IM-169 UPDATING INCOME SOURCES FOR THE GATEWAY TO BETTER HEALTH (GTBH) MANUAL

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  UPDATING INCOME SOURCES FOR THE GATEWAY TO BETTER HEALTH (GTBH) MANUAL

MANUAL REVISION #

1600.010.15.15                               

DISCUSSION:

The purpose of this memorandum is to inform staff that the GTBH Manual section, 1600.010.15.15 Sources of Earned and Unearned Income, was updated to remove sources that are not included sources of income for the program.

Updates were made to the FAMIS eligibility system to reflect these changes. Changes were effective in FAMIS November 1, 2020.  

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/cj

 

IM-168 INCREASE IN VENDOR MAXIMUM MONTHLY MAINTENANCE STANDARD AND MINIMUM AND MAXIMUM SPOUSAL SHARE

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INCREASE IN VENDOR MAXIMUM MONTHLY MAINTENANCE STANDARD AND MINIMUM AND MAXIMUM SPOUSAL SHARE

MANUAL REVISION #

1030.035.10

1030.035.20

1030.035.25

APPENDIX B

DISCUSSION:

Effective January 1, 2021, the Maximum Monthly Maintenance Standard, and the minimum and maximum spousal share amounts are increased. 

 

MAINTENANCE STANDARDS

The new Maximum Monthly Maintenance Standard is $3260.00. IM Manual APPENDIX B – Maintenance Standards for Allotments has been updated to reflect the change effective January 1, 2021.

The Minimum Monthly Maintenance Standard of $2155 was announced in 2020 IM Memo #83, dated June 12, 2020.

 

SPOUSAL SHARE

The new minimum spousal share is $26,076.00. The new maximum spousal share is $130,380.00. Both amounts become effective for any assessment completed on or after January 1, 2021. IM Manual Sections 1030.035.10, 1030.035.20 and 1030.035.25 have been updated to reflect the spousal share increases effective January 1, 2021. 

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/vb

IM-167 INCREASE IN RESOURCE LIMITS FOR QUALIFIED MEDICARE BENEFICIARY (QMB), SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB), AND QUALIFYING INDIVIDUALS (QI-1 OR SLMB2) PROGRAMS

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INCREASE IN RESOURCE LIMITS FOR QUALIFIED MEDICARE BENEFICIARY (QMB), SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB), AND QUALIFYING INDIVIDUALS (QI-1 OR SLMB2) PROGRAMS

MANUAL REVISION #

0865.010.15

Appendix J

Appendix K

Appendix L

DISCUSSION:

Effective January 1, 2021, the QMB, SLMB, and SLMB2 resource limits increased.  For a single individual, the resource limit increased from $7,860 to $7,970.  For a married couple, the resource limit increased from $11,800 to $11,960.  Resource maximums have been updated in the eligibility system.  There is no change in policy regarding how to determine available resources.

The following have been updated:

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/vb

IM-166 JANUARY 2021 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME FOR ALL INCOME MAINTENANCE PROGRAMS EXCEPT MAGI

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  JANUARY 2021 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME FOR ALL INCOME MAINTENANCE PROGRAMS EXCEPT MAGI

MANUAL REVISION#

0410.010.15

0805.020.15

1030.010.05

APPENDIX E

APPENDIX J

APPENDIX K

APPENDIX L

DISCUSSION:

In January 2021, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive a 1.3% Cost of Living Adjustment (COLA). A mass adjustment of FAMIS Child Care, Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance and MO HealthNet for Aged, Blind and Disabled (MHABD) eligibility units (EUs) with SSA, SSI, VA, and/or RR income increases will be completed the weekend of December 12, 2020.

This memorandum discusses the following:

 

NEW AMOUNT OF SSI

Effective 2021, SSI benefit amounts are as follows:

 

NEW AMOUNT

INCREASE

SSI Individual maximum (in own household)

$ 794.00

$ 11.00

SSI Couple maximum (in own household)

$ 1191.00

$ 16.00

SSI Individual in household of another

$ 529.00

$7.00

SSI Couple in household of another

$794.00

$11.00

SSI Essential person/own home

$ 397.00

$ 5.00

The standard SMI Premium is $148.50 for 2021.

 

NEW MO HEALTHNET FOR AGED, BLIND, AND DISABLED STANDARDS

Maximum Allotment to Community Spouse

$3260.00

Minimum Maintenance Standard for Allotments

$2155.00

Maximum Allocation to a child

$397.00

Maximum Allotment to a child

$718.00

Minimum Spousal Share

$26,076.00

Maximum Spousal Share

$130,380.00

Maximum Home Equity

$603,000.00

HCB Maximum

$1388.00

SAB Standard

$857.00

 

ADJUSTING THE ELIGIBILITY UNITS BY PROGRAM

SNAP

SNAP cases will be adjusted for all eligibility units with SSA, SSI, VA, RR income update, or SMI change.

Temporary Assistance

Temporary Assistance cases will be adjusted for all eligibility units with SSA, SSI, VA, or RR income update.

Child Care

Child care cases will be adjusted for all eligibility units with SSA, VA, and RR income. SSI continues to be excluded when determining eligibility for Child Care. Changes in Temporary Assistance grants resulting from the mass adjustment were included in the Child Care and SNAP adjustments. If the Temporary Assistance case is closed, the grant was removed from the Child Care and SNAP budgets.

