Category: 2020

FROM:  KIM EVANS,  DIRECTOR

SUBJECT:  INTRODUCTION OF SUSPENSION OF MO HEALTHNET BENEFITS FOR INCARCERATED PARTICIPANTS FOR ALL MO HEALTHNET PROGRAMS

MANUAL REVISION #07

0105.040.30

0840.020.00

1020.005.00

1885.015.00

1885.040.00

FORMS REVISION #04

IM-33 SUSPENSION

IM-80 Suspension

DISCUSSION:

The 2018 SUPPORT for Patients and Communities Act (H.R. 6, P.L. 115-271) and SB 514 (2019) enacted RSMo §217.930 and §221.125 to require that MO HealthNet (MHN) benefits are suspended for individuals who are incarcerated, rather than ending his/her benefits and closing his/her case. This policy change affects all MO HealthNet for Aged, Blind, and Disabled (MHABD) and Family MO HealthNet (MAGI) programs. This applies only to participants who became incarcerated AFTER August 28, 2019.

Manual sections have been added to the Family MO HealthNet manual and to the MO HealthNet for the Aged, Blind, and Disabled manual to update information regarding participants receiving MHN benefits. For specific information regarding each program, refer to 1885.040.00 Suspension of MAGI Benefits for Incarcerated Individuals and 0840.020.00 Suspending Incarcerated Participants.

To update information for MHN participants that are incarcerated, there will be an assigned unit to make changes in FAMIS and MEDES. All information regarding incarcerated household members received by staff at the Service Centers should be sent to MHNJailsandDOCReport@ip.sp.mo.gov.

Until future system changes are completed, it may appear that there was no change made to cases in FAMIS and MEDES when an individual is incarcerated, but eligibility is suspended and changes are made by MO HealthNet Division (MHD) to prohibit medical expenses to be paid for a suspended participant while  incarcerated.  Staff should review FAMIS comments on EUMEMROL and MEDES comments on the Head of Household’s Client Contact tab, under Notes. Comments should include at a minimum: when a participant became incarcerated, an expected release date, and when information was sent to MHD to suspend benefits.

Participants will be notified of actions taken on cases regarding suspended benefits: when benefits are suspended, when a redetermination is completed and a participant’s benefits are restored, and if a redetermination is completed and a new level of care is authorized. These notices will be sent as IM-33 Suspension and IM-80 Suspension.

If a redetermination and ex parte review is completed and the participant is no longer eligible for any program, a standard adverse action will be sent regarding the reason he/she is no longer eligible (example: no eligible child in the home, over the income limit for MO HealthNet for Families, or no longer meeting the disability requirements).

Changes were also made to update manual sections that referred to closing MHN cases or ending eligibility for MHN participants that are incarcerated. See updates below:

General Information Manual:

0105.040.30 MO HealthNet Application for Inmates in Custody of Department of Corrections

MHABD, December 1973 Eligibility Requirements Manual:

1020.005.00 Inmate of Public Institution

MAGI:

1885.015.00 REMOVING A PERSON

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• All questions regarding this policy should follow normal supervisory channels.

KE/cj/ams

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  CLARIFICATION FOR UPDATING VETERANS ADMINISTRATION (VA) INCOME FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) VENDOR PARTICIPANTS

DISCUSSION:  

The purpose of this memorandum is to clarify policy regarding how VA income is treated when a participant enters a nursing home (vendor) facility.

When a participant enters a vendor facility, his/her VA will be reduced, usually to $90 per month.  This sometimes takes several months to be reduced.  The participant will normally not have to repay VA for the months between reporting the change and the actual reduction in benefits.  Do not reduce the VA payment until it has been verified the benefit has actually been reduced. 

Reducing the VA income budgeted prior to the actual reduction can result in an accumulation of resources, which can cause the participant to lose eligibility due to resources exceeding program limits.

NOTE:  These instructions are opposite the instructions given for SSI income reductions explained in IM-116 dated Aug 6, 2019.  The Social Security Administration requires SSI recipients to repay benefits received after the change in their living situation, VA normally does not.

If it is reported that a participant will be required to repay VA benefits received after entering a vendor facility, verify what months the participant will be required to repay.  Enter an adjustment to coverage using WIBCAs for the months that will be recouped by VA, using the reduced amount.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vb

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INTRODUCTION OF THE IM-4 MO HEALTHNET FLYER

FORM REVISION #03

Flyer

DISCUSSION:

The purpose of this memorandum is to introduce the new Flyer.  This replaces the IM-4 MO HealthNet brochure, which is now obsolete.  The flyer contains information relevant to both Managed Care and Fee for Service participants.    

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Please destroy any previous brochures and immediately begin using this flyer.

KE/mc

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INTRODUCTION OF THE IM-4 VENDOR PLANNING AND IM-4 MO HEALTHNET FOR NURSING HOME CARE FLYERS                                  

FORM REVISION #02

IM-4 Vendor Planning Flyer

IM-4 MO HealthNet for Nursing Home Care Flyer

DISCUSSION:

The purpose of this memorandum is to introduce the new IM-4 Vendor Planning Flyer and IM-4 MO HealthNet for Nursing Home Care Flyer.  This replaces the IM-4 Vendor Planning brochure and IM-4 MO HealthNet for Nursing Home Care brochure, which are now obsolete.  These flyers contain information relevant to Nursing Home Care and Nursing Home Office Locations.      

