FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: IM-1U 90 DAY LETTER UPDATE
IM-1U’s Returned After 90 Days (PDF)
The purpose of this memorandum is to advise the IM-1U’s Returned After 90 Days Letter has been updated.
The following was changed:
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FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: 2019 MO HEALTHNET CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) PREMIUM ADJUSTMENT
MANUAL REVISION #59
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.
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FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: AFFORDABLE INSURANCE DEFINITION
MANUAL REVISION #58
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.
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FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: INTRODUCTION OF FAMILY MO HEALTHNET (MAGI) APPENDIX H ME CODES CHART AND NEWBORN CLARIFICATION
MANUAL REVISION #56
MANUAL ADDITION #
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.
FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: DISABILITY AND SUBSTANTIAL GAINFUL ACTIVITY CALCULATIONS FOR THE TICKET TO WORK HEALTH ASSURANCE (TWHA) PROGRAM
MANUAL REVISION #55
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.
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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
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.
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FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: INTRODUCTION OF THE VETERANS ADMINISTRATION (VA) INCOME GUIDE FOR ALL PROGRAMS AND REVISIONS TO VA INCOME FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS
MANUAL REVISION #53
0805.015.10
0805.015.35
0815.030.05
This memorandum is to introduce the Veterans Administration Income Guide and to announce the revision of MHABD manual sections 0805.015.10 Income Exclusions, 0805.15.35 Income Exemptions/Deductions, and 0815.030.05 Determining Gross Income.
This guide was created to support staff when evaluating and entering Veterans Administration income for all programs.
Manual section 0805.015.10 Income Exclusions, is revised to remove FAMIS income codes and to describe various VA income sources.
Manual section 0805.15.35 Income Exemptions/Deductions, is revised to address VA medical coverage.
Manual section 0815.030.05 Determining Adjusted Gross Income, is revised to remove FAMIS references and to add clarification to the reference to reduced VA pensions.
Two training guides, Veterans Education Assistance Payment in FAMIS and Veterans Administration (VA) Income Exclusions in FAMIS, have been developed to assist staff with entering information into FAMIS.
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FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: GATEWAY TO BETTER HEALTH (GTBH) EXTENSION AND EX PARTE
MANUAL REVISION #52
The purpose of this memo is to announce that the Centers for Medicare and Medicaid Services (CMS) has authorized the extension of the GTBH waiver through December 31, 2022.
This memo is to inform staff that ex parte procedures must be followed before closing a GTBH case and to introduce a new section to the GTBH manual, 1600.030.05 Ex Parte Review.
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FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: FAMILY HEALTHCARE PROGRAM DESCRIPTIONS UPDATE
The purpose of this memorandum is to advise the Family Healthcare Programs description on dss.mo.gov has been updated.
The following has been updated:
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FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: REVISED SPEND DOWN FREQUENTLY ASKED QUESTIONS
The purpose of this memo is to inform staff that the Spend Down Frequently Asked Questions document has been updated to reflect current information, per feedback from the Spend Down Unit. Staff should utilize this resource as a supplement to current Spend Down policy.
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