MHABD

NOTE: The Families First Coronavirus Response Action of 2020 (FFCRA) requires that MO HealthNet (MHN) coverage for individuals be maintained at the same level or better for the duration of the Public Health Emergency (PHE). FAMIS will not act on adverse action to reduce or end MHN coverage due to the COLA changes until the PHE is ended.

When the PHE is ended, actions will be taken to update coverage for individuals whose coverage was maintained due to FFCRA requirements. The following paragraphs may or may not be accurate dependent on when the PHE is officially ended.

Senate Bill 577 (2007) authorized the disregard for Social Security COLA increases for MO HealthNet programs with income eligibility based on federal poverty level until the next FPL adjustment in April. All SSA, SSI, VA, and RR income sources are being updated with the new income amount. FAMIS will populate the verification code to “CO” for COLA adjustment.

For the following MO HealthNet programs, FAMIS will disregard the new SSA and SSI amounts and use the prior SSA and SSI amounts until FPL adjustments. FAMIS adjusted the VA and RR income and use the new adjusted VA and RR amounts effective January 1, 2021.

  • MO HealthNet for the Aged, Blind and Disabled (MHABD) Spend Down (MHSD) and Non Spend Down (MHNS)
  • Qualified Medicare Beneficiary (QMB)
  • Specified Low Income Beneficiary (SLMB)
  • Blind Pension (BP)
  • Program for All-Inclusive Care for Elderly (PACE)
  • Ticket to Work Health Assurance (TWHA) and
  • Gateway to Better Health (GTBH)

For the following MO HealthNet programs, FAMIS will adjust the SSA, SSI, VA and RR income and use the new adjusted SSA, SSI, VA and RR amounts:

See note above. Actions to reduce benefits will not be taken until the COVID PHE has ended. Actions to increase benefits may be taken.

  • Supplemental Aid to the Blind (SAB)
  • Supplemental Nursing Care (SNC)
  • Vendor
  • Home and Community Based (HCB)
  • Missouri Children with Developmental Disabilities (MOCDD)

 

SMI PREMIUM ADJUSTMENT

The standard SMI will increase for 2021 to $148.50. The SMI premium for those who begin receiving Medicare in 2021 will be $148.50. Premiums for those who were receiving Medicare prior to 2021 may be adjusted, if it was less than $144.60 for 2020, but will not increase more than the amount of the increase in Social Security benefit the individual received.

EXAMPLE: Ms. Brown receives Social Security of $1000 and pays $105 SMI in 2020. Effective January 1, her Social Security will increase to $1013. Her SMI will increase, but by no more than the amount of her benefit increase, $13 in this example. It may be necessary to request verification from the participant of their SMI premium.

NOTE: The process for adjusting SMI will continue as last year.

FAMIS will compare the new SMI amount ($148.50) with what is listed on the Medical Expense (MEDEXP/FMXA) screen (current).

If the new expense is:

  • less than current expense – case will be added to error report and MEDEXP will not be updated
  • equal to current expense – no update will be made to MEDEXP
  • greater than current expense – the new SMI amount will be added and FAMIS will check for active QMB, SLMB1 or SLMB2.
    • If active QMB, SLMB1 or SLMB2 case will be added to error report
      • If the current expense is not equal to the old SMI standard expense ($144.60) the case will also be added to the error report

FAMIS will NOT add or end the SMI expense when BENDEX disagrees with what is currently listed on MEDEXP. These cases will be added to an error report for staff to review.

 

MASS ADJUSTMENT PROCESS

The mass adjustment begins in FAMIS on December 12, 2020.

Most EUs with SSA/SSI/VA/RR income that were active by the end of the day on December 6, 2020, with a certification ending January 2021 or later will be adjusted to show the increased benefit amounts. FAMIS identifies any EU that has been previously adjusted by staff, if there is a January 2021 budget with an increased SSA/SSI/VA/RR income, FAMIS will not adjust the case.

FAMIS receives the BENDEX file from Social Security Administration. The BENDEX file contains SSA income information. Information from the file is transmitted to FAMIS during the adjustment, increasing all cases with SSA income that have a matching Benefit Claim Number entered on the Income (FMX0) screen to the amount shown on the file. Cases adjusted with income from the BENDEX file include the comment, “SSA Income Adjusted by the – BENDEX File.”

Cases that do not contain the Benefit Claim Number and cases that the Benefit Claim Number does not match the BENDEX file will be increased 1.3%. The comment, “Adjusted by the system – increased by the COLA Percentage,” will be added to the Monthly Income Comment (FMF7) screen.

FAMIS receives the SDX file from Social Security Administration. The SDX file contains SSI income information. Information from the file is transmitted to FAMIS during the adjustment, increasing all cases with SSI income that have a matching social security number (SSN).  Cases adjusted with income from the SDX file include the comment, “SSI Income adjusted by the system – SDX File,” on the Monthly Income Comment (FMF7) screen.

When the SDX file shows SSI income has started or stopped, FAMIS also added or end dated SSI income based on information transmitted in the file. When FAMIS adds an SSI income source, the comment, “New SSI Income Source Created by the system – SDX File,” will be added to the Monthly Income Comment (FMF7) screen. When FAMIS end dates an SSI income based on information from the SDX file, the comment, “SSI Income End Dated by the system – system calculation,” will be added to the Monthly Income Comment (FMF7) screen.

