IM-071 – FAMIS SUPPLEMENTAL AID TO THE BLIND (SAB) AND BLIND PENSION (BP) ADJUSTMENT

2018 Memorandums

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
PO BOX 2320
JEFFERSON CITY, MISSOURI

IM-#071, 12/19/2018

TO: ALL FAMILY SUPPORT OFFICES
FROM:  PATRICK LUEBBERING, DIRECTOR
SUBJECT:   FAMIS SUPPLEMENTAL AID TO THE BLIND (SAB) AND BLIND PENSION (BP) ADJUSTMENT

MANUAL REVISION #51
0415.005
0510.000.00
BP PRORATION CHART

DISCUSSION:

Effective July 1, 2018, the maximum grant for SAB and BP increases from $738 to $750. A Family Assistance Management Information System (FAMIS) mass adjustment was completed the weekend of June 9, 2018.

This memorandum discusses the following:

ELIGIBILITY UNITS (EUS) IN THE CONTROLLED FLOW

If an eligibility unit (EU) with existing SAB/BP income is in the FAMIS controlled flow, the SAB/BP grant amount will not be adjusted. These cases will appear on the “Cases Not Adjusted/Error” Report and will not be adjusted by the system until the controlled flow is completed. Priority attention must be given to this listing as participant’s SAB/BP grant amount will be incorrect beginning July 1, 2018.

When the case is taken through the flow a July 2018 budget and subsequent budget months must be entered, FAMIS will then calculate the deficiency or retroactive SAB/BP grant amount and issue those payments to the participant. To check for deficiency or retroactive SAB/BP payment issuance after the overnight batch process, view the Payment History (PAYHIST/FM5F) screen.

NOTE: Deficiency (DEF) payments are issued if the month for which they are intended has passed; retroactive (RTO) payments are issued if the month for which they are intended is the current month.

CONFLICT OF ACTIONS

FAMIS adjusts the income 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 new action can be taken. The Eligibility Specialist receives the alert “OUTSTANDING ELIGIBILITY DETERMINATION”. The conflict must be resolved by the Eligibility Specialist.

Access the Action Resolution (ACTRES/ FM5O) screen and void the pending adverse action, if appropriate. Each action must be reviewed to ensure a needed action is not voided.

Adverse actions with reasons APT, MIN, or COO should only be voided if the participant has taken the necessary steps to resolve the closing reason. IF they have not cooperated, by rescheduling the appointment, providing missing releases, etc., do not void the action. FAMIS will resolve the conflict when the initial closing is acted upon.

If it is determined that the previous action can be voided, refer to the user guide Changing an Adverse Action Status for instructions how to void. After voiding the adverse action, access the Eligibility Determination Resolution (EDRES/ FM3Y) screen, run a new eligibility determination, and authorize the new adverse action. FAMIS will produce an Adverse Action Notice (FA510) or a MO HealthNet Adverse Action Notice (FA410) and take action when the notice has expired.

OTHER ACTIONS

For eligibility determinations completed on or before June 9, 2018, FAMIS will use the previous SAB/BP grant amount for the budget months through June 2018. For eligibility determinations completed June 10, 2018 or after, FAMIS will use the previous SAB/BP grant amount for budget months through June 2018 and use the new SAB/BP grant amount for the month of July 2018 and ongoing.

NOTICES

A Claimant Action Notice (FA150) is sent for the following types of cases during the mass adjustment, notifying them of the July 2018 change of benefits:

  • all Child Care cases adjusted;
  • all Temporary Assistance cases adjusted;
  • all Food Stamps case adjusted.

No action notice is being sent for Food Stamps, or Temporary Assistance cases that result in no change (NOCH) in benefits due to the SAB/BP mass adjustment.

An Adult MO HealthNet Adverse Action Notice (FA420) will be sent for Adult MO HealthNet cases that result in a change in benefits due to the SAB/BP adjustment. An Adult MO HealthNet Benefit Notice (FA460) will be sent once the adverse action notice expires.

