IM-88 INTERNAL USE ONLY FORMS REMOVED FROM PUBLIC DEPARTMENT OF SOCIAL SERVICES (DSS) FORMS MANUAL AND MOVED TO THE INCOME MAINTENANCE (IM) FORMS MANUAL

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

 

DISCUSSION:

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

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Update saved links.

 

KE/cj

IM-84 MILEAGE REIMBURSEMENT RATE INCREASE FOR ALL INCOME MAINTANENCE (IM) PROGRAMS

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  MILEAGE REIMBURSEMENT RATE INCREASE FOR ALL INCOME MAINTANENCE (IM) PROGRAMS

MANUAL REVISION #
APPENDIX J

 

DISCUSSION:

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.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/nw

IM-79 EXPIRATION OF COVID-19 VERIFICATION FLEXIBILITIES FOR SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP), TEMPORARY ASSISTANCE (TA) AND CHILD CARE (CC)

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  EXPIRATION OF COVID-19 VERIFICATION FLEXIBILITIES FOR SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP), TEMPORARY ASSISTANCE (TA) AND CHILD CARE (CC)

 

DISCUSSION:

During COVID-19 staff were allowed to provide flexibilities while working with participants to obtain verifications introduced in memo, IM-22 COVID-19 Verification for Food Stamps (FS), Temporary Assistance (TA) and Child Care (CC), dated 3/27/2020.

Beginning August 1, 2021, participants will be required to meet verification eligibility requirements as flexibilities will no longer be adequate when determining eligibility.

Discontinue using Collateral Contact (CC) to prevent cases from pending for verification that was not easily obtained. Instead, process requests for verifications and pending verifications according to pre-COVID-19 requirements.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/ks

IM-78 OBSOLETE FORMS REMOVED FROM DEPARTMENT OF SOCIAL SERVICES (DSS) FORMS MANUAL AND INCOME MAINTENANCE (IM) FORMS MANUAL

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  OBSOLETE FORMS REMOVED FROM DEPARTMENT OF SOCIAL SERVICES (DSS) FORMS MANUAL AND INCOME MAINTENANCE (IM) FORMS MANUAL

 

DISCUSSION:

The DSS Manuals IM Forms Manual (public site) and FSD Intranet IM Forms Manual (internal site) have both been updated to remove forms that are obsolete and no longer to be used by Family Support Division (FSD) staff.

Obsolete forms that were removed:

DOI-1 

Referral for Investigation

IM-1

Application for Benefits

IM-2

Application for Benefits

IM-2

Mod Adult Adult Supplement – Spanish

IM-209

Case Reading Form

IM-23

Client Services Postcard

IM-2C

Expenses of Producing Income – Spanish

IM-2U

Eligibility Recording Form

IM-30C

Explanation of Financial Eligibility

IM-30IBCA

Income Maintenance Budget (IBCA)

IM-31A MC+

MC+ Request for Information

IM-32MC

MC+ Approval Notice (Non-premium groups)

IM-32MPW

MC+ for Pregnant Women Approval Notice

IM-32PRM

MC+ Approval Notice (Premium Group)

IM-32QMB

Notice of Approval

IM-32SLMB

Notice of Approval

IM-33A

Notice of Temporary Assistance/Food Stamp Case Action

IM-33MAF

MAF Notice of Case Action

IM-33MC

MC+ Notice of Denial

IM-33MCC

MC+ Notice of Action

IM-34

Change of Status Summary

IM-35

Identification Data Form

IM-36

Vital Statistics Form

IM-37

Insurance Form

IM-38

IM-2 Recording Worksheet

IM-3A

Reinvestigation Notice

IM-4 MA

Information about your Medical Assistance

IM-42

Inter-county Transfer

IM-42A

County Transfer Letter

IM-80MC

MC+ Advance Action Notice

PC-1

Presumptive Eligibility Determination

PC-2

MO HealthNet for Kids Presumptive Eligibility Determination

SPNDDOWN

Spend Down Calculation Document

 

Audit Document Request Form

 

Flow Chart for Pregnant Women Applications

 

Affidavit of Disaster Loss

 

Case Manager Performance Plan

 

Case Worker Performance Plan

 

Program Improvement Plan

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Discontinue use of any forms shown.
  • Discard any unused forms shown if paper copies are being stored.

 

KE/cj

IM-77 COMMON LAW MARRIAGE UPDATE FOR ALL INCOME MAINTENANCE PROGRAMS

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COMMON LAW MARRIAGE UPDATE FOR ALL INCOME MAINTENANCE PROGRAMS

MANUAL REVISION #
1100.010.00
1105.015.04.15
0205.025.00
1805.030.10.07
1013.000.00

 

DISCUSSION:

If a common law marriage was established in another state, each partner is considered a spouse in Missouri. Common law marriages cannot be initiated in Missouri.

