Category: 2019

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  UPDATE TO INCOME INCLUDED AND EXCLUDED FOR MAGI PROGRAMS

MANUAL REVISION #

1805.030.20.05                             

1805.030.20.10

DISCUSSION:

The purpose of this memorandum is to advise that the MAGI MO HealthNet Policy Manual sections 1805.030.20.05 Income Included Under MAGI and 1805.030.20.10 Income Excluded Under MAGI have been updated.

Updates include:

• Changes in including or excluding alimony from divorces and separation:
  • Finalized before January 1^st, 2019: included
  • Finalized after January 1^st, 2019: excluded

• An increase in the tax filer threshold for earned income from a child to: $12,000 based on the 2018 IRS Publication 501
• Updating the term “commuter expenses” to “per diem reimbursements for travel expenses”
• Updated instructions on verifying excluded income to accept client statement unless there is inconsistent information

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/al

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  ADDING CANCEL CLOSE LANGUAGE TO MANUAL IM-33 MAGI FORM

FORM REVISION #

IM-33MAGI

DISCUSSION:

The purpose of this memorandum is to advise of added language to the manual IM-33MAGI notice form.

Language has been added to the reinstatement box option in order to explain:

• benefits are now reinstated with an effective date;
• benefits had previously been terminated;
• and that the participant will receive an additional notice on the outcome of any possible ongoing coverage.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Select the reinstatement box anytime a case is cancel closed – Review MEDES Resources for current procedures.
• Destroy all previous paper and electronic copies of the manual IM-33MAGI.

PL/al                                                

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  IM-1U 90 DAY LETTER UPDATE                            

IM-1U’s Returned After 90 Days (PDF)

DISCUSSION:

The purpose of this memorandum is to advise the IM-1U’s Returned After 90 Days Letter has been updated.

The following was changed:

• Letterhead was removed;
• The telephone number to contact for pending applications was removed;
• A single telephone number is now listed for both pending and active cases

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/al

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  2019 MO HEALTHNET CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) PREMIUM ADJUSTMENT

MANUAL REVISION #59

Appendix A
Appendix E

DISCUSSION:

The purpose of this memorandum is to introduce the CHIP premium adjustment effective July 1, 2019. Premiums are required for families with income above 150% of the Federal Poverty Level (FPL).  Each year, as required by state statute, the MO HealthNet Division (MHD) establishes the new premium amounts. The new premiums range from a minimum of $15 to a maximum based on family size and gross income, not to exceed 5% of the family’s gross income.  A premium chart with an effective date of July 1, 2019 is attached.

For CHIP cases active prior to July 1, 2019

The MHD Premium Collections Unit is including an advance notice of the upcoming change to premiums with invoices mailed July 2019 to all eligible premium group families. Premiums paid in June for July coverage will not change. Premiums invoiced in July for August coverage will reflect the new premiums.

For CHIP cases starting on or after July 1, 2019

Premiums for CHIP cases beginning on or after July 1, 2019 will immediately reflect the new premium amounts. 

Questions about premiums

Refer any questions concerning premiums to the Premium Collections Unit at (877) 888-2811.

Hearing Requests

Hearings requested as a result of the premium change will be conducted by the MO HealthNet Division (MHD) using normal hearing procedures.  Refer participants to the MHD Participant Services number: (800) 392-2161.

Hearings requested as a result of a change in income or household composition that affect the premium will be conducted by the Family Support Division.  If a hearing is requested on any of these cases, please complete the Application for State Hearing (IM-87) form.  Scan and index the IM-87 and action notice to the FSD Hearing Portal.