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Please destroy any previous brochures and immediately begin using these flyers.

KE/mc

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INTRODUCTION OF THE IM-4 MEDICARE SAVINGS PROGRAM (MSP) FLYER

FORM REVISION #01

IM-4 Medicare Savings Program (MSP) Flyer            

DISCUSSION:

The purpose of this memorandum is to introduce the new IM-4 Medicare Savings Program (MSP) Flyer.  This replaces the IM-4 Qualified Medicare Beneficiaries (QMB) brochure and the Medicare Savings for Qualified Beneficiaries (QMB-A) brochure, which is now obsolete. This flyer contains information relevant to all Medicare Savings Programs.        

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Please destroy any previous brochures and immediately begin using this flyer.

KE/mc

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INTRODUCTION OF THE RELATIONSHIPS SECTION IN THE DECEMBER 1973 ELIGIBILITY REQUIREMENTS MANUAL

MANUAL REVISION #06

1013.000.00

DISCUSSION:

The purpose of this memorandum is to introduce a policy addition to the December 1973 Eligibility Requirements manual, 1013.000.00 Relationships.

This section addresses observed and unobserved marriages in Missouri, defines certain relationships, and discusses relationship verification requirements.

Refer to this section when relationship is in question or affects eligibility for MO HealthNet for the Aged, Blind, and Disabled programs.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/ers

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  BLIND PENSION (BP) DRIVER LICENSE OR PERMIT AND OPERATING A MOTOR VEHICLE DISQUALIFICATIONS

MANUAL REVISION #05
0505.025.05
0505.025.10

DISCUSSION:         

House Bill 2171 (2018) revised Sections 209.030 and 209.040 RSMo and updated several eligibility factors for the Blind Pension (BP) program; see IM Memorandum #58 (2018) and IM Memorandum IM-09 January 25, 2019 for further details. 

This memorandum introduces further clarification for the effects on eligibility when a participant obtains a driver license, driver permit, or is determined to have operated a motor vehicle while receiving Blind Pension (BP).

Obtaining a Missouri driver license is verified by the Department of Revenue (DOR) through MODL interface.  The exchange between DOR and FAMIS is done nightly for all active BP individuals.  Licenses or permits obtained from another state or territory may be reported from other sources, and must be verified prior to imposing a disqualification.

When/if a report is received that a BP participant has been operating a motor vehicle, send the information to the BP Unit located in Lincoln County.   The BP Unit will review Case.net to confirm the issuance of a moving violation and a guilty plea or conviction.   If there is no moving violation, the BP Unit will make a referral to the Welfare Investigation Unit (WIU) to determine if there is sufficient evidence to impose a disqualification.

When an active BP participant obtains a driver license, driver permit, or is determined to have operated a motor vehicle, s/he is no longer eligible for BP and the case will be closed.  In addition the individual will be subject to progressively more severe disqualifications for each subsequent offense.

1. First offense will result in 2 year disqualification.
2. Second offense will result in 4 year disqualification.
3. Third offense will result in permanent disqualification.

NOTE: Disqualifications for obtaining a driver license or permit are sequenced separately from disqualifications for operating a motor vehicle.

EXAMPLE:  Fred receives BP.  MODL interface shows he has obtained a driver license and a disqualification is imposed for his first offense for 2 years.  After serving the 2 year disqualification, Fred reapplies and is approved.  Later the BP unit receives an anonymous report that Fred has been driving around town.  A check of Case.net verified he has received a moving violation for operating without a license, and has pled guilty.  The BP Unit will impose a disqualification for operating a motor vehicle.  This will be his first offense of this type and will last for 2 years. 

Disqualifications will be imposed and tracked manually pending coding changes to FAMIS. ONLY the BP Unit located in Lincoln County and WIU are authorized to impose a BP disqualification.  When/if another office receives a report that indicates a disqualification may be necessary, send the report to the BP Unit.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• When it is discovered that a BP participant has obtained a driver license, driver permit, or operated a motor vehicle, notify the BP Unit: Lincoln.CODFS@dss.mo.gov
• Other staff are not to enter BP disqualifications.

KE/vb

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  CORRECTION OF MAXIMUM ALLOTMENT TO A COMMUNITY SPOUSE

MANUAL REVISION #03

Appendix J

DISCUSSION:

Memorandum IM172 dated December 2, 2019 included an error in the amount of the Maximum Allotment to Community Spouse effective January 1, 2020.   The correct amount is $3216.  

The following have been updated:

• Appendix J
• Medicare Cost Savings Program

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vb

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 #02

0865.010.00
0865.010.15

Appendix J

Appendix K

Appendix L

DISCUSSION:

Effective January 1, 2020, the QMB, SLMB, and SLMB2 resource limits increased.  For a single individual, the resource limit increased from $7,730 to $7,860.  For a married couple, the resource limit increased from $11,600 to $11,800.  Resource maximums have been updated in the Family Assistance Management Information System (FAMIS).  There is no change in policy regarding how to determine available resources.

The following have been updated:

• Eligibility Requirements 0865.010.00
• Resources (QMB) 0865.010.15
• Appendix J.
• Appendix K The MO HealthNet Program Description Aged, Blind, and Disabled Chart
• Appendix L MO HealthNet Aged, Blind and Disabled Income Chart

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vb