EXAMPLE: Edward and Ana state they are common law spouses. Their marriage began in Kansas, where common law marriages can be established. Consider them spouses for eligibility purposes.

The following manual sections have been updated or created to reflect this information:

Child Care will continue to follow Temporary Assistance policy for specified relatives. Refer to 2010.010.00 Relationship of the Applicant to the Child for more information.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Send questions regarding common law marriages through normal supervisory channels.

 

KE/ers

IM-76 TAX CREDIT CHANGES RESULTING FROM THE AMERICAN RESCUE PLAN ACT (ARPA) OF 2021

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  TAX CREDIT CHANGES RESULTING FROM THE AMERICAN RESCUE PLAN ACT (ARPA) OF 2021

 

DISCUSSION:

The ARPA modified the provisions of several commonly used tax credits. Most of the changes are in effect only for 2021. The following tax credits are refundable, meaning the credit amount can be paid directly to the tax filer if his/her tax liability is $0.

 

Child Tax Credit (CTC) Earned Income Credit (EIC) Child and Dependent Care Credit
A credit increase to $3600 for qualifying children ages 0-5; $3000 for children ages 6 through 17. The minimum age to qualify for the EIC is lowered to 19 and the maximum age is removed. The maximum amount of this credit increased to $6000 for one child and $16,000 for two or more children.
One-half of the estimated CTC amount is payable to parents in advance monthly payments starting in July 2021; the other half will be issued as part of 2021 tax refunds. The maximum income for an earner without children is increased to $9820.  
Tax filers will be able to opt out of the advance monthly payments. Some married filers may be treated as unmarried filers in certain circumstances.  

 

Do not count advance monthly payments or lump sum refunds of a refundable tax credit as income or a resource for Income Maintenance programs. For programs that consider resources, count tax credit funds remaining after 12 months as a resource.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/ers

IM-73 RETURNED MAIL FOR ALL INCOME MAINTENANCE (IM) PROGRAMS

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  RETURNED MAIL FOR ALL INCOME MAINTENANCE (IM) PROGRAMS

MANUAL REVISION #

0240.010.20
0262.010.05
0262.010.10
0262.010.15
0262.010.20
0840.025.00
1140.005.50
1140.025.10.05
1885.020.00

 

DISCUSSION:

Manual revisions have been made to the MO HealthNet for the Aged, Blind, and Disabled (MHABD), Family MO HealthNet (MAGI), Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance (TA) policy manuals regarding returned mail. There has been no change to Child Care (CC) policy regarding returned mail.

United States Postal Service (USPS) stickers are placed on mail that is undeliverable. This information shows a forwarding Missouri address, a forwarding out of state address, or no forwarding address (unable to locate). Returned mail may be handled differently depending on the program and the information provided on the sticker.

To ensure consistency across all IM programs, the manual sections shown above have been created or revised. The following information summarizes changes made for each program.

Note: No adverse actions will be taken on any MO HealthNet cases during the COVID-19 Public Health Emergency.

MHABD: A new manual section has been added to the MHABD policy manual which addresses returned mail received by the Family Support Division (FSD).

MAGI: The manual section below has been updated regarding returned mail received by FSD.

SNAP: Due to Simplified Reporting, no action can be taken when returned mail is received by FSD. The manual sections below have been updated.

TA: The returned mail procedures outlined in this memorandum will change processes for TA cases. The TA manual outlines specific procedures for returned mail in relation to the Missouri Work Assistance (MWA) program and TA Drug Testing policy. The manual sections below related to returned mail and unable to locate have been updated to reflect changes in procedure when returned mail is received by FSD.

  • TA Drug Testing Returned Mail Policy 
  • MWA Returned Mail Policy 

CC: Due to Simplified Reporting, no adverse action can be taken when returned mail is received by FSD.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/nw

IM-69 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) AND CHILD CARE SUBSIDY (CC) SLIDING FEE EXPENSE

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) AND CHILD CARE SUBSIDY (CC) SLIDING FEE EXPENSE

 

DISCUSSION:

The Coronavirus Response and Relief Supplemental Appropriations Act of 2021 (CRRSAA) allows for sliding scale fees to be waived for the CC program.

Participants will not be required to pay sliding fees effective June 1, 2021 through September 30, 2022.

Sliding fees are not an allowable expense during this time for SNAP, as the participant is no longer responsible for paying it. CC co-payments charged by child care providers continue to be the responsibility of the participant.

Example: Mrs. Potter’s child Harriett is approved for child care subsidy, 23 full time days per month. Mrs. Potter pays a co-payment of $25 per week to the daycare and has a sliding fee of $2 per full time day. On DCEXP (FMXM) screen her expense is currently listed as $154.33.

Copayment: $25 x 4.333 = $108.33
Sliding fee: $2 x 23 = $46
Total: $108.33 + $46 = $154.33

Effective 6/1/2021 her expense will be reduced to $108.33, the copayment only.