Evidence presented at the hearing must include a copy of the invoice from the Premium Collections Unit, a copy of the budget used to arrive at the monthly gross income, and the IM-4(PRM) reflecting the premium amounts based on income.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

ATTACHMENTS

IM-4 (PRM)

PL/df

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  AFFORDABLE INSURANCE DEFINITION

MANUAL REVISION #58

1840.010.15.05

DISCUSSION:

This memorandum introduces updates made to the MAGI MO HealthNet Policy manual section 1840.010.15.05 Affordable Insurance Definition which includes instructions for calculating the affordability amount manually. This section of policy has been updated to reflect the new Federal Poverty Limit (FPL) affordability standard for each premium level.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/ag

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  INTRODUCTION OF FAMILY MO HEALTHNET (MAGI) APPENDIX H ME CODES CHART AND NEWBORN CLARIFICATION

MANUAL REVISION #56

1860.010.00

1860.010.20

MANUAL ADDITION #

Appendix H ME CODES CHART

DISCUSSION:

The purpose of this memorandum is to introduce Appendix H ME Codes Chart  in the Family MO HealthNet  (MAGI) manual.  This appendix is a comprehensive list of MO HealthNet Eligibility (ME) codes, hierarchy levels, and funding sources, such as Title XIX(19).

The appendix can be used to help determine if a pregnant woman was receiving (or is retroactively eligible for) a qualifying Title XIX coverage on the child’s date of birth, thus making the child automatically eligible for newborn coverage.

This memo also introduces updates to MAGI manual section 1860.010.00 Eligibility to refer staff to the new Appendix H ME Codes Chart and reintroduces 1860.010.20 Eligibility Dates in the Newborn section of the manual.  

NECESSARY ACTION:

• Begin utilizing Appendix H
• Review this memorandum with appropriate staff.
• PL/al/ers

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  DISABILITY AND SUBSTANTIAL GAINFUL ACTIVITY CALCULATIONS FOR THE TICKET TO WORK HEALTH ASSURANCE (TWHA) PROGRAM

MANUAL REVISION #55

0855.005.25

DISCUSSION:

The purpose of this memorandum is to introduce changes made to the 0855.005.25 Disability section of the Medical Assistance for the Aged, Blind, and Disabled (MHABD) manual.

Earnings are not considered in the disability determination for Ticket to Work Health Assurance (TWHA). However, if a participant is ineligible for TWHA based on excess income, a disability determination for MHABD non-spend down/spend down coverage should be explored if the participant’s income, excluding sick and/or vacation pay, is below the Substantial Gainful Activity (SGA) limit for MHABD.

EXAMPLE: Mr. Lee worked 1 week during the month of February for which he received $1,000 in wages. Mr. Lee then received $1,000 for 1 week of vacation pay and $2,000 for 2 weeks of sick pay at $1,000 each week. His total monthly gross income was $4,000.

Mr. Lee’s income exceeds the $3,035.00 limit for TWHA. However, only the $1,000 received for work activities is applied toward the SGA limit of $1,220.00 for MHABD. Therefore, Mr. Lee should have a Medical Review Team (MRT) decision completed to determine eligibility for MHABD spend down.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/cj

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  DECEMBER 1973 ELIGIBILITY REQUIREMENTS MANUAL REVISIONS FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS

MANUAL REVISION #54
1025.010.00
1040.015.10.05
1040.015.10.05.00
1040.015.10.05.05
1040.015.10.05.10
1040.020.30

DISCUSSION:

This memorandum introduces revisions to the December 1973 Eligibility Requirements Manual.

The Cash and Securities section 1025.010.00 Definition has been revised to provide additional policy  related to determining eligibility for MO HealthNet  Programs for the Aged, Blind, and Disabled (MHABD) when the participant and/or their spouse is a party to a Promise to Pay contract, Promissory Note, or Property Agreement.

• Changes have been made to 000.00 Transfers of Property sections:
• Section 1040.015.10.05 is now titled Consideration of Certain Contracts. This section lists definitions and steps to follow when reviewing MO HealthNet cases for applicants/participants who are a party to certain contracts such as Promise to Pay, Promissory Notes, or Property Agreements.
• 1040.015.10.05 has been moved to 1040.015.10.05.00 and revised to provide further clarification.
• Section 1040.015.10.05.05 Promissory Notes has been added, and includes a link to the new Promissory Notes Guide.
• Section 1040.015.10.05.10 Property Agreements has been added.
• Section has been revised to provide additional guidance on how to determine fair and valuable consideration. 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/vm