FAIR HEARING REQUEST

If the EU requests a fair hearing, send the request to the Hearings Unit the same day.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

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IM-070 – MOHEALTHNET ELIGIBILITY UNDER SECTION 1619 OF THE SOCIAL SECURITY ACT

2018 Memorandums

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
PO BOX 2320
JEFFERSON CITY, MISSOURI

IM-#070, 12/18/2018

TO: ALL FAMILY SUPPORT OFFICES
FROM:  PATRICK LUEBBERING, DIRECTOR
SUBJECT:  MO HEALTHNET ELIGIBILITY UNDER SECTION 1619 OF THE SOCIAL SECURITY ACT

MANUAL REVISION #50
0850.000.00
0850.005.00
0850.005.05
0850.005.10
0850.005.20
0850.010.00
0850.015.00
0850.020.00

DISCUSSION:

The purpose of this memorandum is to introduce revisions to the current Medical Assistance Manual Sections related to eligibility for Title XIX MO HealthNet under Section 1619 of the Social Security Act.

1619 status approval through Social Security occurs when disabled individuals lose SSI eligibility due to income from employment. The threshold amount Social Security uses to measure gross earnings for potential 1619 beneficiaries in Missouri as of January 1, 2018 is $37,188 and changes annually. These individuals continue to meet the SSI disability requirements, and their earnings are excluded for MO HealthNet if all other MO HealthNet 1619 eligibility requirements are met.

There are three distinct eligibility requirements. A MO HealthNet recipient must:

  • be approved for 1619 status by Social Security,
  • fall below the Section 1619 resource maximum, and
  • the participant must have received MO HealthNet in the month prior to being approved for 1619 status by the Social Security Administration.

1619 cases are no longer processed in Legacy. The revised manual sections have been updated to remove Legacy system processes, and provide clarification to current policy. The new Section 1619 Eligibility Guide will be helpful when completing eligibility determinations for MO HealthNet 1619.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

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IM-069 – BLIND PENSION ADDENDUM

2018 Memorandums

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
PO BOX 2320
JEFFERSON CITY, MISSOURI

IM-#069, 12/18/2018

TO: ALL FAMILY SUPPORT OFFICES
FROM:  PATRICK LUEBBERING, DIRECTOR
SUBJECT:    BLIND PENSION ADDENDUM

DISCUSSION:

Due to changes to the Blind Pension (BP) program, additional information is required to complete an application or reinvestigation.

A Blind Pension Addendum has been designed to gather the additional driver license information required.

The BP Addendum is required for each person making application for Blind Pension, August 28, 2018 or later. The BP Addendum is required for all reinvestigations beginning August 28, 2018, through and including reinvestigations for October 2018. Reinvestigation forms (FA402) sent by FAMIS for November 2018 will include the necessary questions. A form must be completed by each individual who is requesting or receiving Blind Pension and must be signed by the individual or the authorized representative.

Send the BP Addendum with all mailed paper applications.

Send the BP Addendum with an FA325 Request for Information or an IM31a Request for Information, allowing 10 days for it to be returned, for all pending applications and reinvestigations, as listed above. If it is not returned, the application maybe rejected, or action maybe started to close the case for failure to provide requested information.

NOTE: The BP Addendum must be sent by certified mail.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Require the Blind Pension Addendum for all applications beginning August 28, 2018.
  • Require the Blind Pension Addendum for all reinvestigations beginning August 28, 2018 through and including reinvestigations for October 2018.

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IM-064 MO HEALTHNET ELIGIBILITY REVIEW INFORMATION (FA-402) REVISIONS FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS

2018 Memorandums

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
PO BOX 2320
JEFFERSON CITY, MISSOURI

IM-#064, 12/10/2018

TO: ALL FAMILY SUPPORT OFFICES
FROM:  PATRICK LUEBBERING, DIRECTOR
SUBJECT:   MO HEALTHNET ELIGIBILITY REVIEW INFORMATION (FA-402) REVISIONS FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS

DISCUSSION:

The purpose of this memorandum is to introduce changes made to the FA-402.

Additional information has been added to allow the MO HealthNet Eligibility Review Information (FA-402) form to be used as an application during the ninety (90) day reconsideration period for all MHABD cases. If a case was closed for failure to return the annual review, and the completed FA-402 is returned more than thirty (30) days after the closing date, but within ninety (90) days from the date the case closed as per IM-63, November 21, 2018, the participant is not required to complete a new application form.

The revised FA-402 is available in the IM Forms Manual.  The same version of the FA-402 will be automatically generated by the Family Assistance Management Information System (FAMIS).

