Author: Keith Townsend

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  UPDATE TO MO HEALTHNET GATEWAY TO BETTER HEALTH APPLICATION

FORM REVISION #

IM-1MAGW

DISCUSSION:

The MO HealthNet Gateway to Better Health Application has been updated to reflect the 2021 Substantial Gainful Activity (SGA) income maximum of $1310.00. 

Use this updated version effective immediately and discard all previous versions. 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM:  KIM EVANS, DIRECTOR

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

MANUAL REVISION #

Appendix J, Adult Standards Chart
Appendix K, MO HealthNet Aged, Blind, and Disabled Program Descriptions
Appendix L, Aged, Blind, Disabled Income Chart
Appendix M, Medicare Cost Savings Program

DISCUSSION:

Effective April 1, 2021, the Federal Poverty Level (FPL) income guidelines increase for the following programs: MO HealthNet for the Aged, Blind and Disabled (MHABD) Spend Down and Non-Spend Down, Ticket to Work Health Assurance (TWHA), Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB and SLMB-2), Qualified Disabled Working Individuals (QDWI), MO HealthNet for Disabled Children (MHDC) and Gateway to Better Health programs (GTBH).  The Blind Pension (BP) spousal support income maximum has also increased with the FPL.   

On the weekend of March 06, 2021, MHABD programs with income eligibility based on the federal poverty level will be adjusted. This memorandum includes information on:

• PREMIUM REFUNDS
• INCOME CHARTS AND PROGRAM DESCRIPTIONS

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.

INCOME CHARTS

Income charts are no longer being updated in each manual section, but instead will be updated in the Appendices.  For historical purposes, the income standards listed below will be included in the FPL memo:

MHABD OAA/PTD income standards effective April 01, 2021 through March 31, 2022

MHABD AB income standards effective April 01, 2021 through March 31, 2022

Blind Pension sighted spouse income maximum effective April 01, 2021 through March 31, 2022

QDWI income standards effective April 01, 2021 through March 31, 2022 

QMB income standards effective April 01, 2021 through March 31, 2022

SLMB1 income standards effective April 01, 2021 through March 31, 2022

SLMB2 income standards effective April 01, 2021 through March 31, 2022

TWHA Premiums for Single Cases effective April 01, 2021 through March 31, 2022

TWHA Premiums for Couple Cases effective April 01, 2021 through March 31, 2022

PROGRAM DESCRIPTIONS AND OTHER RESOURCES

The MHABD Standards Chart, MHABD Program Descriptions, MHABD Income Chart, and the Medicare Cost Savings Programs (QMB and SLMB) internet pages are updated in Appendices J, K, L, and M in the MHABD Manual to include the change in FPL income limits.

NECESSARY ACTION:

• Begin using the new federal poverty level income guidelines effective for April 2021 and later.
• Follow the FPL FAMIS Guide to resolve conflicting actions.
• Review this memorandum with appropriate staff.

KE/vm      

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY PENALTIES

MANUAL REVISION #

APPENDIX J

APPENDIX N                                                    

DISCUSSION:

The purpose of this memorandum is to inform staff that the average private pay nursing care rate will increase to $6,588 per month on April 1, 2021.  For applications taken on or after April 1, 2021, use $6,588 to determine the number of months of ineligibility for vendor level services.

The current average private pay nursing care rate can be found on Appendix J.

The historical values for average private pay nursing care rates are listed on Appendix N.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Use $6,588 as the average private pay rate effective for applications on or after April 1, 2021.

KE/vb                                              

FROM:  KIM EVANS, DIRECTOR

SUBJECT:   CLARIFICATION OF THE QUALIFIED INCOME TRUST (QIT) TRUSTEE REQUIREMENTS FOR PARTICIPANTS OF THE HOME AND COMMUNITY BASED (HCB) AND MISSOURI’S CHILDREN WITH DEVELOPMENTAL DISABILITIES (MOCDD) WAIVER PROGRAMS        

MANUAL REVISION # 

1025.015.04.01.02

DISCUSSION:

The purpose of this memorandum is to inform staff of clarification added to the QIT section 1025.015.04.01.02 of the December 1973 Eligibility Requirements manual related to a participant’s selection of a trustee when a QIT is established. 

