IM-106 POLICY UPDATES FOR THE TICKET TO WORK HEALTH ASSURANCE (TWHA) PROGRAM

FROM: KIM EVANS, DIRECTOR

SUBJECT: POLICY UPDATES FOR THE TICKET TO WORK HEALTH ASSURANCE (TWHA) PROGRAM

MANUAL REVISION #

0855.000.00 0855.005.45
0855.005.00 0855.005.45.05
0855.005.35 0855.010.05 Obsolete
0855.005.40 0855.020.00
0855.005.40.01 Appendix K
0855.005.40.05 Obsolete  
0855.005.40.10 Obsolete       

 

DISCUSSION:

Senate Bill 106 requires changes to Missouri’s TWHA program. Missouri’s State Plan Amendment (SPA) for these changes was approved by the Centers for Medicare and Medicaid Services (CMS) on December 20, 2023. The following policy changes to the TWHA program are effective on January 1, 2024:

  • Changes to the asset limit calculations to exclude the value of all retirement accounts,
  • Modified the income calculations by broadening the definition to now consider the income of disabled participants up to 250% FPL, and
  • Changes to the earned income that is disregarded for the non-TWHA Spouse.

The MO HealthNet (MHN) policy sections and appendix listed above are updated to reflect changes made to the TWHA program.

The IM-4 TWHA Brochure is available to assist staff in explaining the purpose of the TWHA program to participants and provide an understanding of TWHA coverage.

Processing information to be used until system updates are complete will be released in an upcoming email memorandum.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/mm

IM-105 MO HEALTHNET (MHN) POLICY CHANGES TO EXTEND POSTPARTUM COVERAGE TO 12 MONTHS

FROM: KIM EVANS, DIRECTOR

SUBJECT: MO HEALTHNET (MHN) POLICY CHANGES TO EXTEND POSTPARTUM COVERAGE TO 12 MONTHS

0810.045.00 1850.040.20.10
0810.045.05 1850.040.30 obsolete
1850.000.00 1850.040.40 obsolete
1850.010.00 1850.040.40.10 obsolete
1850.020.00 1850.040.40.30 obsolete
1850.030.00 1850.050.00
1850.040.10 1855.030.15
1850.040.20 1890.000.00
APPENDIX I  

 

FORM REVISION #

IM-32MAGI

 

DISCUSSION:

Senate Bills 45 and 106, signed by Governor Parson on July 7, 2023 extend postpartum coverage to 12 months for women who have active Medicaid (including prior quarter) or Children’s Health Insurance Programs (CHIP) coverage when their pregnancy ends. The manual sections listed above are updated to reflect these changes. The changes included in this memorandum were effective July 7, 2023. Missouri’s State Plan Amendment (SPA) to implement these changes was approved by the Centers for Medicare and Medicaid Services (CMS) on November 14, 2023.

Note: This change to postpartum coverage does not apply to state funded programs such as Blind Pension (BP), Emergency MHN for Ineligible Aliens (EMCIA), Show-Me Healthy Babies (SMHB) individuals denied MO HealthNet for Pregnant Women (MPW) coverage due to an ineligible immigration status, and Uninsured Women’s Health Services (UWHS).

The following Family MO HealthNet (MAGI) manual sections are now obsolete:

  • 1850.040.30 Coverage When Application Is Made After the Birth
  • 1805.040.40 Extended Women’s Health Services
  • 1850.040.40.10 Eligibility for Other MO HealthNet Programs
  • 1850.040.40.30 Notification of Ineligibility for Extension Due to Insurance

The following sections have been added to the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual:

Appendix I and the IM-32MAGI have been updated to reflect a 12 month postpartum period.

Non-Pregnancy Levels of Care

Individuals receiving coverage under a non-pregnancy MHN level of care will not be moved to a pregnancy level of care unless they request that Family Support Division (FSD) do so.

Postpartum coverage for these individuals is granted within the MHN program they were on the date their pregnancy ended.

  • Non-MAGI Spend Down and Ticket to Work Health Assurance (TWHA) – A pregnant individual under these programs will have continuous coverage from the first day they meet their Spend Down or pay their premium while pregnant through the end of the 12 month postpartum period.
  • CHIP children – If it is not reported that a CHIP child is pregnant until after the pregnancy ends, the child will continue to be covered on the CHIP level of care they had on the date the pregnancy ended through their 12 month postpartum period. Pregnant and postpartum CHIP individuals are not required to pay a premium. However, if it is reported that a CHIP child is pregnant, they will be transitioned to MPW or SMHB for the remainder of their pregnancy through the end of the 12 month postpartum period.