NECESSARY ACTION:

  • Review this memorandum with appropriate staff
  • Destroy all paper versions of the FA-402

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IM-068 – Increase in Vendor Maximum Monthly Maintenance Standard and Minimum and Maximum Spousal Share

2018 Memorandums

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
PO BOX 2320
JEFFERSON CITY, MISSOURI

IM-#068, 12/10/2018

TO: ALL FAMILY SUPPORT OFFICES
FROM:  PATRICK LUEBBERING, DIRECTOR
SUBJECT:    INCREASE IN VENDOR MAXIMUM MONTHLY MAINTENANCE STANDARD AND MINIMUM AND MAXIMUM SPOUSAL SHARE

MANUAL REVISION #47
0815.030.10.10.10
1030.035.10
1030.035.20
1030.035.25
APPENDIX B

DISCUSSION:

Effective January 1, 2019, the Maximum Monthly Maintenance Standard, and the minimum and maximum spousal share amount are increased.

MAINTENANCE STANDARDS

The new Maximum Monthly Maintenance Standard is $3161.00. IM Manual Section 0815.030.10.10.10 and APPENDIX B have been updated to reflect the change effective January 1, 2019.

The Minimum Monthly Maintenance Standard of $2058 was announced in Memo IM-#47, dated August 6, 2018.

SPOUSAL SHARE

The new minimum spousal share is $25,284.00. The new maximum spousal share is $126,420.00. Both amounts become effective for any assessment completed on or after January 1, 2019. 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, 2019.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

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IM-067 JANUARY 2019 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME

SUBJECT:  JANUARY 2019 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOMEMANUAL REVISION #48
0410.010.15
0805.020.15
1030.010.05
APPENDIX E
APPENDIX J
APPENDIX K
APPENDIX L

DISCUSSION:

In January 2019, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive a 2.8% Cost of Living Adjustment (COLA). A mass adjustment of FAMIS Child Care, Food Stamps, 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 8, 2018.

This memorandum discusses the following:

NEW AMOUNT OF SSI

Effective 2019, SSI benefit amounts are as follows:

  NEW AMOUNT INCREASE
SSI Individual maximum (in own household) $771.00 $21.00
SSI Couple maximum (in own household) $1157.00 $32.00
SSI Individual in household of another $ 514.00 $14.00
SSI Couple in household of another $771.00 $21.00
SSI Essential person/own home $386.00 $10.00

The standard SMI Premium is $135.50 for 2019.

NEW MO HEALTHNET FOR AGED, BLIND, AND DISABLED STANDARDS

Effective 2019, SSI benefit amounts are as follows:

Maximum Allotment to Community Spouse $3161.00
Minimum Maintenance Standard for Allotments $2058.00
Maximum Allocation to a child $386.00
Maximum Allotment to a child $686.00
Minimum Spousal Share $25,284.00
Maximum Spousal Share $126,420.00
Maximum Home Equity $585,000.00
HCB Maximum $386.00
SAB Standard $833.00

ADJUSTING THE ELIGIBILITY UNITS BY PROGRAM

Food Stamps

Food Stamp 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 Food Stamp adjustments. If the Temporary Assistance case is closed, the grant was removed from the Child Care and Food Stamp budgets.

MHABD

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, 2019.

  • 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:

  • 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 2019 to $135.50. The SMI premium for those who begin receiving Medicare in 2019 will be $135.50. Premiums for those who were receiving Medicare prior to 2019 may be adjusted, if it was less than $134.00 for 2018, 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 2018. Effective January 1, her Social Security will increase to $1028. Her SMI will increase, but by no more than the amount of her benefit increase, $28 in this example. It may be necessary to request verification from the participant of their SMI premium.

Adding SMI Premium

EUs with an SMI premium verified by the BENDEX file as paid by the individual are eligible for the medical expense for Food Stamp benefits and Child Care assistance. If the individual pays the SMI amount and there is no medical expense type SM on the Medical Expense (MEDEXP or FMXA) screen in FAMIS, the medical expense SM and amount verified by the BENDEX file will be added for the month of January 2019 during the mass adjustment.

The comment, “SMI Expense created for new amount from BENDEX file,” will be added to the Expense Comment (FMF7) screen. If the Benefit Claim Number on the Income (FMX0) screen in FAMIS is blank or incorrect, the system will be unable to complete the adjustment to add the SMI premium as a medical expense.

NOTE: If the SMI premium expense has been entered in FAMIS with the incorrect source code (such as MS or HI), the additional expense type code of SM will be added, allowing the expense twice.