Cases that do not contain the SSN or the SSN do not match the SDX file will be increased by 1.3%. A comment will be added to the Monthly Income Comment (FMF7) screen, “SSI Income Adjusted by the system – system calculation.”

VA and RR income will be increased by the COLA of 1.3%. The comment, “Adjusted by the system – increased by the COLA Percentage,” will be added to the Monthly Income Comment (FMF7) screen.

FAMIS will not complete the eligibility determination for applications in the controlled flow. For pending Child Care or SNAP recertifications, if the child care certification period or last SNAP month of certification is January 2021 or February 2021, the SSA/SSI/VA/RR amount is adjusted by the system. Review the SSA/SSI/VA/RR amount prior to completing the application. If the SSA/SSI/VA/RR amount is not correct, follow instructions in the Manual Adjustments by Field Staff section of the memorandum.

FAMIS will adjust the medical expense type SM-SMI PREMIUM as described in the SMI Premium section of this memorandum. On the SNAP budget, if there was a medical expense entered which did not have an allowable verification code, the FA-150 Action Notice notifies the EU the expense will not be considered in the budget. This includes the medical expenses other than mileage or transportation costs verified by client statement (CS). Medical expenses should be reviewed and discussed with the EU at the next contact to attempt to verify expenses.

If an active FAMIS EU is adjusted or closed, the EU Action Log (FM40) displays the action taken by the system and the benefit amount for the benefit month 012021. To view information that resulted in the action, select the action and press F17=INQAUTH. The Action Authorization (FM3H) screen is displayed. Press F16=BUDSUM to access the Budget Summary screen for each program type. From the Budget Summary screen, press F14=INCSUMM to access the Income Summary Detail (FM33) screen. The income types, sources, and gross amounts are displayed for budget month 01/2021. Press F21=Return to return to the Budget Summary screen, and press F15=EXPSUM to view the Expense Summary (FM34) screen. The expense classes, types, and amounts are displayed for budget month 012021.

Eligibility determinations which have not been run prior to the mass adjustment will be completed during the mass adjustment. This may result in the creation of RTA (ready to authorize) status. An alert “OUTSTANDING ELIGIBILITY DETERMINATION” was generated and must be resolved.

NOTE: It is important to review income from SSA/SSI/VA/RR, and SMI Premium at the next contact to verify the correct amounts.

 

REPORTS WITH ACTIONS NEEDED

The following reports with action needed will be distributed to the SNAP, Temporary Assistance/Child Care, and MO HealthNet Program Administrators for assignment.  Following are instructions on how to process each type of report.

 

CONFLICT OF ACTIONS

FAMIS will adjust the income and expenses on EUs with a pending adverse action at the time of the mass adjustment. This results in a conflict of actions because one adverse action must be completed or voided before the other can be taken. Staff receives the alert “ADVERSE ACTION NEEDS RESOLVING.” The conflict must be resolved by Staff.

To resolve the conflict:

  • Access the Action Resolution (ACTRES or FM50) screen and void the pending adverse action. Refer to the user guide “Changing an Adverse Action Status” for instructions.
  • After voiding the adverse action, access the Eligibility Determination Resolution (EDRES or FM3Y) screen and run a new eligibility determination.
  • Authorize the new adverse action.

 

MANAGED REPORTING/EUs NEEDING REVIEW

There is no longer an “error” report for the COLA adjustment. If the SSA/SSI/VA/RR benefit did not adjust, there is a reason. Some benefits being adjusted require review for accuracy. FAMIS will generate reports in the Managed Reporting system of active EUs that need review. It is important to review and take the necessary actions for each review message to ensure accuracy of all eligibility determinations for these individuals.

To review the reports:

  • From the FSD Employee Intranet, click on the Administration & Systems header then click on Managed Reporting.
  • Log into the Managed Reporting area.
  • Click on the appropriate domain (FAMIS Caseworker Supervisor Reports)

NOTE: The report is also located in FAMIS Eligibility Specialist Reports, FAMIS Manager Level 2 Reports and FAMIS County Office Reports.

  • Click on Cost of Living Adjustments Needing Review.
  • Select SSA/SSI/VA/RR Needing Review to request the online reports.

Each Eligibility Specialist must access the report assigned to him/her by the Program Administrator. A reason for review is included for each EU member on the report. More than one reason may appear for each EU on the report. Review all EU information to ensure correct data is entered.

NOTE: If the Eligibility Specialist discovers something did not adjust as expected or did not adjust correctly, immediately report to FSD Program and Policy through normal supervisory channels.

 

REASONS FOR REVIEW

The following reasons for review will be displayed in the SSA/SSI/VA/RR Needing Review online report in Managed Reporting. It is important to review every eligibility unit displayed and take the following actions to ensure accuracy of the FAMIS record and correct eligibility determinations for these individuals.

  • CHECK JANUARY INCOME – The mass adjustment was unable to update the income for January, or the SSA/SSI/RR/VA income was entered for January 2021, and used in an eligibility determination prior to the COLA mass adjustment.

This reason requires immediate review as these cases did not adjust during the COLA mass adjustment! Verify SSA/SSI/VA/RR income amount, update if necessary using “CO” verification code, and complete an eligibility determination. Complete and verify the January 2021, income amount in FAMIS is the amount after the COLA adjustment.

