Category: IM Memo

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:   UPDATE TO THE GATEWAY TO BETTER HEALTH APPLICATION
FORM REVISION #14
Gateway to Better Health Application (IM-1MAGW)                  

DISCUSSION:

The MO HealthNet Gateway to Better Health Application/ Eligibility Statement has been updated to reflect the current Substantial Gainful Activity (SGA) income maximum of $1220.00. 

Use this updated version effective immediately and discard all previous versions. 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/mc                                            

FROM:PATRICK LUEBBERING, DIRECTOR

SUBJECT:MO HEALTHNET FOR THE AGED, BLIND AND DISABLED MANUAL UPDATES REGARDING PERSONS AGED 22-64 IN STATE MENTAL HOSPITALS

MANUAL REVISION #40

0815.020.00
0815.060.00

DISCUSSION:

The purpose of this memorandum is to notify staff of updated policy regarding individuals aged 22-64 who reside in state mental hospitals.  Medical Assistance for the Aged, Blind, and Disabled manual sections 0815.020.00 Initial Assessment and Medical Certification and 0815.060.00 APPLICANTS OR PARTICIPANTS BETWEEN THE AGES OF 21 AND 65 IN STATE MENTAL HOSPITAL have been updated to reflect the following:

• Individuals aged 22-64 who reside in state mental hospitals are not eligible for MO HealthNet for the Aged, Blind or Disabled (MHABD) coverage.
• Individuals of ANY age who reside in state mental hospitals may receive Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiaries (SLMB) coverage if they are otherwise eligible.

Staff should disregard previous direction to approve individuals aged 22-64 who reside in state mental hospitals for MHABD Non-Spend Down/Spend Down, Vendor, or Mental Health Care (MHC) coverage.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/kp                                                       

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  SIGNATURE REQUEST LETTER UPDATED FOR MO HEALTHNET APPLICATIONS AND REVIEWS

FORM REVISION #13

SIGNATURE REQUEST LETTER

DISCUSSION:

The Signature request letter has been updated so that it can be used with unsigned applications or unsigned reviews received for MO HealthNet for the Aged, Blind, and Disabled or MAGI Programs.  This form can be located alphabetically in the Forms Manual. Discontinue using the IM-1SSL Signature Request Letter.

Application or Review for Closed Case

If the returned form is an application or a review for a case that closed less than 90 days ago, check the top box in the lower shaded section.  Return the original form with the Signature Request Letter and an FSD addressed envelope to the participant within three business days.

Review Case Closed over 90 Days

If the returned form is an unsigned FA-402 for a case that closed more than 90 days ago, send the FA-402 Letter. If the returned form is an unsigned IM-1U, send the IM-1Us Returned After 90 Days Letter.

Review for an Open Case

If the returned form is an unsigned review for a case that has not closed , check the bottom box.  Enter the last date the case will be open if the signed form is not returned.  Send the original unsigned application or review with the Signature Request Letter and an FSD addressed envelope to the participant within three business days.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/ers

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  SHOW ME HEALTHY BABIES (SMHB) COVERAGE FOR THE CHILD AFTER BIRTH

MANUAL REVISION #39

1855.030.05

DISCUSSION:

The purpose of this memorandum is to advise the 1855.030.05 Coverage for the Child After Birth section of the Family MO HealthNet (MAGI) manual has been updated.

Updates include:

• Removing manual processes to add the child
• Removing ME code 73 from the list of appropriate levels of care
• Correcting a spacing typo

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/al

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  CORRECTION OF TYPO IN TMH MANUAL

MANUAL REVISION #38

1820.050.40

DISCUSSION:

The purpose of this memorandum is to correct a typo previously in TMH Manual section 1820.050.40. 

The manual previously stated that “if the third quarterly report is not returned by the 21^st of the 10^th month the parents/caretaker relatives should be suspended on the 22^nd day of the 7^th month”.   The correction now reads “the 22^nd day of the 10^th month”.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/df

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  REFERRAL FOR FINANCIAL EXPLOITATION SECTION OF THE DECEMBER 1973 ELIGIBILITY REQUIREMENTS POLICY UPDATE

MANUAL REVISION #37

1040.030.60

DISCUSSION:

This memorandum introduces revisions to the Referral for Financial Exploitation section of the December 1973 Eligibility Requirements Policy Manual.

The Referral for Financial Exploitation section has been expanded to include policy that will show;

• How the law defines adult abuse,
• Forms of financial exploitation,
• Family Support Division (FSD) reporting requirements, and responsibilities when elderly or adult abuse is suspected, and
• Where to find the FSD legal requirements when release of records in cases of financial exploitation is required.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/vm

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  CLARIFICATION ON MAGI PRE-POPULATED ANNUAL RENEWAL FORM TIMEFRAME

MANUAL REVISION #36

1880.005.00

DISCUSSION:

This memorandum provides clarification to the previously released memo, IM-08 January 25, 2019.  Participants are given 30 days to return the review; however, the IM-80 Adverse Action period does not begin until 10 days prior to the last day of the certification period when the IM-1U is not returned.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/al

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  UPDATE OF POVERTY INCOME GUIDELINES FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED PROGRAMS

 MANUAL REVISION #35

0805.015.45
0855.005.40.05
0855.005.45
0860.005.15.05
0860.005.15.10
0865.010.10.10
0865.010.10.25
0870.010.05
Appendix J, Adult Standards Chart
Appendix K, MO HealthNet Aged, Blind, and Disabled Program Descriptions
Appendix L, Aged, Blind, Disabled Income Chart
Appendix M, Medicare Cost Savings Program

DISCUSSION:

Effective April 1, 2019, the Federal Poverty Level (FPL) income guidelines increase for the following programs: MO HealthNet for the Aged, Blind and Disabled (MHABD) Spend Down and Non-Spend Down, Ticket to Work Health Assurance (TWHA), Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB and SLMB-2), Qualified Disabled Working Individuals (QDWI), MO HealthNet for Disabled Children (MHDC) and Gateway to Better Health programs (GTBH).  The Blind Pension (BP) spousal support income maximum has also increased with the FPL.    