End-Dating SMI Premium

EUs with medical expense type SM on the Medical Expense (MEDEXP or FMXA) screen in FAMIS who are no longer paying the premium are not eligible for this medical expense. If there is a medical expense type SM in FAMIS and the BENDEX file verified the SMI premium is paid by the State of Missouri, the medical expense will be end dated on the Medical Expense (MEDEXP or FMXA) screen in FAMIS as of December 31, 2018. The comment, “SMI Expense ended due to state paying premium – BENDEX file,” was added to the Expense Comment (FMF7) screen.

FAMIS will remove the expense effective the month of January 2019, and complete an eligibility determination. The EU will receive an Action Notice of any change in benefits due to the increase in income and removal of the medical expense. An FA-510 Adverse Action Notice will not be sent to the Food Stamp EUs since this is being done as part of a mass adjustment.

If the participant reports their SMI increased, but no adjustment was completed during the COLA adjustment, check IIVE. If the amount shown on IIVE is not the same as reported by the participant, request verification of the new amount from the participant. The Social Security Administration will send notices with the new benefit amount and SMI premium to each individual.

NOTE: If IIVE and the Social Security Administration letter differ in benefit amount or SMI premium, use the amounts listed on the letter.

MASS ADJUSTMENT PROCESS

The mass adjustment begins in FAMIS on December 8, 2018.

Most EUs with SSA/SSI/VA/RR income that were active by the end of the day on December 7, 2018, with a certification ending January 2019 or later will be adjusted to show the increased benefit amounts. FAMIS identifies any EU that has been previously adjusted by the Eligibility Specialist, if there is a January 2019 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 2.8%. 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 2.8%. 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 2.8%. 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 Food Stamp recertifications, if the child care certification period or last Food Stamp month of certification is January 2019 or February 2019, 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 County Staff section of the memorandum.

FAMIS will adjust, end, or add the medical expense type SM-SMI PREMIUM as described in the SMI Premium section of this memorandum. On the Food Stamp 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 012019. 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 012019. 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 012019.

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.

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 2019, and used in an eligibility determination prior to the COLA mass adjustment.
  • Log into the Managed Reporting area.

    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 2019, 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 Food Stamp 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 Food Stamp benefits. If the Supplement Nursing Care grant is not budgeted, add the grant to the Income (FMX0) screen and act upon the action.

  • NEW SMI EXPENSE ADDED – The SMI Premium (SM) expense has been added as a deduction in FAMIS because BENDEX has a self-pay SMI.

    Request an IIVE interface to verify the SMI premium. If an incorrect “type” code for the SMI premium is in FAMIS on the Medical Expense (FMXA) screen, the EU will be receiving the deduction twice. Enter an end date for the incorrectly coded expense and complete an eligibility determination.

    If the SMI premium has recently been approved for state payment, (i.e.: QMB, SLMB), the BENDEX file may not reflect this change. If a medical expense code SM is added during the mass adjustment which is now being paid by the State, end date the premium and complete the eligibility determination.

  • Last Year SMI>Last Year Max – The amount of the medical expense type SM–SMI PREMIUM in FAMIS is larger than $135.50. 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 2.8% and rounding down to the nearest dollar.

The Eligibility Specialist must enter the new SSA/SSI/VA/RR amounts for new Child Care, Food Stamp, and Temporary Assistance applications processed after December 7, 2018.

The Eligibility Specialist 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 2018 or January 2019 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 2019.

CONTROLLED FLOW

If a Child Care, Food Stamp, 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 2019 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 10, 2018
  • AR100s accompanying the Adverse Action Notices, to the authorized representatives will be dated December 10, 2018
  • The Action Notices sent to BP participants will be dated December 10, 2018 due to being sent by certified mail
  • AR100s accompanying the Action Notices, to the BP authorized representatives will be dated December 10, 2018, and will be sent by certified mail
  • Notices will not be generated for no change (NOCH) actions in FAMIS

Food Stamps

An FA-150 Action Notice is generated for mass adjustment actions REDU (reduction), and CLOS (closing) notifiying 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  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 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 the Eligibility Specialist 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 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 10, 2018. 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 27, 2018, 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 27, 2018.

