FROM: KIM EVANS, DIRECTOR
SUBJECT: 2021 POVERTY INCOME GUIDELINES FOR FAMILY MO HEALTHNET (MAGI) PROGRAMS EXTENDED
MANUAL REVISION #
Appendix A
The MAGI income guidelines in Appendix A which posted April 1, 2021 have been extended through March 31, 2022. The updated Appendix A can be found in the Family MO HealthNet (MAGI) Manual.
Review this memorandum with appropriate staff.
KE/bl
FROM: KIM EVANS, DIRECTOR
SUBJECT: INTERNAL USE ONLY FORMS REMOVED FROM PUBLIC DEPARTMENT OF SOCIAL SERVICES (DSS) FORMS MANUAL AND MOVED TO THE INCOME MAINTENANCE (IM) FORMS MANUAL
The DSS Manuals Forms Manual (public site) is intended to be used primarily by the public. The purpose is to assist participants and community partners who help participants with applying for and maintaining assistance from the Family Support Division (FSD).
The DSS Manuals Forms Manual (public site) has been updated to remove forms that are for internal use only. This includes many forms that staff complete and send to participants, as well as forms that are for field processing only and should not be accessible to participants.
The forms listed below are now available to staff only in the FSD Intranet Forms Manual (internal site).
Internal Use Only forms removed from the DSS Manuals Forms Manual:
|
BCC-1 |
BCCT Temporary Medicaid Authorization |
|
CARS-3 |
Demand Letter for Overissuance |
|
CARS-3 |
Out State Demand Letter (OTSTAT) |
|
CARS-3-AE |
Agency Error |
|
CARS-3-IHE |
Inadvertent Household Error (SPV-N) |
|
CARS-3-IHE-H |
Inadvertent Household Error Suspected Program Violation (SPV-Y) |
|
CTYINFO |
County Information Template (IM Forms) |
|
FA-351 |
Child Care Provider Health and Safety Information |
|
FA-352 |
Child Care Invoicing And Payment Information |
|
FA-402 |
Letter for FA-402’s Returned After 90 Days |
|
FA-700 |
Confidentiality Agreement |
|
FA-701 |
FAMIS User Request |
|
FA-702 |
Request for Access to FAMIS Information |
|
FA-703 |
Access or Revocation of Profile to a FAMIS User Granted by Central Security Administrator |
|
FSD/DBH |
Coversheet |
|
FSD/WIU |
Tracking Sheet |
|
IM-115 |
Request for Food Stamp Household Report |
|
IM-14 |
Request for Interpretation of Policy |
|
IM-145 OTH |
Change Report Form |
|
IM-16 |
Communication Transmittal |
|
IM-16 Log |
Child Support TA Sanction Request |
|
IM-204 |
Returned Check Register |
|
IM-206 |
Check Transmittal |
|
IM-210 MHN |
Report of MHN Quality Control Review |
|
IM-29 |
MAGI |
|
IM-29 |
Medicaid Eligibility Authorization |
|
IM-29 OPE |
Out-of-Pocket Expenses |
|
IM-29 SPDN |
Notification of Spend Down Coverage |
|
IM-30A |
MA Spend Down Worksheet |
|
IM-30B |
Surplus Computation Worksheet |
|
IM-31 |
Appointment Letter |
|
IM-311Q |
QC Referral For Contact/Sanction |
|
IM-31A |
Request for Information |
|
IM-31A |
Request for Information Electronic |
|
IM-31A |
Request for Information – Spanish |
|
IM-31A SHMB |
Request for Information Show Me Healthy Babies |
|
IM-31M |
Notification of Missed Interview |
|
IM-31Q |
Notice Of Contact Requested |
|
IM-31SPDN |
Spend Down Notification |
|
IM-32DIV |
Temporary Assistance Diversion Approval Notice |
|
IM-32MAGI |
Approval Notice |
|
IM-32MAWD |
Notice of Case Action |
|
IM-32SMHB |
Action Notice – SMHB |
|
IM-32SPDN |
Notice of Approval for Medical Assistance Spend Down |
|
IM-33 |
Notice of Case Action |
|
IM-33A |
Notice of Temporary Assistance/Food Stamp Case Action |
|
IM-33MAGI |
MAGI Notice of Case Action |
|
IM-33MAGI |
MAGI Notice of Case Action – Spanish |
|
IM-33MHF |
MO HealthNet for Families Notice of Action |
|
IM-33TMH-R |
Transitional MO HealthNet Quarterly Report |
|
IM-360A |
Extension or Closing Summary |
|
IM-363 |
Notice of Temporary Assistance Extension for Hardship Action |
|
IM-365 |
EMCIA Cover Sheet |
|
IM-39 |
Request For Employment Security Information – Outside State Of Missouri |
|
IM-39A |
Request For Public Assistance Information – Outside The State Of Missouri |