NOTE: CHIP/SMHB individuals in their postpartum period who request to be moved to Title XIX level of coverage will not be able to regain eligibility under postpartum.

Prior Quarter

Individuals who apply for coverage after their pregnancy ends and are found eligible for prior quarter coverage, including the date the pregnancy ended, will be eligible for 12 months of postpartum coverage.

Extended Women’s Health Services (EWHS)

The EWHS program is discontinued with the implementation of 12 month postpartum. The UWHS program remains in place.

Annual Renewals

Annual renewals are not to be completed until the end of the 12 month postpartum period. An ex parte renewal will be attempted prior to sending a pre-populated renewal form to the participant.

System Updates

Updates are in progress in both eligibility systems to systematically grant 12 months of postpartum coverage. Review MEDES Resources, key word “Mitigation” for the manual process to follow on MAGI levels of care. The Non-MAGI manual process will be released in an email memorandum.

 

NECESSARY ACTION:

  • Review MEDES Resources, key word “Mitigation” for the MAGI manual process to follow until system updates can be completed.
  • Review this memorandum with appropriate staff.

 

 

 

KE/rc

IM-104 CONTINUOUS ELIGIBILITY FOR CHILDREN

FROM: KIM EVANS, DIRECTOR

SUBJECT: CONTINUOUS ELIGIBILITY FOR CHILDREN

 

DISCUSSION:

Effective January 1, 2024, Missouri is implementing Continuous Eligibility for Children (CEC) as directed in the Consolidated Appropriations Act, 2023. CEC allows continuous eligibility for 12 months for children ages 18 and under.

Eligibility may only be terminated prior to the end of the 12 month period if the child meets one of the following criteria:

  • Turns 19,
  • Ceases to be a resident of the State of Missouri,
  • The child or child’s representative requests a voluntary termination of eligibility,
  • The child dies, or
  • Eligibility is erroneously granted at the most recent determination, redetermination, or renewal due to agency error or fraud, abuse, or perjury attributed to the child or child’s representative.

Policy updates will be released once the Centers for Medicare and Medicaid Services (CMS) has approved Missouri’s State Plan Amendment.

Note: Additional information on processing procedures is forthcoming.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/vh

IM-103 CHILD CARE (CC) SUBSIDY PROGRAM TRANSITIONED TO DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION (DESE) CHILD CARE DATA SYSTEM

FROM: KIM EVANS, DIRECTOR

SUBJECT: CHILD CARE (CC) SUBSIDY PROGRAM TRANSITIONED TO DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION (DESE) CHILD CARE DATA SYSTEM

 

DISCUSSION:

Effective Monday December 18, 2023, eligibility for the CC Subsidy program will no longer be worked in FAMIS and will be transitioned to DESE’s Child Care Data System (CCDS). DESE took over administration and policy for the CC subsidy program August 28th, 2021.

  • December 14, 2023, will be the last day work will be done in Family Support Division’s (FSD) eligibility system.
  • The evening of December 15, 2023, all CC cases which are active, pending or in the controlled flow will be transitioned to DESE’s Child Care Data System (CCDS).

FSD staff, excluding the Child Care Unit, will no longer complete the following actions:

  • registering and processing new CC applications
  • cancel rejecting or cancel closing CC cases
  • authorizing children to CC providers
  • reviewing and processing changes in circumstance

Active CC cases that are transferred to CCDS will show in FSD’s eligibility system as closed. Pending CC cases without an eligibility determination will show as rejected. In January 2024, all converted CC cases will show on EULOG as CDS instead of AUC.

Effective December 15th, 2023, FSD staff will scan CC documents or applications received by mail/drop off or electronically to FSD.IM.CHILDCARE@DSS.MO.GOV. Current CC applications will be accepted by DESE, but new applications for CC will be available online at https://dese.mo.gov/childhood/child-care-subsidy/child-care-data-system December 19th, 2023.