  • Food Stamp

    Food Stamp 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

    If the EU requests a hearing on a Temporary Assistance adjustment by December 20, 2018, the EU may request Temporary Assistance 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 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 December 20, 2018, 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 20, 2018, 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 20, 2018, 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

    If the EU receiving an FA-420 Adverse Action Notice requests a hearing on the MO HealthNet adjustment by December 20, 2018, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. County 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 MO HealthNet 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 20, 2018, 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.
  • Each Eligibility Specialist must access SSA/SSI/VA/RR Needing Review online report in Managed Reporting for their primary caseload.
  • Apply MO HealthNet policy for “CO” income verification to disregard SSA and SSI COLA adjustments until FPL adjustment in April.

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IM-063 MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS ANNUAL REVIEW POLICY UPDATES

2018 Memorandums

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
PO BOX 2320
JEFFERSON CITY, MISSOURI

IM-#063, 11/27/2018

TO:  ALL FAMILY SUPPORT DIVISION OFFICES
FROM:  PATRICK LUEBBERING, DIRECTOR
SUBJECT:  MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS ANNUAL REVIEW POLICY UPDATES
MANUAL REVISION #47
0840.000.00
0840.005.00
0840.005.05

DISCUSSION:

This memorandum introduces revisions to the Annual Review section of the Adult MO HealthNet Policy Manual.

  • Annual Review (general overview)
    • Annual Reviews are to be completed once every 12 months.
  • Reconsideration Period
    • When the MO HealthNet Eligibility Review Information form (FA-402) is received within thirty (30) days of the action to close the case, and all information is present, the annual review can be completed. The case can be reopened without a lapse in coverage.
    • When the MO HealthNet Eligibility Review form is received after the 30th day but within 90 days of the case closing, the review form may be used in place of an Application.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

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IM-066 PROTECTED CASELOADS

2018 Memorandums

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
PO BOX 2320
JEFFERSON CITY, MISSOURI

IM-#066, 11/26/2018

TO:  ALL FAMILY SUPPORT DIVISION OFFICES
FROM:  PATRICK LUEBBERING, DIRECTOR
SUBJECT:  PROTECTED CASELOADS

DISCUSSION:

The purpose of this memo is to update IM-#54 (5/25/2017) regarding Protected Caseloads.

Protected Caseloads have been established in the Family Assistance Management Information System (FAMIS) and Missouri Eligibility Determination and Enrollment System (MEDES) to protect Family Support Division (FSD) employees from inadvertently accessing or taking action on protected cases.

All applications and active cases where an FSD employee is a member of the household must be assigned to a protected caseload. Only Eligibility Specialists assigned to a protected caseload may authorize benefits for other FSD employees. Every FSD employee is responsible for immediately notifying their supervisor when a conflict or possible conflict arises so that the supervisor can make other arrangements for handling the client’s case.

Protected Load procedures are based on the following DSS Administrative Policies:

Conflict of Interest (2-500), which states that employees “are to perform their assigned duties in a manner which precludes any potential for a conflict of interest or the appearance of a conflict of interest” and “are specifically prohibited from any direct or indirect involvement in determining eligibility for or providing services to a client or applicant if the employee has any personal or financial relationship with the client or applicant. Personal relationships are defined as those that extend beyond a mere acquaintance, or which may compromise the decisions of the employee involved, either in fact or in appearance.

Work Rules (2-115) and Code of Conduct (2-120)

Information Security Management (6-100), which states workforce members are prohibited from accessing information regarding themselves, friends or relatives or making any other inquiries or updates that are not required in the performance of their official duties.

The protected load will serve applicants and recipients who meet any of the following criteria:

  • A victim of domestic violence;
  • A victim of human trafficking;
  • A participant in the Safe at Home program (Please see Safe at Home Address Procedure for FAMIS and MEDES, Email Memo #1 (2018);        
  • An employee of the Family Support Division (FSD);
  • A family member (spouse, parent or child) residing with an FSD employee (Applicant/recipient must reside in the same household has the FSD employee to be considered protected);
  • A case on which an FSD employee is the Authorized Representative;
  • A temporary employee currently assigned to FSD.

FSD Employee Applications and Active Cases

Effective immediately all applications and active cases where an FSD employee is a member of the household or an authorized representative must be assigned to a protected caseload. The employee should complete the Protected Load Cover Sheet (attached) and the Protected Load Request form (attached) then email the completed forms to ConfidentialFiles@ip.sp.mo.gov. The email subject line should be Protected Load – Initial Notification. Employees may also call 573-751-8959 and provide their identifying information. These cases will be moved into the protected load by the Customer Relations Unit (CRU).