On the weekend of March 09, 2018, MO HealthNet for the Aged, Blind and Disabled programs in FAMIS with income eligibility based on the federal poverty level will be adjusted. This memorandum includes information on:

• PREMIUM REFUNDS
• REQUEST FOR HEARING/CONTINUED BENEFITS
• INCOME CHARTS AND PROGRAM DESCRIPTIONS

PREMIUM REFUNDS

Premiums paid for April coverage will be refunded to the participant if the FPL causes the case to become eligible as a non-premium case. The refund process will take approximately 8 weeks to complete.

REQUEST FOR HEARING/CONTINUED BENEFITS

Any participant receiving an FA-420 MO HealthNet Adverse Action Notice may request a hearing on the mass adjustment action.   

If a participant receiving an FA-420 requests a hearing on the adjustment within ten days from the date of the notice, the participant may request benefits be continued at the level received before the FPL adjustment, until the hearing decision is made. Staff should inform the participant if continued benefits are issued and the agency is determined to be correct, a claim will be established for any overpayment.

Refer to the FAMIS Changes Due to the Federal Poverty Level Adjustments page in FAMIS Resources for eligibility system processes to allow continued MO HealthNet benefits at the same level of care prior to the FPL adjustment when a hearing decision is pending.  The guide will also provide information regarding specific cases in FAMIS the FPL mass adjustment is unable to systematically adjust. 

INCOME CHARTS

Income Charts are no longer being updated in each Manual Section, but instead will be updated in the Appendices.  For historical purposes, the income standards listed below will be included in the FPL memo:

MHABD OAA/PTD Income standards effective April 01, 2019 through March 31, 2020

MHABD AB Income standards effective April 01, 2019 through March 31, 2020

Blind Pension sighted spouse income maximum effective April 01, 2019 through March 31, 2020

QDWI income standards effective April 01, 2019 through March 31, 2020 

QMB income standards effective April 01, 2019 through March 31, 2020

SLMB1 income standards effective April 01, 2019 through March 31, 2020

SLMB2 income standards effective April 01, 2019 through March 31, 2020

TWHA Premiums for Single Cases

TWHA Premiums for Couple Cases

PROGRAM DESCRIPTIONS AND OTHER RESOURCES

The MO HealthNet for the Aged, Blind, and Disabled (MHABD) Standards Chart, MO HealthNet Aged, Blind, and Disabled Program Descriptions, the MO HealthNet Aged, Blind, Disabled Income Chart, and the Medicare Cost Savings Programs (QMB and SLMB) internet pages are updated in Appendices J, K, L, and M in the Medical Assistance for the Aged, Blind, and Disabled Manual to include the change in FPL income limits.

NECESSARY ACTION:

• Begin using the new federal poverty level income guidelines effective for April 2019 and later.
• Follow the FPL FAMIS Guide to resolve conflicting actions.
• Review this memorandum with appropriate staff.

PL/vm

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  2019 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI MO HEALTHNET PROGRAMS

MANUAL REVISION #34

1805.030.20.20.05

1800.000.00 APPENDIX A

1800.000.00 APPENDIX B

1800.000.00 APPENDIX D

1800.000.00 APPENDIX E

FORM REVISION #12

IM-4PRM

DISCUSSION:

Effective April 1, 2019, the Federal Poverty Level (FPL) income guidelines are increased for:

• MO HealthNet for Kids (MHK);
• Children’s Health Insurance Program (CHIP);
• MO HealthNet for Pregnant Women (MPW);
• Show-Me Healthy Babies Program (SMHB);
• Uninsured Women’s Health Services (UWHS); and
• All Presumptive Eligibility programs
  • Temporary MO HealthNet During Pregnancy (TEMP);
  • Show-Me Health Babies Presumptive Eligibility (SMHB-PE);
  • Presumptive Eligibility for Children (PC); and
  • Presumptive Eligibility for Parents/Caretaker Relatives (MHF-PE)

NOTE: New poverty income guidelines for Presumptive Eligibility programs will be provided to Qualified Entities by Income Maintenance Program and Policy.

Any cases in Annual Renewal status on April 1, 2019 will not receive the FPL update until the renewal is completed.

All other MAGI cases will be adjusted in April 2019 based on the new FPL income guidelines and notices sent.

PREMIUM REFUNDS

Premiums paid for April coverage will be refunded to the participant if the FPL causes the case to become eligible as a non-premium case.  The refund process will take approximately 8 weeks to complete.

REQUEST FOR HEARING/CONTINUED BENEFITS

Any household receiving an IM-80 Adverse Action Notice may request a hearing on the adjustment action within 10 days from the date of the notice.

If a household receiving an IM-80 Adverse Action Notice requests a hearing on the adjustment within 10 days of the notice, the household may request benefits continue at the level before the FPL adjustment until the hearing decision is made. Staff should inform the household that if continued benefits are issued and the agency is determined to be correct, a claim will be established for any overpayment.

PROGRAM DESCRIPTIONS AND OTHER RESOURCES

The Internet pages MHK/MHF/TA Income Chart and Do Your Children Need Health Coverage are updated to include the change in FPL income limits.

NECESSARY ACTION:

• Begin using the new federal poverty level income guidelines effective for April 2019 and later.
• Review this memorandum with appropriate staff.

PL/df