  • VENDOR LEVEL OF CARE EU MEMBERS – There is an active Nursing Home Level of Care for an individual receiving SNAP benefits.

Review the living arrangement of the individual. If the individual is not in an allowable living arrangement, update the living arrangement on the Address Screen (FM0A), and complete an eligibility determination.

If the individual is in an allowable living arrangement, review the Income (FMX0) screen to ensure the Supplemental Nursing Care (N1) grant is budgeted for SNAP benefits. If the Supplement Nursing Care grant is not budgeted, add the grant to the Income (FMX0) screen and act upon the action.

  • Last Year SMI>Last Year Max – The amount of the medical expense type SM–SMI PREMIUM in FAMIS is larger than $148.50. Some individuals are required to pay a larger Medicare premium due to late enrollment. The mass adjustment cannot automatically adjust these premiums. Request an IIVE interface to verify the SMI premium and adjust, if necessary. Complete an eligibility determination.
  • Bendex SMI Not Found – There is a SMI premium amount in FAMIS, but the BENDEX file does not show a SMI premium.

Request an IIVE interface to verify whether or not there is a SMI premium. Remove the SMI expense and complete an eligibility determination.

  • CLAIM NUMBER IS BLANK – There is no claim number for the SSA/SSI/VA/RR and the income has been adjusted by percentage. Although this is not a mandatory field at this time, it is very important that the claim number is verified and added for every person receiving SSA/SSI/VA/RR benefits.

Request an IIVE interface to verify the claim ID and add to FAMIS. It is important for the accuracy of the FAMIS record to record the correct claim number on the Select Income (SELINC) screen.

  • BENDEX SSA INCOME NOT FOUND – SSA income is verified on the BENDEX file, however, there is no SS income type in FAMIS. Verify receipt of SSA income and budget in FAMIS as appropriate.

Request an IIVE interface to verify the income from Social Security and add to FAMIS. Complete an eligibility determination.

  • Multiple SSI for Individual – An individual has more than one source of SSI. This usually occurs when an individual has SSI and SSA and the SSA was entered into FAMIS as SSI.

Request an IIVE interface to verify the income sources. Update FAMIS to show the correct income source. Be sure to enter the SSA claim number for future adjustments. Complete an eligibility determination.

  • CURRENT INCOME AMOUNT IS ZERO – SSI/SSA/RR/VA income code is on the Income (FMX0) screen with zero amounts on the Income Amount (FMX3) screen.

Verify income amount. If the EU is no longer receiving this income, end date the income. If the EU is receiving the income, enter the income and complete an eligibility determination.

  • NOT ADJUSTED – There is SSA/SSI/VA/RR income in FAMIS which was not adjusted on an active case.

There are some reasons the SSA/SSI/VA/RR income could not be adjusted. Verify the correct amount of income and review the eligibility unit to determine if action is needed. Complete an eligibility determination.

 

MANUAL ADJUSTMENTS BY FIELD STAFF

To manually adjust the SSA/SSI/VA/RR income in FAMIS, first attempt to verify the new amount from BENDEX/SDX printouts or the IIVE interface. If not available, compute the new SSA/SSI/VA/RR amount by multiplying the original amount by 1.3% (2020 amount x 1.013) and rounding down to the nearest dollar.

Staff must enter the new SSA/SSI/VA/RR amounts for new Child Care, SNAP, and Temporary Assistance applications processed after December 6, 2020.

Staff must enter the updated SSA/SSI/RR/VA income in FAMIS for all programs using the verification code “CO”- COLA if the income increased due to the COLA increase, but was not adjusted during the mass adjustment.

FAMIS will use the CO verification code to determine when to use the December 2020 or January 2021 SSI/SSA/VA/RR. FAMIS is programmed to disregard the SSA/SSI income increase until the federal poverty level (FPL) adjustment in April if the verification code is “CO” for the following MO HealthNet programs:

  • MO HealthNet for the Aged, Blind and Disabled (MHABD) spend down (MHSD), and non-spend down (MHNS),
  • Qualified Medicare Beneficiary (QMB),
  • Specified Low-Income Medicare Beneficiary (SLMB),
  • Blind Pension (BP),
  • Program for All-Inclusive Care for the Elderly (PACE), and
  • Ticket to Work Health Assurance (TWHA), and
  • Gateway for Better Health (GTBH)

NOTE: For prior quarter months, enter the prior SSA/SSI income amount with the appropriate verification code (HC, TC) for months prior to January 2021.

 

CONTROLLED FLOW

If a Child Care, SNAP, Temporary Assistance or MO HealthNet application is in the controlled flow, review the SSA/SSI/VA/RR benefit. Determine the correct SSA/SSI/VA/RR benefit amount and manually adjust the benefit amount effective January 2021 and later months when completing the application/controlled flow.

 

BLANK VERIFICATION CODE PEN (Pending)

During the mass adjustment, FAMIS will set the status to PEN (Pending) for cases with an unacceptable or blank verification code. The Eligibility Specialist receives the alert –“Action Not Authorized”. If no action is taken by an Eligibility Specialist, FAMIS will send an FA-510 or FA-420 Adverse Action Notice to reduce or close as appropriate, as the unacceptable or blank verification code has not been resolved.