Employees who wish to apply for benefits may do so by:

  • Fax – 573-522-2886
  • Mail – FSD/CRU, PO Box 2320, Jefferson City, MO, 65102
  • Email – ConfidentialFiles@ip.sp.mo.gov with “Protected Load – Application” in the subject line
  • Visiting any FSD Resource Center
  • Online at mydss.mo.gov

Employees choosing to submit their application to a FSD Resource Center or online must notify the CRU. Notification can be done by completing the Protected Load Cover Sheet (attached) and the Protected Load Request Form (attached) then submitting the completed forms via email to ConfidentialFiles@ip.sp.mo.gov, The email subject line should be Protected Load – Initial Notification or by calling 573-751-8959.

Employees who wish to report changes to their benefit cases may do so by submitting the completed Protected Load Cover Sheet via email to ConfidentialFiles@ip.sp.mo.gov with the email subject line Protected Load – Correspondence, by faxing the information to 573-522-2886, by mailing the documentation to the FSD/CRU, P O Box 2320, Jefferson City, MO 65102, by submitting the information to a FSD Resource Center or by calling the Customer Relations Unit at 573-751-8959. (If the case is not yet in the protected load, a completed Protected Load Request Form must also be submitted.)

Local Office Process

Family Support Division Resource and Processing Centers who identify applications, change reports, reinvestigations, re-certifications, or any other documentation on cases in the protected load should date stamp all documentation, log all documentation in ITrackRS per local instruction, stop all work on the case, and scan the completed Protected Load Cover Sheet, the Protected Load Request form, and all documentation via email to ConfidentialFiles@ip.sp.mo.gov with the subject line Protected Load – Correspondence, for review and processing.

Call Center employees who identify a protected case using the below criteria should follow the Call Center instructions regarding submitting a Protected Load call to the Customer Relations Unit. 

A protected case can be identified as follows:

FAMIS – When viewing a FAMIS case, FAMIS Program Participation (FAMISPAR/FM0D) screen of a case in the protected load will populate with information. The protected load numbers in FAMIS are 004613, 004614, 004615, and 004616.  If there is no information showing when viewing a case on FAMISPAR/FM0D, it means that the client has no benefits at this time.  The case is not a protected load case.

FAMIS (CC, TA, FS) pending tasks – If you are working a task associated to a case in the protected load, you will need to complete the Protected Load Cover Sheet and email the coversheet to ConfidentialFiles@ip.sp.mo.gov for review and handling. Include Protected Load – Correspondence in the email subject line. Update the task to ‘completed’ after emailing the cover sheet.

FAMIS (MHABD) pending tasks – If you are working a task associated to a case in the protected load, you will need to complete the Protected Load Cover Sheet and email the coversheet to ConfidentialFiles@ip.sp.mo.gov for review and handling. Include Protected Load – Correspondence in the email subject line. Reassign the task to Carolyn Arl, Userid: ARLWZA.

MEDES – When viewing a protected case in MEDES on the person search tab, asterisks will show under the ‘person’ and ‘address’ sections indicating that the case is sensitivity level ‘2’ (protected load case) or a sensitivity level ‘3’ (safe at home case).

MEDES Pending Tasks – If you are working a task associated to a MEDES case showing a sensitivity level ‘1,’ and find that the case meets the Protected Load criteria,  complete the Protected Load Cover Sheet (attached) and the Protected Load Request form (attached) and then email the completed forms to ConfidentialFiles@ip.sp.mo.gov for review and handling. Include Protected Load – Correspondence in the email subject line. Update the task to ‘completed’ after emailing the cover sheet.

If a task is located on a MEDES case, where the case information is not viewable, complete the Protected Load Cover Sheet, include the task number and email the completed form to ConfidentialFiles@ip.sp.mo.gov for review and handling. Include Protected Load – Correspondence in the email subject line.

Web Applications – When an application is received through the online application process, and it is identified as a Protected Case, please follow the steps below:

  • Update Documentation Comments to show “Protected Load App” on indexing card & un-assign the app, save changes to card.
  • Protected loads: 004613, 004614, 004615, 004616
  • App/verification will return to the indexing queue and specialized staff will register
  • Send email to Michele Thomas-CRU (CC: Anna Beckett, Carolyn Arl & Shawna Hillen)
      • Email Subject line: Web app – Protected Load received (date)
      • Body of email: Web App ID#, list programs applied for and request the CRU to register the application.

