MAGI) UPDATE AND CLARIFICATION

DISCUSSION:

The purpose of this memorandum is to provide clarification to Memo IM-19 COVID-19 Verifications for Family Healthcare Programs (MAGI).  IM-19 introduced temporary policy to allow Family Support Division (FSD) to waive many eligibility verification requirements for MAGI programs during the COVID-19 public health emergency (PHE.)

For the duration of the PHE, applications can be rejected for various reasons, but active cases can only be closed in certain circumstances.  Cases on which a Request for Information (IM-31A) is sent, but no response is received, will require review after the PHE ends. For this reason, send IM-31As as a last resort.  Utilize all available resources. This includes but is not limited to, IMES, IIVE, and/or FAMIS and use sound judgement before attempting contact with the participant. 

For more information about contacting participants, see the updated MEDES COVID-19 Self-Attestation Guide.

Resume Reasonable Compatibility

Per clarification from the Division of Legal Services, resume use of Reasonable Compatibility (RC) procedures to attempt to confirm self-attested income.

• If electronically obtained information (EOI) is RC with self-attested income, verify the evidence with RC.
• If EOI is not RC with self-attested income, but the EOI does not clearly contradict self-attested income, verify the income as self-attested. See the MEDES COVID-19 Self-Attestation Guide for examples.
  • Enter a comment to describe the self-attested income and electronic data. Include in the comment “self-attestation accepted due to special circumstances.  42 CFR 435.952(c)(3).”
• If EOI is not RC with self-attested income and clearly contradicts self-attested income, contact the participant. See the MEDES COVID-19 Self-attestation Guide for examples.

Included Income Types

 The participant must provide enough information about the income to determine an income amount in order for the income to be considered self-attested.  If income cannot be considered self-attested, contact the participant.

EXAMPLE:  Marcy is processing a change report on which the participant claimed a job at Wal-Mart making $12.75 per hour. The participant didn’t list weekly hours or a gross amount and pay frequency.  Marcy cannot determine self-attested income with this information.

Excluded Income Types

Do not send an IM-31A to request clarification of an excluded/non-countable income type.  If a current amount can be found on an available resource (such as IIVE for SSI or INTRFACE for child support) enter the amount found on the available resource.  Add a note to explain where the information was obtained and what, if anything, the participant reported about the income.

File IMES, IIVE, or other resources in the electronic case record, as directed by policy.

Tax Filing Status

Continue to accept self-attestation of tax filing status.  If tax filing status is not declared for a participant, contact the participant for more information.        

 Reasonable Opportunity

 Follow normal procedures to allow a reasonable opportunity period except: 

• Accept self-attestation of a pending SSN application for participants eligible to receive a reasonable opportunity period.
• Accept self-attestation of application for a birth certificate for participants eligible to receive a reasonable opportunity period.
• See the MEDES COVID-19 Self-attestation Guide for more information.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Review the updated MEDES COVID-19 Self-attestation Guide.
• Exhaust all available resources for verification before attempting contact with a participant.
• Attempt phone contact before sending an IM-31A.

KE/ers/al/ams/kg

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  REVISION OF THE IM-31A PQ MAGI
FORM REVISION #
IM-31A PQ MAGI

DISCUSSION:

The purpose of this memo is to introduce changes to the IM-31A PQ MAGI form.  This form is used to request prior quarter information that may not have been captured on the IM-1SSL application form.  The new version of the form includes fillable fields and formatting changes. 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Refer to IM-24 from 3/5/2018, for information on use of the IM-31A PQ MAGI form.

KE/ers

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  SUPPLEMENTAL NURSING CARE (SNC) MANUAL CORRECTION
MANUAL REVISION #
0605.010.00

DISCUSSION:

The SNC manual section was missing instructions that clarified the actions necessary when an individual is found ineligible for SNC. Instructions have been added to section 0605.010.00 No change in process is necessary for staff.  FAMIS is programmed to explore eligibility for the additional programs as required.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vb

FROM: KIM EVANS, DIRECTOR

SUBJECT: CORRECTION OF LINK IN THE BREAST AND CERVICAL CANCER TREATMENT MANUAL

MANUAL REVISION #
1305.025.05 

DISCUSSION:

The purpose of this memo is to correct a link in the Breast and Cervical Cancer Treatment manual. The link to a map of Show Me Healthy Women providers is found at: https://health.mo.gov/living/healthcondiseases/chronic/showmehealthywomen/providermap.php

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/df