Review the case file and search the ECM and/or the VFR. If the verification is provided, change the verification code, run an eligibility determination, and authorize the action. If the verification has not been previously requested, request the verification on the FA-325 Request for Information form. Once verification is received, update FAMIS with the verification and complete an eligibility determination.  If the verification is not received, FAMIS will send an FA-510 or FA-420 Adverse Action Notice to reduce or close as appropriate, after the FA-325 expires.

NOTICES

  • The Adverse Action Notices will be dated December 14, 2020.
  • AR100s accompanying the Adverse Action Notices, to the authorized representatives will be dated December 14, 2020.
  • The Action Notice generated by the mass adjustment will be dated December 29, 2020, to allow adequate mail time due to the large volume of cases affected (except BP).
  • Notices will not be generated for no change (NOCH) actions in FAMIS.

SNAP

An FA-150 Action Notice is generated for mass adjustment actions REDU (reduction), and CLOS (closing) notifying the EU the action has been taken.

Child Care

The FA-510 Adverse Action Notice is generated for any Child Care EU whose benefits are reducing. The FA-150 Action Notice will be generated after the FA-510 Adverse Action Notice expires, if the EU has not requested a hearing, including a request to continue receiving at the current rate pending the hearing decision.

Temporary Assistance

Only the FA-150 Action Notice is generated for a Temporary Assistance EU due to the mass adjustment, unless there is a pending adverse action at the time of the mass adjustment. If there is a pending adverse action at the time of the mass adjustment, refer to Conflict of Actions section in this memorandum to resolve.

MO HealthNet

An FA-420 Adverse Action Notice is generated for any MO HealthNet for the Aged, Blind or Disabled programs whose benefits are reducing or closing due to the mass adjustment. An FA-460 Action Notice is generated for mass adjustment actions after the Adverse Action Notice expires, if the EU has not requested a hearing, including a request to continue receiving at the current rate pending the hearing decision.

 

INTERIM CHANGES AFTER MASS ADJUSTMENT

There are times when SSA and SSI have changes in the amounts that are not related to a COLA adjustment (i.e.: one spouse dies and the other has SSA and/or SSI adjustment). When this happens and a budget adjustment is necessary Staff can enter the verification code (HC or TC) as appropriate. FAMIS will then adjust the SSA and SSI income appropriately.

When completing budget adjustments after mass adjustment, if the verification code is “CO” and there has been no other change to SSA and SSI amounts, leave the verification code “CO” in verification field. Changing the verification code to any other code will incorrectly budget the SSA and SSI COLA amount prior to FPL adjustment in April.  

 

REQUEST FOR HEARING/CONTINUED BENEFITS

If the EU requests a fair hearing, see IM Memo #74 dated July 23, 2015 APPLICATION FOR STATE HEARING (IM-87) FOR ALL INCOME MAINTENANCE PROGRAMS AND THE FOOD STAMP PROGRAM  for procedures for processing the hearing request.

The FA-510 and FA-420 Adverse Action Notices are dated December 14, 2020. Any EU receiving an FA-510 or FA-420 Adverse Action Notice may request a hearing on the mass adjustment action within 90 days from the date of the notice.

The FA-150 and FA-460 Action Notices generated by the mass adjustment are dated December 29 2020, except the certified notices to BP participant. Mass adjustment actions REDU (reduction), and CLOS (closing) receive the FA-150 and FA-460 Action Notice notifying the EU the action has been taken. Any EU receiving an FA-150 Action Notice may request a hearing on the mass adjustment action within 90 days from December 29, 2020.

  • SNAP

SNAP EUs receiving the FA-150 Action Notice of a reduction (REDU) or closing (CLOS) due to the cost of living mass adjustment alone are not eligible for continued benefits at the level before the mass adjustment.

  • Temporary Assistance

Temporary Assistance EUs receiving the FA-150 Action Notice of a reduction (REDU) or closing (CLOS) due to the cost of living mass adjustment alone are not eligible for continued benefits at the level before the mass adjustment.

If the EU receives an FA-510 Adverse Action Notice based on a previous determination in which a Conflict of Action was resolved due to the COLA mass adjustment and they request the hearing prior to the expiration of that FA-510 they may continue at the level before the mass adjustment until the hearing decision is made. Staff should inform the EU that if continued benefits are issued and the agency is determined to be correct, a claim will be established for the overpayment.

To continue the Temporary Assistance benefits at a higher amount for EUs who received an FA-510 Adverse Action Notice pending the hearing decision, update the action status to HOLD (HOL) on the Action Resolution (FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions.

If the EU requests a hearing after the FA-510 expires, the EU is not eligible for continuation of benefits at the level before the mass adjustment, but is still entitled to the fair hearing. Once the Hearing Decision is rendered, take steps to process the EU’s eligibility according to the Decision and Order.

  • Child Care

If the EU receiving an FA-510 Adverse Action Notice requests a hearing on the Child Care adjustment by December 24, 2020, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. Staff should inform the EU that if continued benefits are issued and the agency is determined to be correct, a claim will be established for the overpayment.

To continue the Child Care benefits at a higher amount for EUs who received an FA-510 Adverse Action Notice pending the hearing decision, update the action status to HOLD (HOL) on the Action Resolution (FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions.