If an individual wants to apply for CC or has verification needed for a childcare determination may mail it to:

Missouri Childcare Subsidy Program
PO Box 527
Hillsboro MO. 63050

If individuals call with questions about CC subsidy (eligibility, application, authorizations, changes), direct them to call 573-415-8605. This number will ONLY be active starting December 19th, 2023 and cannot be provided to participants before the go live date.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/ch

 

IM-102 UPDATES TO THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) CLAIMS PROCESS AND DETERMINING THE AMOUNT OF THE CLAIM FOR SIMPLIFIED REPORTING HOUSEHOLDS MANUAL SECTIONS

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATES TO THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) CLAIMS PROCESS AND DETERMINING THE AMOUNT OF THE CLAIM FOR SIMPLIFIED REPORTING HOUSEHOLDS MANUAL SECTIONS

MANUAL REVISION #
1142.010.00
1142.035.10.05

 

DISCUSSION:

Effective October 1, 2023, the threshold for establishing claims for participating households for Administrative Error (AE) and Inadvertent Household Error (IHE) increased to $250. The threshold for Suspected Program Violation (SPV) and Intentional Program Violation (IPV) claims remain $0. 1142.010.00 Claims Process

1142.035.10.05 Determining the Amount of the Claim for Simplified Reporting Households’ example clarifying the claim period for households that fail to report when their total income exceeds the 130% of poverty amount was revised.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/se

IM-101 INTRODUCTION TO CHILD CARE (CC) SUBSIDY PROGRAM UNDER THE AUTHORITY OF THE DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION (DESE)

FROM: KIM EVANS, DIRECTOR

SUBJECT: INTRODUCTION TO CHILD CARE (CC) SUBSIDY PROGRAM UNDER THE AUTHORITY OF THE DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION (DESE)

 

DISCUSSION:

Effective the weekend of December 16, 2023, the CC program will be transferred from FAMIS to a new eligibility system that is overseen by DESE.

Effective December 18, 2023 a specialized unit will complete eligibility determinations for CC applications as this eligibility program will no longer be held in FAMIS.

DESE has provided the attached letter to assist FSD staff when applicants/participants inquire about the CC program during the transition timeframe. The letter will be mailed to all FSD resource centers to post for participants to provide guidance on questions they may have.

FSD will release more information on this transition prior to December 16, 2023, which will include how to guide participants on reporting CC changes or applying for the program.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/ch

 

IM-100 2024 FAMILY MO HEALTHNET (MAGI) COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION (VA) AND RAILROAD (RR) INCOME

FROM: KIM EVANS, DIRECTOR

SUBJECT: 2024 FAMILY MO HEALTHNET (MAGI) COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION (VA) AND RAILROAD (RR) INCOME

 

 

DISCUSSION:

Effective January 2024 VA and RR participants will receive a 3.2% COLA. System updates will be made the weekend of December 16, 2023.

Note: Annual renewals resumed for all MO HealthNet (MHN) programs on April 1, 2023. An annual renewal must be completed before a determination of ineligibility or lesser coverage can be made. The eligibility system will not reduce or end MHN coverage due to the COLA changes until an annual renewal has been completed for the case.

Cases Adjusted

Cases that include income types VA and/or RR benefits in the eligibility system are subject to an automatic increase of 3.2% for those income types. The eligibility system will end date the previous income and add a new piece of income evidence that reflects the adjusted income amount.

Note: Actions to reduce benefits will not be taken until an annual renewal has been completed.

Cases That Did Not Adjust

Some cases will not adjust during the COLA. These cases will require manual intervention from staff to add the increased income amounts. As cases are reviewed, check the income on each case to determine if the current income is entered. Update and verify income as required using established procedures.

Notices

For case updates made as a result of COLA, the eligibility system will finalize the decision(s) and send out the appropriate notices.

Note: Adverse Action notices will not be issued until an annual renewal has been completed.

 

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

KE/vh

IM-99 JANUARY 2024 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME FOR ALL INCOME MAINTENANCE PROGRAMS EXCEPT MAGI MO HEALTHNET

FROM: KIM EVANS, DIRECTOR

SUBJECT: JANUARY 2024 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME FOR ALL INCOME MAINTENANCE PROGRAMS EXCEPT MAGI MO HEALTHNET

MANUAL REVISION #
APPENDIX B
APPENDIX D
APPENDIX E
APPENDIX J
APPENDIX K

 

DISCUSSION:

In January 2024, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive an 3.2% Cost of Living Adjustment (COLA).