Under 42 USC 1396p(d)(4)(B), participants who meet all other eligibility requirements for the HCB and MOCDD programs (except for income), will become eligible to receive waiver services when the participant creates a QIT and deposits the portion of his/her income that is over the income maximum standard for HCB or MOCDD. That portion of a participant’s income deposited into the QIT is excluded from the HCB or MOCDD budget.  Any gains on income held in the QIT are also excluded for HCB and MOCDD. 

During the process of establishing a QIT, the participant is required to select a trustee for administration of the trust.  Clarification has been added to the manual explaining the requirement for the participant to select a trustee for the proper administration of his/her QIT, but the participant is not required to select a trustee who is bonded.  It is assumed by the Family Support Division the participant will select a trustee based on who he/she feels most confident will protect assets held in the QIT, and one who will follow guidelines established for how funds may be distributed to the participant from the QIT.

See the Qualified Income Trusts section 1025.015.04.01.02 under “Deposits and Distributions from the QIT” for information about QIT distribution requirements. Staff must continue to follow the instructions in this section when funds from a QIT have been misused or mishandled.  This policy applies whether or not the trustee of the QIT is bonded.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vm                                             

FROM:  KIM EVANS, DIRECTOR

SUBJECT:   UPDATE TO SUSPENSION FOR INCARCERATED PARTICIPANTS FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS AND FAMILY MO HEALTHNET (MAGI) PROGRAMS

MANUAL REVISION #

0840.020.00

1885.040.00

DISCUSSION:

MO HealthNet (MHN) benefits must be suspended for any participant who becomes incarcerated. Suspension for Incarcerated Participants policy was added to the MHABD and MAGI manuals in February 2020.

Family Support Division (FSD) has received clarification regarding annual renewals, interim changes, inpatient events, and redeterminations prior to release. MHABD manual section 0840.020.00 Suspending Incarcerated Participants and MAGI manual section 1885.040.00 Suspension of MAGI Benefits for Incarcerated Individuals have been updated with these clarifications.

Annual renewals must be completed each year, but may be completed with known information if new information is not received on a review form or available through agency sources (such as IIVE, IMES, or other electronic sources) or information provided by other eligibility members. Annual renewals and interim changes in an eligibility unit CANNOT cause a suspended MO HealthNet participant to lose benefits. Specialized units will take action to keep the benefits from ending prior to redetermination at release.

A new disability determination is not required for all suspended participants prior to restoring benefits. If the participants were eligible based on disability prior to incarceration, FSD may be able to use that disability determination.  Medical Review Team (MRT) disability determinations are to be considered valid while a participant is suspended through the end of the determination approval period (as shown on MRT Information/FMJR screen). If the participant’s MRT determination has not expired, then it is still valid and a new MRT determination is NOT required.  

If an incarcerated participant was receiving Social Security Disability income or SSI prior to incarceration, the income can be expected to be restored by Social Security Administration upon release if the participant was incarcerated for less than 12 months. Disability does not have to be established by FSD. An MRT determination is NOT required to restore benefits, but should be explored if Social Security or SSI income has not resumed by the next annual review.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Specialized units must send a Request for Interpretation of Policy (IM-14) if further clarification is needed, such as if a participant’s case is closing.

KE/cj/ams                                                   

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  UPDATE OF 1619 THRESHOLD AMOUNT

MANUAL REVISION #

0850.005.20

Appendix J

Appendix K

Appendix L

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 $3,693 effective January 1, 2021.

NECESSARY ACTION:

• Review this memorandum with appropriate

KE/vb