If the EU requests a hearing after December 24, 2020, the EU is not eligible for continuation of benefits at the level before the mass adjustment, but is still entitled to the fair hearing. Once the Hearing Decision is rendered, take steps to process the EU’s eligibility according to the Decision and Order.

  • MO HealthNet

The Families First Coronavirus Response Action of 2020 (FFCRA) requires that MO HealthNet (MHN) coverage for individuals be maintained at the same level or better for the duration of the Public Health Emergency (PHE). FAMIS will not act on adverse action to reduce or end MHN coverage due to the COLA changes until the PHE is ended.

When the PHE is ended, actions will be taken to update coverage for individuals whose coverage was maintained due to FFCRA requirements. The following paragraphs may or may not be accurate dependent on when the PHE is officially ended.

If the EU receiving an FA-420 Adverse Action Notice requests a hearing on the MHN adjustment by December 24, 2020, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. Staff should inform the EU that if continued benefits are issued and the agency is determined to be correct, a claim will be established for the overpayment.

To continue the MHN benefits at a higher amount for EUs who received an FA-420 Adverse Action Notice pending the hearing decision, update the action status to HOLD (HOL) on the Action Resolution (FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions.

If the EU requests a hearing after December 24, 2020, the EU is not eligible for continuation of benefits at the level before the mass adjustment, but is still entitled to the fair hearing. Once the Hearing Decision is rendered, take steps to process the EU’s eligibility according to the Decision and Order.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • State Office will provide the SSA/SSI/VA/RR Needing Review report to be reviewed by designated staff.
  • Apply MO HealthNet policy for “CO” income verification to disregard SSA and SSI COLA adjustments until FPL adjustment in April.

 

KE/vb                       

 

IM-165 INTRODUCTION TO THE ELECTRONIC VERIFICATION SYSTEM (EVS)

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INTRODUCTION TO THE ELECTRONIC VERIFICATION SYSTEM (EVS)

MANUAL ADDITION #

0110.060.00 0110.060.15.10 0110.060.25
0110.060.45 0110.060.05 0110.060.15.15
0110.060.30 0110.060.10 0110.060.15.20
0110.060.35 0110.060.15 0110.060.15.25
0110.060.40 0110.060.15.05 0110.060.20

FORM REVISION #

Authorization for Verification (IM-6EVS) 

DISCUSSION:

Several new eligibility tools are being implemented by the Family Support Division (FSD). These tools are designed to ease some of the burden on participants to provide verification while improving the accuracy of eligibility determinations.

EVS is the larger umbrella term for many electronic verification sources- some of which FSD has used for years, and some of which are new to the agency.

This memo introduces the manual sections, forms, guides, and training information for the EVS.

The following manual sections have been added to the General Information Manual:

0110.060.00 Electronic Verification System
0110.060.05 Electronic Verification System Legal Basis
   0110.060.10 Use of Electronic Verification System Sources
   0110.060.15 Fair Credit Reporting Act Authorization
   0110.060.15.05 FCRA Authorization Eligibility Factor for MHABD
   0110.060.15.10 FCRA Authorization for MO HealthNet for Disabled Children Cases
   0110.060.15.15 Ex Parte Review When MHDC Participants Turn Age 18
   0110.060.15.20 Ex Parte Review When Participant Moves from Family MO HealthNet to MO HealthNet for the Aged, Blind, and Disabled
   0110.060.15.25 Ex Parte Review When Participant Revokes FCRA Authorization
0110.060.20 Information Reported by Electronic Verification System Causes Ineligibility
0110.060.25 Reported Non-Financial Information from the Electronic Verification System
0110.060.30 Reported Income Information from the Electronic Verification System
0110.060.35 Reported Resource Information from the Electronic Verification System
0110.060.40 Electronic Verification System Case Record Entries
0110.060.45 Electronic Verification System Responses Received After the Eligibility Determination

It is very important that all staff review the new manual sections thoroughly.

Training will be conducted using a series of webinars to introduce the new EVS sources and requirements. You will receive notifications and invitations to these trainings via email.

The following new guides have been created:

Electronic Verification System Sources

Accuity Portal Guide

The following guides have been updated:

MHABD Caseworker Reference Guide- Liquid Assets

Comment Quick Reference Guide – Liquid Resources section

New EVS Sources:

  • Accuity: Portal that provides information regarding liquid assets such as bank accounts.
    • This source will be accessed for the MO HealthNet for the Aged, Blind, and Disabled (MHABD) program at the time of application and at annual renewal.
    • Accessing information from Accuity at application and annual review is required by federal regulation 42 U.S.C. § 1396w.
    • Release is scheduled for December 1, 2020.
  • Benefit Assessment: Portal titled Accurint for Government Eligibility that provides information regarding real property, personal property, incarceration, and death.
    • This source will be accessed as needed for the MHABD and Family MO HealthNet (MHN) programs at the time of application and annual renewal.
    • Release is scheduled for December 2020.
  • Program Participation Analyzer (PPA): Portal that provides information regarding duplicate participation in other states for participants of the MHABD, Family MHN, Temporary Assistance (TA), and Child Care (CC) programs.
    • This source will be accessed for MHABD, Family MHN, TA, and CC cases at the time of application and annual renewal.
    • MHABD release is scheduled for December 2020.
    • TA and CC release is scheduled for January 2021.
  • National Accuracy Clearinghouse (NAC): Portal that provides information regarding duplicate participation in other states for the Supplemental Nutrition Assistance Program (SNAP).
    • This source will be accessed for SNAP cases at the time of application and mid-certification review.
    • Release is scheduled for March 2021.