|
IM-41TA |
TANF Months Used |
|
IM-54 |
Referral for Services |
|
IM-54A |
Home and Community Based Services Referral/Assessment |
|
IM-58 |
Transitional MO HealthNet Suspension Notice |
|
IM-61 |
Social Information Summary |
|
IM-62 |
Notice of Eligibility for Nursing Facility/Other Vendor |
|
IM-62 PEME |
Notice Of Post Eligibility Medical Expense Reduction In Surplus |
|
IM-62 PEME-NFA |
PEME Facility Notification – Approval |
|
IM-62 PEME-NFD |
PEME Facility Notification – Denial |
|
IM-63 HWD |
MO HealthNet Undue Hardship Waiver Decision |
|
IM-63 HWN |
MO HealthNet Undue Hardship Waiver Letter |
|
IM-63 HWR |
MO HealthNet Undue Hardship Waiver Request |
|
IM-66 MAN |
Medical Appointment Notification |
|
IM-66 MAR |
Medical Appointment Notification – Authorized Representative |
|
IM-66 MRN |
Medical Appointment Reschedule Notification |
|
IM-66 MRR |
Medical Appointment Reschedule Notification – Authorized Representative |
|
IM-6EBT |
Authorization for Release of Information |
|
IM-76 |
Social Security Referral Request |
|
IM-80 |
Adverse Action Notice |
|
IM-80PRE |
Pre-Closing Notice |
|
IM-80SPDN |
Non-spend down to spend down Adverse Action Notice |
|
IM-80TMH |
Adverse Action Notice |
|
IM-82A |
Notice of Vendor Termination |
|
IM-89 |
Agency Representative Food Stamp Hearing Control Log |
|
IM-90 |
Withdrawal of Request for Hearing |
|
IM-90A |
Agency Action Rescinded |
|
IM-90B |
Agency Action Withdrawn Participant Notification |
|
IM-94A |
Family Child Care Provider Notice of Registration (Appr/Rej) |
|
IM-94B |
Parental Notice of Family Child Care Provider Registration (Appr/Rej) |
|
Menu |
Adds Menu Items for IM Forms to MS Word |
|
MO 580-2421 |
Family Care Safety Registration – Child Care And Elder-Care Worker Registration |
|
MRT Checklist |
MRT Checklist |
|
PE-1 |
SSL Application |
|
PE-2 |
Worksheet |
|
PE-3 |
PE Auth |
|
PE-3 |
TEMP SMHB |
|
WRKRINFO |
Worker Information Template |
|
SSI/SSDI Transition Letter |
|
|
|
SSI/SSDI Transition Letter – Spanish |
|
Signature Request Letter |
|
|
Internal Inspections Report/Field Office |
|
|
IRS Notice Log |
|
|
Research and Evaluation Request |
|
|
Standard Visitor Log |
|
|
DHSS Referral Letter |
|
|
DHSS Referral Letter-Spend Down |
|
|
Application for Other Benefits letter |
|
|
MO HealthNet Spend Down Discussion Checklist |
|
|
Temporary Assistance Diversion Transmittal Form |
KE/cj
FROM: KIM EVANS, DIRECTOR
SUBJECT: APPLICATION FOR HEALTH COVERAGE & HELP PAYING COSTS (IM-1SSL) UPDATED
FORM REVISION #
IM-1SSL
The IM-1SSL has been updated to add new options for applicants to submit their application to Family Support Division.
Mail to: Family Support Division
615 E. 13th St.
Kansas City, MO 64106
Email to: FSD.Documents@dss.mo.gov
Fax to: (573) 526-9400
KE/cj
FROM: KIM EVANS, DIRECTOR
SUBJECT: INTRODUCING MO HEALTHNET (MHN) INFORMATIONAL NOTICE (IM-34 AEG) FOR USE WITH MHN APPLICATION PROCESSING
FORM REVISION #
IM-34 AEG
The MHN Informational Notice (IM-34 AEG) is a new form Family Support Division (FSD) will send to applicants who may potentially be eligible for MHN Adult Expansion Group (AEG). The IM-34 AEG advises participants that they were rejected for MO HealthNet for Families, but they will still be evaluated for AEG when FSD begins processing AEG applications.
When a determination will reject an adult applicant, but must be authorized to approve benefits for a pregnant individual or a child (age 0-18 years old), staff must fill out this form, send a copy to the participant, and a copy to the electronic file.
EXAMPLE: Carla applies for MHN for herself and her husband, George. Carla reports that she is pregnant and there are no other children in the home. The eligibility system determines that Carla is eligible for MO HealthNet for Pregnant Women and George is ineligible as there is no eligible child in the home. However, George may be eligible for AEG.