The weekend of December 9, 2023, a mass adjustment will be completed in the eligibility system for Child Care (CC), Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance (TA), and Non-MAGI MO HealthNet cases. Income increases for SSA, SSI, VA, and/or RR and other adjustments will be completed. Medicare Premium amounts and federal eligibility standards will also be updated.

Note: The 2024 COLA will have the following effect on SNAP cases:

  • Increase in SNAP benefit reductions for January 2024.
  • Increase in SNAP closures for December 2023.

SSI Increases

SSI TABLE 2023 AMOUNT 2024 AMOUNT INCREASE
SSI Individual maximum (in own household) $914 $943 $29
SSI Couple maximum (in own household) $1371 $1415 $44
SSI Individual in household of another $609 $629 $20
SSI Couple in household of another $914 $943 $29
SSI Essential person/own home $458 $472 $14

 

Non-MAGI Standards Adjustments

NON-MAGI STANDARDS 2023 AMOUNT 2024 AMOUNT
Maximum Allotment of Community Spouse $3,716 $3,854
Minimum Maintenance Standard for Allotments $2,289 $2,465
Maximum Allocation to a child $457 $472
Maximum Allotment to a child $763 $821
Minimum Spousal Share $29,724 $30,828
Maximum Spousal Share $148,620 $154,140
Maximum Home Equity $688,000 $713,000
HCB Maximum $1,598 $1,649
SAB Standard $987 $1,019

 

Supplementary Medical Insurance (SMI) Premium Adjustment

The standard SMI, commonly known as Medicare Part B, premium will increase for 2024 to $174.70. Premiums for Medicare participants who pay less than the standard premium amount will not have an increase of more than the amount of the increase in Social Security benefit the individual received.

Additional Non-MAGI Program Increases

Resource Limits for Medicare Savings Programs (QMB/SLMB/QI-1)
For a single individual, the resource limit increases to $9,430 for a married couple, the resource limit increases to $14,130. There is no change in policy regarding how to determine available resources.

Minimum and Maximum Spousal Share
The 2024 minimum spousal share is $30,828. The new maximum spousal share is $154,140. Both amounts become effective for any assessment completed on or after January 1, 2024.

Substantial Gainful Activity (SGA)
The SGA monthly amounts increase and are as follows:

  • $2,590 for statutorily blind individuals
  • $1,550 for non-blind individuals

 

Appendices Updates

The following appendices were updated to show the new amounts:

  • MO HealthNet for Aged, Blind, and Disabled Manual
    • Appendix B – Maintenance Standards for Allotments
    • Appendix E – HCB Income Maximums
    • Appendix J – Eligibility Standards for Non-MAGI Programs
    • Appendix K – MO HealthNet eligibility for Non-MAGI Programs
  • December 1973 Eligibility Requirements Manual
    • Appendix D – Substantial Gainful Activity

 

Adjustments by Program and Mass Adjustment Process

All programs will be adjusted according to program. Review FAMIS Resources for further information about the mass adjustment process.
Senate Bill 577 (2007) authorized the disregard for Social Security COLA increases for certain MO HealthNet (MHN) programs with income eligibility based on federal poverty level (FPL) until the next FPL adjustment in April. All SSA, SSI, VA, and RR income sources will be updated with the new income amount and verification code “CO” for COLA adjustment.

Note: For budget months prior to January 2024, do not use the “CO” – COLA verification code.

Note: Actions to reduce MHN benefits will take effect after an annual renewal is completed during the transition/unwinding period.

 

Reports with Actions Needed

Reports with action needed will be distributed to the appropriate teams. Follow the instructions in FAMIS Resources on how to process each type of report.

 

Request for Hearing/Continued Benefits

When a fair hearing is requested, follow current fair hearing request procedures.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Search “COLA” or “Adjustment” in FAMIS Resources for processing guidance.
  • State Office will provide the SSA/SSI/VA/RR Needing Review report to designated staff.
  • Allow MHN Policy for “CO” income verification to disregard SSA and SSI COLA Adjustments until the Federal Poverty Level (FPL) Adjustment in April.