 

Fair Credit Reporting Act (FCRA) requirements:

The Accuity and Accurint for Government Eligibility portals provide information from a consumer reporting agency, which adds some additional requirements for FSD.

  • Authorization: Applicants and recipients give their authorization to match information with the consumer reporting agency when the applicant signs the application. FSD needs authorization from eligibility unit members who are not applying for or receiving public assistance benefits before reviewing EVS sources that have FCRA requirements, also known as FCRA sources. Please thoroughly review manual section 0110.060.15 Fair Credit Reporting Act Authorization for additional information.
  • Notices: When information provided by a consumer reporting agency results in an adverse action, additional language must be included on the adverse action and action notices. FSD is required to notify the participant that information from a consumer reporting agency was used in the eligibility determination and the contact information for the consumer reporting agency.
    • New codes have been created that prompt FAMIS to add this wording to the appropriate notices. These codes are included in the user guide for each FCRA source.
    • MEDES system work is still being completed. Manual notices must be sent if information from the Accurint for Government Eligibility portal results in a negative case action. Based on the types of information provided by Accurint for Government Eligibility, this would be incarceration. Death information reported by Accurint for Government Eligibility does not have FCRA requirements.

 

Contact information for FCRA sources:

 Contact information for Accuity and Accurint for Government Eligibility will be included on the appropriate notices when information received from these sources results in an adverse actions. If a participant contacts FSD and questions the information that was reported by Accuity or Accurint for Government Eligibility staff can refer them to the company that reported the information.

Accuity:
LexisNexis Risk Solutions Bureau, LLC
Consumer Inquiry Department
P.O. Box 105108
Atlanta, GA 30348-5108
Phone: 1-888-530-7378

Accurint for Government Eligibility:
LexisNexis Risk Solutions Bureau, LLC
Consumer Inquiry Department
P.O. Box 105108
Atlanta, GA 30348-5108
Phone: 1-877-497-2621

 

New system codes in FAMIS:

Each FCRA source has two new FAMIS verification codes. It is very important that you use the correct code so that the case pends only when appropriate and the correct wording goes out on the notices.

AS-Accuity Statement
AC-Accuity Confirmation

GS-Accurint for Government Eligibility Statement
GC-Accurint for Government Eligibility Confirmation

The AS and GS codes will pend the case, acting as if the verification code is left blank, and a Request for Information Notice will be generated. The AC and GC codes act as if verification has been received and will not pend the case.

As discussed in manual section 0110.060.20 Information Reported by Electronic Verification System Causes Ineligibility, FSD cannot close a case due to information reported solely by a source. When an EVS match returns information that indicates that an applicant or participant is ineligible and this information was NOT reported by the participant, FSD must request additional information from the applicant or participant. This could be in the form of contact with the participant to confirm the information or the request of additional verification.

When deciding which verification code to use, consider the current verification requirements for each program.

AS and GS codes will be used in the following situations:

  • Information reported by the EVS results in ineligibility;
  • Information reported by the EVS is questionable or additional details are needed before an eligibility determination can be completed

AC and GC codes will be used in the following situations:

  • Additional information was requested due to an EVS match, and the information was provided by the participant;
  • EVS confirms participants statement and no additional verification is required

 

Referrals to the Program Integrity and Welfare Investigations Units:

There have been no changes to the referral process to the Program Integrity (PIU) or Welfare Investigations Units (WIU).

For WIU referrals:

If the verification received results in a determination of ineligibility and benefits have previously been issued, submit a referral for investigation to the Welfare Investigations Unit (WIU) using the Overpayment Portal in the FSD Worksite. Select the appropriate reason for the referral. In the narrative, indicate the referral is based on an EVS match and list the specific portal. Make a comment in FAMIS documenting the referral.

If the verification received results in a determination of ineligibility and benefits have not been issued, do not submit a referral for investigation.

 

Field Processes:

Field process guides will be housed on the Accuity page on FSD’s Intranet Site. To access the Accuity page from FSD’s intranet site click on the button labeled “FSD Work Sites.”  In addition to future memos, you may receive information regarding field processes, best practices, and frequently asked questions from your Program Administrators or Managers.

Any questions about any of the topics covered in this memo should be sent through normal supervisory channels. Policy questions can be submitted by managers to the policy unit email addresses:

          MHABD and Family MHN: COLE.MHNPOLICY@dss.mo.gov

          SNAP: COLE.FSPOLICY@dss.mo.gov

          TA and CC: FSD.COLETAPOLICY@dss.mo.gov

If a case specific policy clearance is needed, the Request for Interpretation of Policy (IM-14) process should be utilized.

The new tools are part of your eligibility toolbox for improving accuracy and easing some of the verification burden for FSD participants!

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

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IM-164 COVID-19 EIGHTH EXTENSION OF PANDEMIC SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (P-SNAP) EMERGENCY ALLOTMENTS

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 EIGHTH EXTENSION OF PANDEMIC SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (P-SNAP) EMERGENCY ALLOTMENTS

DISCUSSION:

The Families First Coronavirus Response Act (FFCRA) allows for Emergency Allotments (EA) of supplemental benefits for the Supplemental Nutrition Assistance Program (SNAP/Food Stamps) to be issued to eligible SNAP households.  The P-SNAP program raises a household’s SNAP allotment to the maximum amount for the household size. 