The IM-34 AEG was added to the IM Forms Manual for staff to access.
KE/cj
FROM: KIM EVANS, DIRECTOR
SUBJECT: AVAILABLE RESOURCES FOR OLD AGE ASSISTANCE (OAA) AND PERMANENT AND TOTAL DISABILITY (PTD) CALCULATED USING CONSUMER PRICE INDEX-URBAN
MANUAL REVISION #
1030.000.00
Dated 7/1/2021, IM-70 Annual Mo HealthNet for Aged, Blind, and Disabled (MHABD) Asset Limit Increase shows the Individual Asset Limit increased to $5,035 and Couple Asset Limit increased to $10,070. These figures were calculated using the Consumer Price Index-Urban (CPI-U). CPI-U is the measure of the average change over time in the prices paid by urban consumers for a market basket of consumer goods and services. Manual Section 1030.000.00 has been updated to reflect the changes in the assets as well as a definition of CPI-U.
KE/mc
FROM: KIM EVANS, DIRECTOR
SUBJECT: MILEAGE REIMBURSEMENT RATE INCREASE FOR ALL INCOME MAINTANENCE (IM) PROGRAMS
MANUAL REVISION #
APPENDIX J
The state mileage rate used to calculate expenses for all IM programs increased from $.43 per mile to $.49 per mile effective 07/01/2021. Use the rate of $.49 per mile when calculating mileage expenses.
Eligibility system updates were completed on 07/21/2021 to reflect the rate increase. Appendix J of the MO HealthNet for the Aged, Blind and Disabled manual has been updated to reflect the change.
Note: Final approval for the increased rate was received after July benefits were created. Affected cases have been adjusted to reflect this change for July 2021 and notices will be generated.
KE/nw
FROM: KIM EVANS, DIRECTOR
SUBJECT: APPLICATIONS SIGNED BY A RELATIVE REQUESTING MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) BENEFITS
MANUAL REVISION #
0105.010.00
Section 0105.010.00 SIGNING THE APPLICATION of the General Information Manual was updated to specify that a relative is a person aged 18 years or older who is related to the applicant biologically, by marriage, or by adoption.
This is consistent with Family MO HealthNet (MAGI) Manual, 1802.020.00 SIGNING THE APPLICATION.
KE/cj
FROM: KIM EVANS, DIRECTOR
SUBJECT: SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) IM-210 FORM AND INSTRUCTIONS REVISED
FORM REVISION #
Report of SNAP Quality Control Review (IM-210)
Instructions for Completing the IM-210
The Report of SNAP Quality Control Review form (IM-210) and Instructions have been updated. The updated form revises Food Stamps to SNAP, job title terms and time frames. The revised form is currently available in the IM Forms Manual.
KE/mm
FROM: KIM EVANS, DIRECTOR
SUBJECT: RESUME SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) RECERTIFICATION INTERVIEWS
The Food and Nutrition Services (FNS) option to waive SNAP recertification interviews has ended. SNAP recertification interviews resumed August 1, 2021.
NOTE: Continue to waive recertification interviews for households in which all adult (18 and over) members are disabled or elderly, no household member has earned income, and there are no changes in circumstances. Use the SNAP Recertification Interview Decision User Guide when determining if an interview is necessary.
Recertification applications that are pending when interviews resume (received prior to August 1, 2021) will be waived.
KE/ks
FROM: KIM EVANS, DIRECTOR
SUBJECT: MANUAL SECTIONS REVISED TO ONLY INCLUDE THE ESTATE RECOVERY INFORMATION NECESSARY FOR THE ADMINISTRATION OF MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS
MANUAL REVISION #
Revisions have been made to the Estate Recovery section in 0880.005.00 of the MHABD Manual, and the December 1973 Eligibility Requirements Manual section 1025.015.04.01 on Special Needs Trusts, Supplemental Needs Trusts, and Pooled Trusts.
These sections have been updated to remove the descriptive stipulations surrounding when the MO HealthNet Division (MHD) Cost Recovery Unit will or will not file an estate recovery claim against the estate of an MHABD recipient or former recipient. This information is not necessary or required in order for Family Support Division (FSD) staff to determine eligibility for MHABD programs. Estate Recovery section 0880.005.00, has also been revised to include the current email address for the MHD Cost Recovery Unit, as listed below.
As a reminder, staff are prohibited from providing any financial planning advice to participants, authorized representatives, attorneys, or legal guardians. Estate recovery is a legal matter that is managed and overseen exclusively by the MHD Cost Recovery Unit. Participants and/or representatives must be directed to contact MHD directly for assistance, and information regarding estate recovery regulations, processes, and procedures:
KE/vm