NOTE: All other types of expenses listed on the DCEXP (FMXM) screen remain unchanged, such as mileage (MI). MI is added to DCEXP screen as a separate expense, and should not be combined with the co-payment or sliding fee expenses.

Adverse action notices will be sent for active SNAP households prior to any reduction in benefits.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/vb

IM-61 APPOINTING AN AUTHORIZED REPRESENTATIVE (IM-6AR) LARGE PRINT AND SPANISH TRANSLATION FORMS ADDED TO THE FORMS MANUALS

FROM: KIM EVANS, DIRECTOR

SUBJECT: APPOINTING AN AUTHORIZED REPRESENTATIVE (IM-6AR) LARGE PRINT AND SPANISH TRANSLATION FORMS ADDED TO THE FORMS MANUALS

FORM REVISION #
IM-6AR LP
IM-6AR SPANISH

 

DISCUSSION:

The IM-6AR with a revision date of 11/2019 has been converted to large print (IM-6AR LP) and translated into Spanish (IM-6AR Spanish). Both versions of the form are now available in the Department of Social Services (DSS) Forms Manual and the Income Maintenance (IM) Forms Manual.

This is NOT a new revision and no information has changed on the English version.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/cj

IM-47 COVID-19 ECONOMIC IMPACT PAYMENTS RESULTING FROM THE AMERICAN RESCUE PLAN ACT 2021 FOR ALL INCOME MAINTENANCE (IM) PROGRAMS

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 ECONOMIC IMPACT PAYMENTS RESULTING FROM THE AMERICAN RESCUE PLAN ACT 2021 FOR ALL INCOME MAINTENANCE (IM) PROGRAMS

MANUAL REVISION #

0205.005.30.10

0210.015.35.40

0805.015.10

1025.015.01.02

1110.020.30

1115.015.90

1805.030.20.10

 

DISCUSSION:

Economic Impact Payments (EIP), also known as Stimulus Payments, were approved as part of the American Rescue Plan Act, 2021 (ARPA) which was signed into law on March 11, 2021.  The ARPA contains changes that affect the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance (TA) Program, Child Care Subsidy (CC), and MO HealthNet (MHN) Programs.

 

Economic Impact Payments

U.S citizens and resident aliens will receive an EIP up to $1,400 for each individual and each qualifying child if:

  • they are not a dependent of another taxpayer and
  • have a work eligible Social Security number with Adjusted Gross Income (AGI) up to:
    • $75,000 for individuals
    • $112,500 for head of household filers and
    • $150,000 for married couples filing joint returns

Single filers with an AGI above $80,000, head of household filers with an AGI over $120,000, and joint filers with an AGI exceeding $160,000 will not receive a stimulus payment.

Eligible retirees and recipients of Social Security, Railroad Retirement, Disability or Veterans’ benefits as well as taxpayers who do not make enough money to normally file a tax return will receive a payment. This also includes those who have no income, as well as those whose income comes entirely from certain benefit programs, such as Supplemental Security Income benefits.

Retirees who receive either Social Security Retirement or Railroad Retirement benefits will also receive payments automatically.

 

MO HealthNet Non-MAGI Programs, SNAP, TA, and CC:

  • Payments are excluded as income.
  • Payments are excluded as a resource for the first 12 months from receipt.

NOTE: EIP payments reported in the month received will be entered as a resource. DO NOT enter as income in FAMIS. Any money left from an EIP 12 months after receipt will be counted as a resource.

 

Family MO HealthNet (MAGI) Programs:

  • Payments are excluded as income.

NOTE: Make a note in the eligibility system regarding the amount received. The payment is not to be entered as income on the case. Example of note: Ms. Smith reported she received $1,400 EIP on 3/24/2021.

 

FAMIS Entries

If the EIP is reported as income in the month received, enter it as a resource on the SELFRES (FMWB) screen. DO NOT ENTER AS INCOME ON SELINC (FMX2). The excluded amount should always equal the total EIP when entering for the same month it was received along with any other excluded balances for that month. Use Code CV in the Excl Rsn field for the EIP or CB if multiple exclusion reasons exist. Please use the FAMIS Resource Guide (search “liquid resources”) for acceptable verification codes.

If the balance of the EIP is reported the month after receipt, exclude any remaining balance of the EIP in the accounts as CV following normal procedures for entering liquid resources.

Though the EIP amount authorized by the ARPA is different, please refer to IM-35 COVID-19 ECONOMIC IMPACT PAYMENTS RESULTING FROM THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT FOR THE MO HEALTHNET, FOOD STAMP, TEMPORARY ASSISTANCE AND CHILD CARE SUBSIDY PROGRAMS for guidance to capture the EIP income as an excluded resource.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/nw