          NOTE: if it is only a verification provided separately, be sure to indicate this.

For further instructions regarding the Web application process, please view the Web App Registration and Indexing Guide in the FSD Work Site.

NOTE:  All verifications/documentation for Protected Load cases are NOT to be scanned into the ECM.  Please follow the above instructions to submit any documentation.

ATTACHMENTS

PROTECTED LOAD REQUEST FORM

Protected Load Request Form

This form is to be used when the applicant’s benefit case is not yet in the protected load but meets the criteria stated above, or, the request does not meet the criteria stated above and the applicant is requesting their case remain in, or be moved to, the protected load. This form must be completed by the employee on the applicant’s behalf. Completed forms should be emailed to ConfidentialFiles@ip.sp.mo.gov with Protected Load – Correspondence in the subject line, for review and processing.

PROTECTED LOAD COVER SHEET

Protected Load Cover Sheet

This form is to be used by the employee as a cover sheet to provide information, such as notes, task information, along with any verification or documentation.  Completed forms should be emailed to ConfidentialFiles@ip.sp.mo.gov with Protected Load – Correspondence in the subject line. 

NECESSARY ACTION:

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IM-065 – Notification to Participants when MoHealthnet for Aged, Blind and Disabled (MHABD) Eligibility Review Forms (FA-402) are Received After the Ninety (90) Day Reconsideration Period

2018 Memorandums

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
PO BOX 2320
JEFFERSON CITY, MISSOURI

IM-#065, 11/26/2018

TO: ALL FAMILY SUPPORT OFFICES
FROM:  PATRICK LUEBBERING, DIRECTOR
SUBJECT:    NOTIFICATION TO PARTICIPANTS WHEN MO HEALTHNET FOR AGED, BLIND, AND DISABLED (MHABD) ELIGIBILITY REVIEW FORMS (FA-402) ARE RECEIVED AFTER THE NINETY (90) DAY RECONSIDERATION PERIOD

DISCUSSION:

This memorandum introduces the letter staff mail to former MHABD participants who return a completed FA-402 more than ninety (90) days after their case closed for failure to complete an annual review.  This letter notifies former participants the Family Support Division (FSD) received their FA-402 more than ninety (90) days after their case closed, and they must reapply:

When the FA 402 is received:

  • Within 30 days of the date the closing action was completed on the EU Action Log (EULOG) screen, cancel close the case.
  • More than thirty (30) days but within ninety (90) days of the date the closing action was completed on the EU Action Log (EULOG) screen, use the FA 402 as an application form. The time of more than 30 days but within 90 days is called the reconsideration period.
  • Ninety-one (91) or more days after the date the closing action was completed on the EU Action Log (EULOG) screen, mail a manually generated Letter for FA-402s Returned after 90 Days.

The FA-402 may be used as an application if received more than thirty (30) days after the MO HealthNet case closes but within ninety (90) days from the closing date; however, if it is received outside the 90 day reconsideration period, the Letter for FA-402’s Returned After 90 Days must be manually generated.  The letter instructs the household to reapply and provides the methods for reapplying.  This letter must be mailed to each household who returns the FA-402 ninety-one (91) or more days after the case has closed for failure to complete the annual review.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff

PL/vm

IM-062 REGAINING FOOD STAMP ELIGIBILITY MANUAL UPDATE

2018 Memorandums

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
PO BOX 2320
JEFFERSON CITY, MISSOURI

IM-#062, 10/05/2018

TO:  ALL FAMILY SUPPORT DIVISION OFFICES
FROM:  PATRICK LUEBBERING, DIRECTOR
SUBJECT: REGAINING FOOD STAMP ELIGIBILITY MANUAL UPDATE

MANUAL REVISION #46
1105.035.40

DISCUSSION:

The purpose of this memo is to inform staff the Food Stamp Manual reference 1105.035.40 Regaining Food Stamp Eligibility has been updated, due to a Food and Nutrition Service (FNS) clarification. The manual update clarifies how to process expedited applications when an ABAWD is regaining eligibility. It is acceptable for an application to expedite and pend for verification.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

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