 

 

 

KE/cj

IM-98 QUALIFIED MEDICARE BENEFICIARY (QMB) AND SPECIFIED LOW-INCOME MEDICARE BENEFICIARY GROUP 1 (SLMB1) ENROLLMENT IS AUTOMATIC FOR MO HEALTHNET (MHN) PARTICIPANTS

FROM: KIM EVANS, DIRECTOR

SUBJECT: QUALIFIED MEDICARE BENEFICIARY (QMB) AND SPECIFIED LOW-INCOME MEDICARE BENEFICIARY GROUP 1 (SLMB1) ENROLLMENT IS AUTOMATIC FOR MO HEALTHNET (MHN) PARTICIPANTS

MANUAL REVISION #

0805.000.00 0865.035.05
0820.035.00 0870.000.00
0840.010.40 0870.035.00
0865.000.00 1805.065.00
0865.035.00 1885.045.00

 

DISCUSSION:

Enrollment in QMB and SLMB1 is automatic for all eligible MHN participants. Eligibility for QMB and SLMB1 must be explored when processing an application for MHN coverage.

Explore eligibility for QMB and SLMB1 when completing annual renewals, changes in circumstance, or applications for other types of assistance. If the claimant does not already receive QMB or SLMB1 coverage and appears to be eligible, take actions to add QMB or SLMB1 coverage.

When a participant becomes eligible for QMB or SLMB1, the SMI premium is no longer an allowable deduction. This may cause an increase in spend down or cause a non-spend down participant to have a spend down. A participant may choose to close QMB or SLMB1 coverage. If the participant makes the request in person or by phone, explain the financial impact so the participant makes an informed decision.

Note: Medical expenses must be updated on the Medical Expense screen (MEDEXP/FMXA) in the eligibility system.

The following sections were added to the Family MO HealthNet (MAGI) Manual:

The following section was added to the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual:

The remaining MHABD Manual sections listed above are updated to reflect automatic enrollment policy, update general terminology and remove outdated processes.

Note: Continue to follow current processing procedures for Non-MAGI applications.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/sh

IM-97 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) MANUAL UPDATE REMOVING LINKS TO OBSOLETE FAMIS USER GUIDES

FROM: KIM EVANS, DIRECTOR

SUBJECT: SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) MANUAL UPDATE REMOVING LINKS TO OBSOLETE FAMIS USER GUIDES

MANUAL REVISION #
1102.000.00
1102.005.02
1102.015.55
1115.015.00
1115.035.30 
1135.010.10

 

DISCUSSION:

The SNAP manual is updated to remove links to obsolete charts and guides. Access FAMIS Resources for information previously found in the obsolete charts and guides. Additionally, policy and terminology is revised to align with current processing methods.

Changes are summarized below:

1102.000.00 Verification

  • The following obsolete charts and guides are removed:
    • Comments Quick Reference Chart,
    • Editing and Adding Text to the FA-325 user guide, and
    • Allowable FAMIS Verification Codes.
  • Link to Verification/Evidence Matrix added.
  • Link to FAMIS Resources added.
  • Policy regarding Comments or Notes updated.

1102.005.02 Documentation of Verification

  • The definition of documentation expanded.
  • Comments Quick Reference Chart removed.
  • Link to FAMIS Resources added.
  • Policy regarding Comments or Notes updated.

1102.015.55 Income Maintenance and Employment Security Interface (IMES)

  • Manual header section updated to Income Maintenance and Employment Security Interface (IMES), previously Employment History (IMES)
  • Comments Quick Reference Chart removed.
  • Updated policy to incorporate current process of retaining copies of IMES in the participant’s case record.
  • Added Note regarding when to request verification.
  • Policy regarding Comments or Notes updated.

1115.015.00 Income Exclusions

  • Comments Quick Reference Chart removed.
  • FAMIS system references removed.
  • Policy regarding Comments or Notes updated.

1115.035.30 Calculating Income Deductions

  • Comments Quick Reference Chart removed.
  • FAMIS system references removed.
  • Policy regarding Comments or Notes updated.
  • Example added on averaging expenses.

1135.010.10 Changes Reported by Eligible Striker Household

  • Manual header section updated, changed Eligibility Unit to Household
  • Comments Quick Reference Chart removed.
  • FAMIS system references removed.
  • Policy regarding Comments or Notes updated.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

 

KE/ch