Supplemental benefits have been issued by the Family Support Division (FSD) in March through November 2020 as part of the P-SNAP program.  P-SNAP has been extended through December 2020.  Beyond December 2020, participation in P-SNAP will be decided on a month to month basis during the COVID-19 health crisis.

SNAP households do not need to apply for P-SNAP.  The supplemental benefit will be automatically added to the Electronic Benefit Transfer (EBT) card.

Note:  Households that already receive the maximum allotment for their household size will not have a benefit increase.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

KE/ks

IM-163 ALLOWING ADDITIONAL MEDICAL SOURCES TO PROVIDE MEDICAL RECORDS FOR DISABILITY DETERMINATIONS FOR THE MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAM

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  ALLOWING ADDITIONAL MEDICAL SOURCES TO PROVIDE MEDICAL RECORDS FOR DISABILITY DETERMINATIONS FOR THE MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAM

MANUAL REVISION #

1060.005.05

DISCUSSION:

The Medical Review Team (MRT) uses medical evidence to determine if a MO HealthNet applicant or participant meets disability requirements in situations where the participant does not meet an exception to verification of disability 1060.005.00 VERIFICATION OF DISABILITY.

Manual reference 1060.005.05 Obtaining Medical Evidence For Medical Review Team has been updated to allow additional acceptable medical sources for medical records and clarify the Medical Review Team – Processing Center (MRT-PC) procedures.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/cj

IM-162 CORRECTION TO DATE FIELD ON THE NOTICE OF POST ELIGIBILITY MEDICAL EXPENSE REDUCTION IN SURPLUS (IM-62 PEME) FORM

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  CORRECTION TO DATE FIELD ON THE NOTICE OF POST ELIGIBILITY MEDICAL EXPENSE REDUCTION IN SURPLUS (IM-62 PEME) FORM

FORM REVISION #

IM-62 PEME

DISCUSSION:

The IM-62 PEME form was revised to correct an error in the date field. Staff must now enter the date the form is created and sent as it is no longer pre-populated. 

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/cj

IM-161 PUBLIC ADMINISTRATOR LIAISONS FOR ALL INCOME MAINTENANCE PROGRAMS

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  PUBLIC ADMINISTRATOR LIAISONS FOR ALL INCOME MAINTENANCE PROGRAMS

DISCUSSION:

The purpose of this memorandum is to inform staff of updated Public Administrator (PA) liaisons. Public Administrators have a designated Family Support Division (FSD) staff member with whom they, their deputies, or their staff can discuss and resolve issues on behalf of participants for whom they are legal guardians or conservators. The PA liaisons may respond to case inquiries and take case action as needed on all Income Maintenance programs.

There are now three PA liaisons within FSD, each with an assigned region. The Kansas City Region has merged with the North Region. The PA liaison will contact the Public Administrator or their staff that corresponds to the county the participant resides in based on the map found here: MHABD Nursing Home Units Map.

Below are the current PA liaisons:

North Region (includes Kansas City area)
Angela Hibner
601 W Mohawk Rd
Chillicothe, MO 64601
Livingston.codfs@dss.mo.gov

St. Louis Region (includes Madison County)
Mary Wisdom
413 Burris St
Fredericktown, MO 63645
Madison.codfs@dss.mo.gov

South Region Beth Ann Blackburn
Highway 160 West
PO Box 717
Gainesville, MO 65655
Ozark.codfs@dss.mo.gov

Cases in which Public Administrators are involved will now be processed by Butler County, Home and Community Based Services (HCB) Processing Center in Poplar Bluff. Do not refer Public Administrators or their staff to the PA liaisons if they contact the Customer Service Center and can be assisted during that point of contact.

All staff are permitted to discuss cases in which a Public Administrator is the customer’s conservator/guardian with the Public Administrator or anyone who works in the Public Administrator’s office, as long as a copy of the court order approving the conservatorship or guardianship is contained in the case record. The PA liaisons have been instructed to maintain a list of staff in each Public Administrator’s office as a reference.

A Departmental Vendor Number (DVN) is assigned to each Public Administrator and should be filled out in the DVN field. This DVN will ensure that if the Public Administrator changes all cases attached to this DVN will be updated.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

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IM-160 BLIND PENSION RESIDENCY REQUIREMENT UPDATED ON ONLINE INFORMATION PAGE

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  BLIND PENSION RESIDENCY REQUIREMENT UPDATED ON ONLINE INFORMATION PAGE

DISCUSSION:

The Blind Pension online information page has been updated to better explain the eligibility requirement of Missouri residency.

A participant meets the residency requirement to receive Blind Pension when he/she intends to remain in Missouri if:

  • the participant has been a resident of Missouri for at least 12 months prior to application for Blind Pension, or
  • the participant became blind while he/she was a resident of Missouri, and has maintained residency in Missouri since becoming blind, (whichever is the shortest time period).

NOTE: Blind Pension applications and maintenance are handled exclusively by the Blind Service Center in Lincoln County.

 

NECESSARY ACTION:

 

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